Renal Tubular Acidosis

What is Renal Tubular Acidosis?

Renal tubular acidosis refers to the electrolytic disturbances caused due to impaired excretion of renal Hydrogen ions or impaired bicarbonate resorption or abnormal production of aldosterone. This condition leads to a chronic metabolic acidosis with a gap in an anion. Usually, hyperchloremia or excess of chlorine in blood may be present. Other features may be with electrolytes of Potassium and Calcium. Chronic renal tubular acidosis is associated with damages of renal tubules in your kidneys. If ignored or not diagnosed at the right time, this condition may lead to chronic kidney diseases.

Renal tubular acidosis is classified based on the mechanism involved. If the impairment is with Hydrogen ion excretion, the defect is called Type 1 renal tubular acidosis. In Type 2 renal tubular acidosis, impairment is caused due to bicarbonate resorption. In Type 4 renal tubular acidosis, the defect is caused by decrease in the level of aldosterone. Type 4 is very common, whereas type 1 is rare and type 2 is extremely rare.

Symptoms

Generally, renal tubular acidosis is asymptomatic, meaning that it causes no symptoms or signs. It is rare for a severe electrolyte imbalance to happen, but in case it does, your situation could be life-threatening. Some symptoms of renal tubular acidosis are:

  • Nephrolithiasis or Kidney stones
  • Nephrocalcinosis (Calcium deposits in kidney)
  • Electrolyte excretion
  • Extracellular fluid volume depletion
  • Muscle weakness
  • Hyporeflexia
  • Paralysis
  • Bone pain in adults
  • Rickets in children
  • Cardiac arrhythmia

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Causes

The causes of type 1 renal tubular acidosis could be:

  • Sjögren's syndrome
  • Hyperparathyroidism
  • Lupus
  • Analgesic nephropathy
  • Kidney transplant rejection
  • A hereditary form of deafness
  • Renal medullary cystic disease
  • Obstructive uropathy
  • Chronic urinary tract infections

The causes of type 2 renal tubular acidosis could be: 

  • Kidney transplant rejection
  • Wilson’s disease
  • Fanconi syndrome
  • Cystinosis
  • Hereditary fructose intolerance
  • Multiple myeloma
  • The causes of type 4 renal tubular acidosis could be –
  • Obstructive uropathy
  • Addison’s disease
  • Syndrome Hyporeninemic Hypoaldosteronism
  • Heparin
  • Potassium sparing Diuretics
  • Diabetic Nephropathy
  • Interstitial Nephritis

 

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Risks

Risk factors of renal tubular acidosis include:

  • Hypergammaglobulinemia Lupus
  • Family history
  • Certain anti-inflammatory drugs and ACE inhibitors
  • High-fat diets
  • Diabetes
  • Obesity
  • Kidney failure

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Prevention

Unfortunately, most of the causes of renal tubular acidosis are not preventable. However, following are some prevention measures you can adopt:

  • Maintain your health by consuming healthy food
  • Maintain the levels of blood pressure and diabetes
  • Regularly exercise

 

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How is it diagnosed?

At Medanta, renal tubular acidosis is diagnosed using the following methods:

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How is it treated?

The treatment mode adopted by your specialist at Medanta against renal tubular acidosis depends on the type of the disease. The common modes are 

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  • Alkali therapy

    pH value of urine is corrected and the electrolytes are balanced, by adding alkali to neutralize acids. Agents like Sodium bicarbonate or Sodium citrate are used.

  • Vitamin D supplements

    Oral calcium supplements may be recommended by your doctor if the cause of renal tubular acidosis is rickets or skeletal deformities. To treat type 1 renal tubular acidosis, Sodium bicarbonate or Sodium citrate is administered in stipulated dosages. To treat type 2 renal tubular acidosis, dietary changes are suggested such that bicarbonate replacement exceeds the acid load. Also, Sodium bicarbonate may be used as a substitute for citrate salts for increased tolerance. Additional Potassium supplements may also be prescribed.
    To treat type 4 renal tubular acidosis, volume expansion of extracellular fluid is required. Also, frequent alkalization may be needed. Your urologist may also recommend mineralocorticoid replacement therapy, in which 0.1 to 0.2 mg of fludrocortisone is administered once a day to treat the condition. However, care needs to be exercised in this method, because the process could exacerbate the existing conditions of hypertension, edema or cardiac arrest.

When do I contact the doctor?

Get medical help right away if any of the following emergency symptoms develop: Decreased alertness or disorientation, decreased consciousness and seizures.

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