Incidence of Radiographically Evident Bone Disease, Nephrocalcinosis, and Nephrolithiasis in Various Types of Renal Tubular Acidosis

Abstract

The syndrome of renal tubular acidosis has been categorized into three physiologic types that have different clinical findings and prognostic and therapeutic implications. We reviewed radiographs of the skeleton and kidneys in 92 patients (56 children and 36 adults) with renal tubular acidosis in order to determine whether the radiologic findings could be related to the type of syndrome. Forty-four patients had Type 1 renal tubular acidosis, 18 had Type 2, and 30 had Type 4. Evidence of skeletal abnormalities was uncommon (17 per cent) and was confined to patients who had the Type 2 disorder or azotemia. The children with Type 2 and skeletal abnormalities had rickets; the adults had osteopenia without pseudofractures. Nephrocalcinosis was evident in approximately one fourth of the group (29 per cent) and was restricted to patients with the Type 1 syndrome. In patients with Type 4, osteopenia was evident in 12 per cent, all of whom were azotemic. Our observations indicate that the radiographic manifestations of renal tubular acidosis are influenced by the physiologic type of renal tubular acidosis.

Delayed Presentation of Short Bowel Syndrome Complicated with Severe Degree of Nutritional Deficiencies, Nephrocalcinosis and Distal Renal Tubular Acidosis

“…Hypercalciuria occurs due to effects of chronic acidosis on both bone resorption and the renal tubular reabsorption of calcium. Hypocitraturia and hypercalciuria cause urolithiasis, nephrocalcinosis and recurrent urinary tract infections [6]. Our patient had a normal anion gap hyperchloremic metabolic acidosis with low plasma bicarbonate with values below 10 mmol/l with high urine pH (5.5 or higher) and hypokalemia which confirmed distal RTA.…”

Osteomalacia secondary to renal tubular acidosis due to Sjögren’s syndrome: a case report and review of the literature

“…However, if so, why were there only 13 cases that developed osteomalacia associated with SjS? Proximal RTA is a well-known cause of osteomalacia [3]. This fact may be due, in part, to phosphate wasting and subsequent hypophosphatemia and to acquired vitamin D deficiency, since the proximal tubule is a major site of formation of activated vitamin D. Additionally, acidemia can directly decrease in bone mineralization.…”

“…Renal involvement, such as tubulointerstitial nephritis, renal tubular acidosis (RTA), and glomerular disease, may occur as an extraglandular manifestation of SjS [2]. Although RTA is one of the causes of osteomalacia [3], only a few case reports of osteomalacia with SjS have been published. Here, we report a case diagnosed as osteomalacia associated with SjS and reviewed the literature.…”

Osteomalacia, Severe Thoracic Deformities and Respiratory Failure in a Young Woman with Anorexia Nervosa

“…Nutritional and gastrointestinal disorders, 1α-hydroxylase impairment due to Fanconi syndrome or proximal-type renal tubular acidosis and hereditary resistance to vitamin D may also induce osteomalacia (9), as can familial X-linked hypophosphatemia or phosphatonin-producing mesenchymal tumors (tumor-induced osteomalacia) (10). In the current case, an undetectable serum level of 25(OH)D and low serum level of 1,25(OH)2D indicated severe vitamin D deficiency, which subsequently led to hypocalcemia and an increased serum level of iPTH.…”