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==Overview==
==Overview==
Patients with renal tubular acidosis can present with acute or chronic onset of symptoms. Patients usually doesn't have a typical history or symptoms. Common symptoms of renal tubular acidosis include vomiting, dehydration and electrolyte abnormalities with acidosis.
==History==
==History==
The significant information that needs to focused in the history of the patient includes:<ref name="pmid16356241">{{cite journal |vauthors=Ring T, Frische S, Nielsen S |title=Clinical review: Renal tubular acidosis--a physicochemical approach |journal=Crit Care |volume=9 |issue=6 |pages=573–80 |date=2005 |pmid=16356241 |pmc=1414010 |doi=10.1186/cc3802 |url=}}</ref>
* Onset of symptoms acute or chronic
* Associated symptoms and signs from changes in
** Pulmonary
** Cardiovascular
** Neurologic
** Musculoskeletal function
==Symptoms==
==Symptoms==


The clinical manifestations of renal tubular acidosis depend upon the underlying etiology and type of acidosis.  
The clinical manifestations of renal tubular acidosis depend upon the underlying etiology and type of acidosis.<ref name="pmid25823989">{{cite journal |vauthors=Santos F, Ordóñez FA, Claramunt-Taberner D, Gil-Peña H |title=Clinical and laboratory approaches in the diagnosis of renal tubular acidosis |journal=Pediatr. Nephrol. |volume=30 |issue=12 |pages=2099–107 |date=December 2015 |pmid=25823989 |doi=10.1007/s00467-015-3083-9 |url=}}</ref>


{| class="wikitable"
{| class="wikitable"
! colspan="2" |Type of RTA
! colspan="3" |Type of RTA
!
!Adult/ Infant
!
!Symptoms
|-
|-
| rowspan="2" |Distal renal tubular acidosis
| rowspan="2" |Distal renal tubular acidosis
|Recessive form
| colspan="2" |Recessive form
|Infancy
|Infancy
|
|
Line 25: Line 35:
* Rickets
* Rickets
|-
|-
|Dominant form  
| colspan="2" |Dominant form  
|Adults
|Adults
|
|
Line 35: Line 45:
* CKD
* CKD
|-
|-
|Proximal renal tubular acidosis
| rowspan="4" |Proximal renal tubular acidosis
| rowspan="3" |Isolated proximal renal tubular acidosis
|Transient or sporadic proximal RTA
|Infants
|
* Tachypnea
* Growth failure
* Recurrent vomiting
* Feeding difficulties
* Persistently low serum bicarbonate level
|-
|Autosomal recessive proximal RTA
| rowspan="2" |Adults
|
|
* Severe hypokalemic
* Hyperchloremic, metabolic acidosis
* Growth retardation
* Ocular abnormalities such as glaucoma, cataracts, and band keratopathy.
|-
|Autosomal dominant proximal RTA
|
|
* Short stature
* Metabolic acidosis
|-
| colspan="3" |Fanconi syndrome
|
|
* Hypophosphatemia due to phosphaturia
* Renal glucosuria
* Aminoaciduria
* Tubular proteinuria
* Growth failure
* Episodes of hypovolemia due to polyuria
* Volume depletion
* Bony abnormalities, including rickets and osteomalacia due to hypophosphatemia and low levels of calcitriol (1,25 dihydroxy vitamin D)
* Constipation and muscle weakness
|-
|-
|Mixed renal tubular acidosis (Type 3)
|Mixed renal tubular acidosis (Type 3)
| colspan="2" |Autosomal recessive
|Infants
|
|
* Features of both distal and proximal RTA
* Osteopetrosis
* Cerebral calcification
* Mental retardation
* Bone fragility
* Growth failure
* Facial dysmorphism
* Conductive hearing loss
* Blindness
|-
| rowspan="2" |Aldosterone deficiency or resistance (Type 4)
| colspan="2" |Resistance
|Adults
|
|
|
* Hyperkalemia, hyponatremia and mild acidosis
* Failure to thrive
* Hypotension
|-
|-
|Aldosterone deficiency or resistance (Type 4)
| colspan="2" |Deficiency
|
|Infants
|
|
|
* Congenital adrenal insufficiency
* Aldosterone synthase deficiency
* Pseudohypoaldosteronism distal and 2 (also known as Gordon syndrome)
|}
|}
=== Common symptoms ===
Common symptoms of renal tubular acidosis include:<ref name="pmid22919024">{{cite journal |vauthors=Khositseth S, Bruce LJ, Walsh SB, Bawazir WM, Ogle GD, Unwin RJ, Thong MK, Sinha R, Choo KE, Chartapisak W, Kingwatanakul P, Sumboonnanonda A, Vasuvattakul S, Yenchitsomanus P, Wrong O |title=Tropical distal renal tubular acidosis: clinical and epidemiological studies in 78 patients |journal=QJM |volume=105 |issue=9 |pages=861–77 |date=September 2012 |pmid=22919024 |doi=10.1093/qjmed/hcs139 |url=}}</ref>
* Headache
* Lack of energy
* Nausea, and vomiting
* Mental confusion progressing to stupor
* Persistent tachypnea or hyperpnea to compensate
* Musculoskeletal abnormalities
** Osteomalacia
** Osteitis fibrosa
** Rickets
** O0steomalacia
** Osteopenia
== References ==
{{reflist|2}}

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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]

Overview

Patients with renal tubular acidosis can present with acute or chronic onset of symptoms. Patients usually doesn't have a typical history or symptoms. Common symptoms of renal tubular acidosis include vomiting, dehydration and electrolyte abnormalities with acidosis.

History

The significant information that needs to focused in the history of the patient includes:[1]

  • Onset of symptoms acute or chronic
  • Associated symptoms and signs from changes in
    • Pulmonary
    • Cardiovascular
    • Neurologic
    • Musculoskeletal function

Symptoms

The clinical manifestations of renal tubular acidosis depend upon the underlying etiology and type of acidosis.[2]

Type of RTA Adult/ Infant Symptoms
Distal renal tubular acidosis Recessive form Infancy
  • Severe hyperchloremic metabolic acidosis (serum bicarbonate levels may decrease below 10 mEq/L)
  • Moderate to severe hypokalemia (serum potassium ≤ 3.0 mEq/L)
  • Nephrocalcinosis
  • Vomiting
  • Dehydration
  • Poor growth
  • Rickets
Dominant form Adults
  • Common initial finding is renal stone or nephrocalcinosis
  • Mild or no acidosis
  • Mild to moderate hypokalemia
  • Poor growth
  • Bone disease
  • CKD
Proximal renal tubular acidosis Isolated proximal renal tubular acidosis Transient or sporadic proximal RTA Infants
  • Tachypnea
  • Growth failure
  • Recurrent vomiting
  • Feeding difficulties
  • Persistently low serum bicarbonate level
Autosomal recessive proximal RTA Adults
  • Severe hypokalemic
  • Hyperchloremic, metabolic acidosis
  • Growth retardation
  • Ocular abnormalities such as glaucoma, cataracts, and band keratopathy.
Autosomal dominant proximal RTA
  • Short stature
  • Metabolic acidosis
Fanconi syndrome
  • Hypophosphatemia due to phosphaturia
  • Renal glucosuria
  • Aminoaciduria
  • Tubular proteinuria
  • Growth failure
  • Episodes of hypovolemia due to polyuria
  • Volume depletion
  • Bony abnormalities, including rickets and osteomalacia due to hypophosphatemia and low levels of calcitriol (1,25 dihydroxy vitamin D)
  • Constipation and muscle weakness
Mixed renal tubular acidosis (Type 3) Autosomal recessive Infants
  • Features of both distal and proximal RTA
  • Osteopetrosis
  • Cerebral calcification
  • Mental retardation
  • Bone fragility
  • Growth failure
  • Facial dysmorphism
  • Conductive hearing loss
  • Blindness
Aldosterone deficiency or resistance (Type 4) Resistance Adults
  • Hyperkalemia, hyponatremia and mild acidosis
  • Failure to thrive
  • Hypotension
Deficiency Infants
  • Congenital adrenal insufficiency
  • Aldosterone synthase deficiency
  • Pseudohypoaldosteronism distal and 2 (also known as Gordon syndrome)

Common symptoms

Common symptoms of renal tubular acidosis include:[3]

  • Headache
  • Lack of energy
  • Nausea, and vomiting
  • Mental confusion progressing to stupor
  • Persistent tachypnea or hyperpnea to compensate
  • Musculoskeletal abnormalities
    • Osteomalacia
    • Osteitis fibrosa
    • Rickets
    • O0steomalacia
    • Osteopenia

References

  1. ↑ Ring T, Frische S, Nielsen S (2005). "Clinical review: Renal tubular acidosis--a physicochemical approach". Crit Care. 9 (6): 573–80. doi:10.1186/cc3802. PMC 1414010. PMID 16356241.
  2. ↑ Santos F, Ordóñez FA, Claramunt-Taberner D, Gil-Peña H (December 2015). "Clinical and laboratory approaches in the diagnosis of renal tubular acidosis". Pediatr. Nephrol. 30 (12): 2099–107. doi:10.1007/s00467-015-3083-9. PMID 25823989.
  3. ↑ Khositseth S, Bruce LJ, Walsh SB, Bawazir WM, Ogle GD, Unwin RJ, Thong MK, Sinha R, Choo KE, Chartapisak W, Kingwatanakul P, Sumboonnanonda A, Vasuvattakul S, Yenchitsomanus P, Wrong O (September 2012). "Tropical distal renal tubular acidosis: clinical and epidemiological studies in 78 patients". QJM. 105 (9): 861–77. doi:10.1093/qjmed/hcs139. PMID 22919024.
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