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Kidney Tubular Acidosis

Kidney Tubular Acidosis
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Kidney tubular acidosis—also called renal tubular acidosis (RTA)—is a condition that occurs when the kidneys do not properly filter acids from the blood into the urine causing the blood to become too acidic.

Without treatment and over time, acidity of the blood can lead to one or more of the following:

  • Failure to thrive
  • Kidney stones
  • Bone disease
  • Chronic kidney disease
  • Acute kidney injury

There are four types of renal tubular acidosis:

  • Type 1. Type 1 renal tubular acidosis—also called distal RTA—occurs relatively far from the beginning of the renal tubule (the part of the kidney where acid and waste products are removed from the blood). A main effect of distal RTA is low blood potassium levels, which can cause extreme weakness, irregular heartbeat, paralysis and, more rarely, death. Type 1 RTA can be inherited or a symptom of:
    • Analgesic nephropathy
    • Chronic active hepatitis
    • Chronic urinary tract infections
    • A hereditary form of deafness
    • Hyperparathyroidism
    • Hyperthyroidism
    • Lupus
    • Obstructive uropathy
    • Primary biliary cirrhosis
    • Rejection of a transplanted kidney
    • Renal medullary cystic disease
    • Sickle cell disease
    • Sjögren's syndrome
  • Type 2. Type 2 renal tubular acidosis—also called proximal RTA—occurs closer to the beginning of the renal tubule. This type of RTA occurs more often in infants as part of a disorder called Fanconi syndrome (a disorder in which certain needed minerals are passed into the urine instead of being reabsorbed into the bloodstream). Proximal RTA can also occur as a symptom of some inherited disorders that keep the body from effectively breaking down and using nutrients. Examples of inherited disorders that can lead to proximal RTA include cystinosis (a condition in which the amino acid cystine builds up in the body and damages cells) and Wilson's disease.
  • Type 3. Type 3 renal tubular acidosis is considered to be a combination of Type 1 RTA and Type 2 RTA.
  • Type 4. Type 4 renal tubular acidosis—also called hyperkalemic RTA—occurs when a part of the kidney called the distal tubule fails to move electrolytes from the blood to the urine, causing a buildup of electrolytes in the blood. Hyperkalemic RTA can happen if there is a deficiency of the hormone aldosterone or the distal tubule fails to respond to aldosterone. This type of RTA can also occur as a side effect of the use of certain medicines such as diuretics, blood pressure medicines, antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), anticoagulants and immunosuppressants. Hyperkalemic RTA can also be caused by a variety of conditions that affect kidney structure and function such as:
    • Diabetic nephropathy
    • Human immunodeficiency virus (HIV)
    • Addison’s disease
    • Sickle cell disease
    • Urinary tract obstruction
    • Lupus
    • Amyloidosis
    • Removal or obstruction of both adrenal glands
    • Kidney transplant rejection

Diagnosis of Kidney Tubular Acidosis

In order to diagnose kidney tubular acidosis, your child's doctor may perform the following tests:

  • Blood test. A blood test can check the acid-base balance in your child's blood. If the blood contains more acid than it should, renal tubular acidosis could be the underlying cause. The amount of potassium in the blood can also tell the doctor which type of RTA your child has.
  • Urinalysis. A urinalysis can check the acid-base balance in your child's urine. If the urine contains less acid than it should, renal tubular acidosis could be the underlying cause. The amount of sodium, potassium and chloride in the urine can also tell the doctor which type of RTA your child has.
  • Renal ultrasound. Some forms of RTA can cause calcium deposits in the kidneys, such as stones. A kidney ultrasound will show this.

Treatments

Treatments

For children with all types of kidney tubular acidosis, the primary goal is to neutralize the acid in the blood. This goal can be accomplished with several types of medicines. Children with RTA are often treated with large doses of an oral alkali (a medicine that neutralizes acid). Examples of oral alkali medicines include sodium bicarbonate and sodium citrate. Your child's doctor may also recommend vitamin D supplements to help prevent bone problems.

Your child’s bone growth and development should improve. Alkali therapy also helps lower the risk of kidney stones as well as stabilizes kidney function so that acute kidney injury does not progress.

Key Points to Remember

Key Points to Remember


  • Kidney tubular acidosis (also called renal tubular acidosis) occurs when the kidneys fail to filter acids from the blood into the urine, causing the blood to become too acidic.
  • If left untreated, renal tubular acidosis can lead to acute kidney injury.
  • The primary goal of treatment is to neutralize the acid in the blood. Your child's doctor may prescribe an alkaline medicine to accomplish this task.

Support Services & Resources

Support Services & Resources

Visit the trusted websites below to learn more about kidney tubular acidosis.

Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.

Learn More About Riley Support Services

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

The NIDDK website provides in-depth information about renal tubular acidosis.

Locations

Locations

Locations

In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.

Riley Pediatric Nephrology & Kidney Diseases

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11725 N Illinois St
Carmel, IN 46032

317.274.2563

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Riley Pediatric Nephrology & Kidney Diseases

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575 Riley Hospital Dr
Indianapolis, IN 46202

317.274.2563

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Departments Treating This Condition

Departments Treating This Condition

  • Nephrology & Kidney Diseases
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