Renal tubular acidosis medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Renal tubular acidosis}} | {{Renal tubular acidosis}} | ||
{{CMG}} ; {{AE}} {{ADG}} | {{CMG}} ; {{AE}} {{ADG}} {{SAH}} {{JSS}} | ||
==Overview== | ==Overview== | ||
Alkalization of the urine along with correction of [[electrolyte]] abnormalities is the mainstay of treatment in patients diagnosed by [[renal tubular acidosis]]. [[Sodium bicarbonate]] with potassium replacement are the medications recommended along with correction of underlying cause. | |||
==Medical Therapy== | ==Medical Therapy== | ||
Treatment includes correction of pH using alkali therapy and concomitant correction of electrolyte imbalances. | Medical therapy is the mainstay of treatment in patients diagnosed by renal tubular acidosis. The pharmacological intervention depends upon the underlying physiological defect and type of renal tubular acidosis.<ref name="pmid29344509">{{cite journal |vauthors=Berend K |title=Review of the Diagnostic Evaluation of Normal Anion Gap Metabolic Acidosis |journal=Kidney Dis (Basel) |volume=3 |issue=4 |pages=149–159 |date=December 2017 |pmid=29344509 |doi=10.1159/000479279 |url=}}</ref><ref name="pmid28127482">{{cite journal |vauthors=Oguejiofor P, Chow R, Yim K, Jaar BG |title=Successful Management of Refractory Type 1 Renal Tubular Acidosis with Amiloride |journal=Case Rep Nephrol |volume=2017 |issue= |pages=8596169 |date=2017 |pmid=28127482 |pmc=5239826 |doi=10.1155/2017/8596169 |url=}}</ref><ref name="pmid776486">{{cite journal |vauthors=Hirschman GH, Rao DD, Oyemade O, Chan JC |title=Renal tubular acidosis: practical guides to diagnosis and treatment |journal=Clin Pediatr (Phila) |volume=15 |issue=7 |pages=645–50 |date=July 1976 |pmid=776486 |doi=10.1177/000992287601500716 |url=}}</ref> | ||
* 1. Distal tubular acidosis (Type 1 renal tubular acidosis) | |||
** 1.1 Adults | Treatment includes correction of [[pH]] using alkali therapy and concomitant correction of electrolyte imbalances. | ||
*** Preferred regimen (1): Sodium bicarbonate or Sodium citrate 0.25 to 0.5 mEq/kg | *1. [[Distal tubular acidosis]] (Type 1 renal tubular acidosis) | ||
**** The aim of alkali therapy is to achieve a relatively normal serum bicarbonate concentration (22 to 24 mEq/L). | **1.1 Adults | ||
** 1.2 Children | ***Preferred regimen (1): [[Sodium bicarbonate]] or [[Sodium citrate]] 0.25 to 0.5 mEq/kg PO q6h. | ||
*** Preferred regimen (1): Sodium bicarbonate or Sodium citrate 2 mEq/kg | ****Note:-The aim of [[alkali]] therapy is to achieve a relatively normal serum [[bicarbonate]] concentration (22 to 24 mEq/L). | ||
* 2. Proximal tubular acidosis (Type 2 renal tubular acidosis) | **1.2 Children | ||
** 2.1 Adutls | ***Preferred regimen (1): [[Sodium bicarbonate]] or [[Sodium citrate]] 2 mEq/kg q8h. | ||
*** | *2. Proximal tubular acidosis (Type 2 renal tubular acidosis) | ||
**2.1 Adutls | |||
***Preferred regimen (1): [[Sodium bicarbonate]] 1 mEq/kg po q6h. | |||
****Note: Excess [[bicarbonate]] is required to balance [[acidosis]]. | |||
****Excess replacement results in [[Hypokalemia|hypokalemia.]] | |||
**2.2 Children | |||
***Preferred regimen (1): [[Sodium bicarbonate]] 2 to 4 mEq/kg q6h. | |||
*3. Hypoaldosteronism (Type 4 renal tubular acidosis) | |||
**3.1 RTA with deficiency of hormone | |||
***Preferred regimen (1) : [[Fludrocortisone]] : 0.1 to 0.3 mg/day orally | |||
**3.2 RTA with hormone resistance | |||
***Preferred regimen (1): [[Furosemide]] 20-80 mg PO q12h | |||
***Preferred regimen (2): [[Bumetanide]] 0.5-2 mg PO q12h | |||
***Note: Potassium restriction along with increased salt diet. | |||
* In conditions associated with carbonic anhydrase deficiency and proton back leak sodium alkai or potassium alkali solution is recommended to correct the [[acidosis]]. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 13:38, 1 August 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2] Syed Ahsan Hussain, M.D.[3] Jogeet Singh Sekhon, M.D. [4]
Overview
Alkalization of the urine along with correction of electrolyte abnormalities is the mainstay of treatment in patients diagnosed by renal tubular acidosis. Sodium bicarbonate with potassium replacement are the medications recommended along with correction of underlying cause.
Medical Therapy
Medical therapy is the mainstay of treatment in patients diagnosed by renal tubular acidosis. The pharmacological intervention depends upon the underlying physiological defect and type of renal tubular acidosis.[1][2][3]
Treatment includes correction of pH using alkali therapy and concomitant correction of electrolyte imbalances.
- 1. Distal tubular acidosis (Type 1 renal tubular acidosis)
- 1.1 Adults
- Preferred regimen (1): Sodium bicarbonate or Sodium citrate 0.25 to 0.5 mEq/kg PO q6h.
- Note:-The aim of alkali therapy is to achieve a relatively normal serum bicarbonate concentration (22 to 24 mEq/L).
- Preferred regimen (1): Sodium bicarbonate or Sodium citrate 0.25 to 0.5 mEq/kg PO q6h.
- 1.2 Children
- Preferred regimen (1): Sodium bicarbonate or Sodium citrate 2 mEq/kg q8h.
- 1.1 Adults
- 2. Proximal tubular acidosis (Type 2 renal tubular acidosis)
- 2.1 Adutls
- Preferred regimen (1): Sodium bicarbonate 1 mEq/kg po q6h.
- Note: Excess bicarbonate is required to balance acidosis.
- Excess replacement results in hypokalemia.
- Preferred regimen (1): Sodium bicarbonate 1 mEq/kg po q6h.
- 2.2 Children
- Preferred regimen (1): Sodium bicarbonate 2 to 4 mEq/kg q6h.
- 2.1 Adutls
- 3. Hypoaldosteronism (Type 4 renal tubular acidosis)
- 3.1 RTA with deficiency of hormone
- Preferred regimen (1) : Fludrocortisone : 0.1 to 0.3 mg/day orally
- 3.2 RTA with hormone resistance
- Preferred regimen (1): Furosemide 20-80 mg PO q12h
- Preferred regimen (2): Bumetanide 0.5-2 mg PO q12h
- Note: Potassium restriction along with increased salt diet.
- 3.1 RTA with deficiency of hormone
- In conditions associated with carbonic anhydrase deficiency and proton back leak sodium alkai or potassium alkali solution is recommended to correct the acidosis.
References
- ↑ Berend K (December 2017). "Review of the Diagnostic Evaluation of Normal Anion Gap Metabolic Acidosis". Kidney Dis (Basel). 3 (4): 149–159. doi:10.1159/000479279. PMID 29344509.
- ↑ Oguejiofor P, Chow R, Yim K, Jaar BG (2017). "Successful Management of Refractory Type 1 Renal Tubular Acidosis with Amiloride". Case Rep Nephrol. 2017: 8596169. doi:10.1155/2017/8596169. PMC 5239826. PMID 28127482.
- ↑ Hirschman GH, Rao DD, Oyemade O, Chan JC (July 1976). "Renal tubular acidosis: practical guides to diagnosis and treatment". Clin Pediatr (Phila). 15 (7): 645–50. doi:10.1177/000992287601500716. PMID 776486.