Causes and risk factors
Carbonate resorption or abnormal aldosterone production may be responsible for distal renal tubular acidosis. Renal hydrogen excretion is impaired. Distal renal tubular acidosis can be caused by several factors like Sjogren’s syndrome, systemic lupus erythematous, rheumatoid arthritis, liver cirrhosis, nephrocalcinosis, renal transplantation, sickle cell anemia, chronic urinary tract obstruction, drugs such as analgesics, and hereditary disorders .
Clinical presentation
It is characterized by hypokalemia, hyperchromic metabolic acidosis, nephrocalcinosis, nephrolithiasis. Patient with dRTA presents with loin pain, blood in urine, muscle weakness, and cramps. There can be rapid breathing. There is tendency to urinary stone, calcium deposition in kidneys [nephrocalcinosis], low potassium level [hypokalemia]. Confusion may occur. dRTA can present with rickets in children or osteomalacia in adults. Urine pH is more than 5.5.
Investigation
Medical history by the patient and clinical examination by the doctor helps in diagnosis. Blood test to measure electrolyte levels is done. Arterial blood gas is measured. Urine pH is determined by urinalysis. MRI or CT scan of kidneys may be advised.
Treatment
Distal renal tubular acidosis is treated with oral alkaline medication. Once acidosis is managed, bone demineralization is reversed. Underlying cause of disease, if any, should be treated. Medicines like analgesics may give symptomatic relief.
Other Modes of treatment
The other modes of treatment can also be effective in treating dRTA. Homoeopathy is a science which deals with individualization and considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly, the Ayurvedic system of medicine which uses herbal medicines and synthetic derivates is also found to be effective in treating dRTA.
