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Renal Tubular Acidosis

Jason M. Kurland, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Renal tubular acidosis (RTA) is composed of a group of disorders characterized by an inability of the kidney to resorb bicarbonate/secrete hydrogen ions, resulting in normal anion ga...

DIAGNOSIS

HISTORY

  • Often asymptomatic (particularly type IV)

  • In children: failure to thrive, rickets

  • Anorexia, nausea/vomiting, constipation

  • Weakness or polyuria (due to hypokalemia)

  • Polydipsia

  • Osteomalacia ...

TREATMENT

MEDICATION

First Line

  • Provide oral alkali to raise serum HCO3 to normal. Start at a low dose and increase until HCO3 is normal. Give as sodium bicarbonate (7.7 mEq NaHCO3/650 mg tab), sodium c...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Patient Monitoring

  • Electrolytes 1 to 2 weeks following initiation of therapy, monthly until serum HCO3 corrected to desired range, and then as clinically indicated

  • ...

REFERENCES

1
Reddy P. Clinical approach to renal tubular acidosis in adult patients. Int J Clin Pract.  2011;65(3):350–360. [View Abstract on OvidMedline]
2
Liamis G, Milionis HJ, Elisaf M. Pharmac...

CODES

ICD10

N25.89 Oth disorders resulting from impaired renal tubular function 

ICD9

588.89 Other specified disorders resulting from impaired renal function 

SNOMED

  • 1776003 Renal tubular acidosis (disorde...

CLINICAL PEARLS

  • Consider RTA in cases of normal anion gap metabolic acidosis with normal/near-normal renal function.

  • Type I RTA: urine pH >5.5 in setting of acidemia; positive urine anion gap; acide...

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