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Distal renal tubular acidosis
Alternative namesRenal tubular acidosis - distal; Renal tubular acidosis type I; Type I RTA; RTA - distal; Classical RTA
The term "renal" refers to the kidney. The kidney contains over a million functional units called nephrons, which filter your blood and produce urine. Distal renal tubular acidosis is caused by abnormal excretion of acid from the distal tubule of each nephron. As a result, your body is left an acidic state (called acidosis).
Causes, incidence, and risk factors
When healthy, your body is very slightly alkaline. Acidic substances in the body, such as carbon dioxide, are buffered (counteracted) by alkaline substances, primarily bicarbonate. Your kidneys regulate your body's pH by controlling acids and bicarbonate buffer.
An acidic state in your body can be caused by high carbon dioxide levels ( respiratory alkal ). It can also be caused by low bicarbonate levels ( metabolic acidosis ).
Distal renal tubular acidosis (Type I RTA) is a disorder caused by a defect in the secretion of hydrogen ions in the distal renal tubule of each nephron. This reduces the reabsorption of bicarbonate into the bloodstream.
Renal tubular acidosis causes disorders related to the loss of bicarbonate and inability to excrete hydrogen. The body attempts to maintain a balance between positively charged and negatively charged molecules. If the excretion of a molecule is abnormal, the excretion of other molecules may become abnormal in an attempt to maintain a balance.
There is an increased incidence of kidney stones and nephrocalcinosis associated with the excessive excretion of calcium and phosphate through the kidneys.
Signs and tests
The goal is to restore the normal pH (acid-base level) and normal electrolyte balance. This will indirectly correct bone disorders and reduce the risk of nephrocalcinosis and kidney stones. The underlying cause should be corrected if it can be identified.
Alkaline medications such as potassium citrate and sodium bicarbonate are administered to correct the acidic condition of the body. Sodium bicarbonate administration may correct the loss of potassium and calcium.
Vitamin D and calcium supplements are usually not given because the tendency toward nephrocalcinosis persists even after bicarbonate therapy.
Expectations (prognosis)The disorder must be treated to reduce its effects and complications, which can be permanent and/or life-threatening. Most cases resolve successfully with treatment.
Calling your health care providerCall your health care provider if symptoms indicate distal renal tubular acidosis may be present.
Call your health care provider if new symptoms develop, including bone pain , pain in the back or flank or abdomen, skeletal deformities, increased heart rate or irregular heartbeat , muscle cramps , decreased urine output , bloody urine , or other symptoms.
Severe decrease in alertness or orientation , decreased consciousness , and seizures , are emergency symptoms that can develop.
PreventionThere is no prevention for this disorder.
Update Date: 11/14/2003A.D.A.M. editorial. Previously reviewed by Andrew Koren, M.D., Department of Nephrology, NYU-Mount Sinai Medical Center, New York, NY. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT