Clinical forms of distal tubular acidosis

1. Primary hereditary forms: nephrocalcinosis.

2. Secondary forms:

1) immune pathology of the tubules;

2) Transplanted kidney;

3) interstitial nephritis with papillitis;

4) medullary cystic kidney;

5) cirrhosis of the liver;

6) medicinal effects - amphotericin B, vitamin D, lithium;

7) diuresis after obstruction;

8) hypoaldosteronism.

Treatment of renal tubular acidosis should be aimed primarily at correcting the disturbed acid-base balance in the body. To this end, solutions of sodium hydrogencarbonate are introduced. With a decrease in the amount of potassium in the serum, potassium preparations( for example, panangin in age dosages) should be administered. In the complex of treatment of acidosis, it is recommended to include the intake of citrate mixtures( citric acid, sodium or potassium citrate, distilled water).

In cases of osteoporosis and osteomalacia( softening of bone tissue due to the washing out of calcium) shows the appointment of drugs of vitamin D or its metabolites( oxydevite).When hypocalcemia( reducing the amount of calcium in the blood serum) is recommended to use calcium preparations( calcium gluconate) to normalize the level of calcium in the blood. When forming kidney stones, the use of magnesium oxide is recommended for 3-4 weeks for a long time( 2-3 years).In order to prevent the formation of kidney stones, it is advisable to exclude from the diet products rich in oxalates( sorrel, spinach, tomato juice, chocolate, etc.).Drug treatment should be carried out against a background of general strengthening treatment with the inclusion of alkaline mineral waters( Borjomi type), fruit juices, food protein restriction in animals( potato diet), the use of a complex of vitamins( A, E, Group B).

Under the influence of complex medicamentous treatment, the general condition, the parameters of phosphorus-calcium metabolism, the activity of alkaline phosphatase of blood are improved, positive dynamics of the radiologic picture of structural changes in bone tissue is determined. Special control should be carried out for indicators of pH of blood, urine and calcium and phosphorus in the blood, which should be determined once every 7-10 days.

Surgical treatment can be recommended only to children with severe bone deformities of the lower limbs, which make it difficult to move them. To do this, it is necessary to achieve a 2-year stabilization of clinical and biochemical indicators.

The prognosis worsens with the adherence of pyelonephritis, renal stone disease and the development of chronic renal failure.