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Renal Tubular Acidosis

Ryan M Song, M.D. and Venkata Behara, M.D. Reviewed 06/2021
 


BASICS

DESCRIPTION

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

DIAGNOSIS

HISTORY

  • Often asymptomatic (particularly type IV)

  • In children: failure to thrive, rickets

  • Anorexia, nausea/vomiting, constipation

  • Weakness or polyuria (due to hypokalemia or hypercalciuria)

  • Polyd...

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 (HCO3) (7.7 mEq NaHCO3/650 mg tab), s...

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] ...

CODES

ICD10

N25.89 Oth disorders resulting from impaired renal tubular function 

SNOMED

  • 1776003 Renal tubular acidosis (disorder)

  • 236461000 Distal renal tubular acidosis (disorder)

  • 24790002 Proximal renal ...

CLINICAL PEARLS

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

  • Type I RTA: urine pH >5.5 in setting of acidemia; positive UAG; acidemia can be severe.

  • Type I...

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