Prevalence of Endemic Distal Renal Tubular Acidosis and Renal Stone in the Northeast of Thailand

Abstract

We have previously reported a large group of patients with endemic distal renal tubular acidosis (EdRTA) admitted to the hospitals in the northeast of Thailand. Since large number of patients were identified in a relatively short period of time, and in an area whose population is homogeneous, we were led to investigate the prevalence of the condition in the area. A survey was conducted in five villages (total population of 3,606) within the northeast of Thailand. 3,013 villagers were examined for urinary citrate concentration and short acid loading test was performed in those with low urinary citrate. 2.8% of the population (2.2-3.4%, 95% confidence interval) failed to lower their urine pH after acid loading; within this group, 0.8% of the population had serum potassium less than or equal to 3.5 mEq/l. In addition a large number of villagers were found to have low urinary citrate concentration and there was concurrent high prevalence of renal stone. The prevalence of EdRTA and renal stone was higher in villagers with poorer socioeconomic status, suggesting that environmental factors play a major role in their pathogenesis. Villagers with acidification defect have 2.4 times the chance of having renal stone and/or nephrocalcinosis. EdRTA is therefore one of the important factors responsible for the high prevalence of renal stone in the area. In conclusion we have confirmed the high prevalence of EdRTA in the northeast of Thailand and provided data showing high prevalence of renal stone and hypocitraturia in the same population.

Novel AE1 mutations in recessive distal renal tubular acidosis. Loss-of-function is rescued by glycophorin A.

“…eAE1 contributes structurally to red cell integrity (8) and to organismic respiratory function by increasing blood CO 2 carrying capacity (7). kAE1 lacks the amino-terminal 65-amino acid residues of eAE1 (9, 10) and provides the major exit route for HCO 3 Ϫ in exchange for Cl Ϫ across the basolateral membrane of the type A IC during urinary acidification (11).…”

“…Kidney AE1 contributes to urinary acidification by providing the major exit route for HCO 3 Ϫ across the basolateral membrane. Several AE1 mutations cosegregate with dominantly transmitted nonsyndromic renal tubular acidosis (dRTA).…”

Urolithiasis in the Pediatric Age Group

“…In North American and certain European countries, stones tend to be located in the upper urinary tract 6 and are largely of calcium oxalate or struvite in composition, while in certain parts of Southeast Asia lower urinary tract stones predominate. 3,4,5 The high incidence of these stones in endemic areas is attributed predominantly to a cereal-based, low-protein diet as well as a high incidence of urinary tract infection, whereas in the United States and Scandanavian countries, metabolic disorders are the most common cause of renal stones. 8 Urolithiasis is common in Middle Eastern countries including the UAE and represents one of the major urological problems that cause significant morbidity, including end-stage renal disease.…”

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“…Kidney stone diseases occur in 15-17% of the population in northeast Thailand and it is an important public health problem 1,2 . High concentrations of calcium carbonate in water and a low-nutrient diet are contributing factors to this disease 1 .…”

“…High concentrations of calcium carbonate in water and a low-nutrient diet are contributing factors to this disease 1 . Kidney stones are commonly composed of calcium oxalate monohydrate (COM), especially in the form of COM microcrystals [3][4][5] .…”