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Renal Tubular Acidosis

Jason Kurland, MD Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Renal tubular acidosis (RTA) is composed of a group of disorders characterized by an inability of the kidney to resorb bicarbonate (HCO3)/secrete hydrogen ions, resulting in normal a...

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
Weir MA, Juurlink DN, Gomes T, et al. Bet...

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 UAG; acidemia can be s...

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