Renal tubular acidosis medical therapy

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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.

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). 
  • 1.2 Children
    • 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.
  • 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.