Refining Diagnostic Approaches in Nephrolithiasis: Incomplete Distal Renal Tubular Acidosis

Goldfarb, David S.

doi:10.2215/cjn.07160717

Cited by 6 publications

(3 citation statements)

References 15 publications

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“…In adults, both dRTA and idRTA are associated with low Bone Mineral Density [ 49 ]. Although still debated, the common explanation for this finding is that increased protein intake or catabolic stress may cause recurrent bouts of acid load and transient episodes of metabolic acidosis that are sufficient to cause mineral calcium losses [ 50 , 51 ].Treatment with potassium citrate or bicarbonate improves bone mineral turn-over and density, and decreases calciuria in idRTA, supporting this interpretation [ 52 ]. Hypercalciuria and hypocitraturia are frequent in idRTA, thus explaining the increased risk of calcium renal stones in these patients.…”

Section: Complete and Incomplete Drta In Adult Patientsmentioning

confidence: 99%

“…An important clinical issue in idRTA is whether this condition should be specifically investigated [ 50 ] since functional tests for its diagnosis are complex and time-consuming, and treatment of renal stone formers and MSK patients with idRTA is similar to that of patients with idiopathic calcium nephrolithiasis.…”

Section: Complete and Incomplete Drta In Adult Patientsmentioning

confidence: 99%

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Distal renal tubular acidosis: a systematic approach from diagnosis to treatment

et al. 2021

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Renal tubular acidosis (RTA) comprises a group of disorders in which excretion of hydrogen ions or reabsorption of filtered HCO3 is impaired, leading to chronic metabolic acidosis with normal anion gap. In the current review, the focus is placed on the most common type of RTA, Type 1 RTA or Distal RTA (dRTA), which is a rare chronic genetic disorder characterized by an inability of the distal nephron to secrete hydrogen ions in the presence of metabolic acidosis. Over the years, knowledge of the molecular mechanisms behind acid secretion has improved, thereby greatly helping the diagnosis of dRTA. The primary or inherited form of dRTA is mostly diagnosed in infancy, childhood, or young adulthood, while the acquired secondary form, as a consequence of other disorders or medications, can happen at any age, although it is more commonly seen in adults. dRTA is not as “benign” as previously assumed, and can have several, highly variable long-term consequences. The present review indeed reports and summarizes both clinical symptoms and diagnosis, long-term outcomes, genetic inheritance, epidemiology and current treatment options, with the aim of shedding more light onto this rare disorder. Being a chronic condition, dRTA also deserves attention in the transition between pediatric and adult nephrology care, and as a rare disease it has a place in the European and Italian rare nephrological diseases network.

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Section: Complete and Incomplete Drta In Adult Patientsmentioning

confidence: 99%

Section: Complete and Incomplete Drta In Adult Patientsmentioning

confidence: 99%

Distal renal tubular acidosis: a systematic approach from diagnosis to treatment

et al. 2021

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“…However, hypocitraturia distinguishes the dRTA patients from normal subjects who happen to have a high urine pH. One can consider acid loading studies if more definitive diagnosis is needed [39,40], but seldom does the result of acid stress studies actually change management [41]. Finally, a high pH with a markedly positive NH 4 -SO 4 should make one consider the presence of UPB.…”

Section: Clinical Applicationmentioning

confidence: 99%

Neglected analytes in the 24-h urine: ammonium and sulfate

Asplin¹

2021

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of reviewEvaluation of the kidney stone patient includes measurement of 24 h urine chemistries. This review summarizes the application of physiologic principles to the interpretation of urine chemistries, using sulfate and ammonium to estimate diet acid load, and the renal response. Recent findingsThere has been increased recognition of the need to measure urine ammonium excretion in the clinical setting in order to understand renal acid excretion. Some 24 h urine kidney stone panels include ammonium measurements, providing an opportunity to apply this measurement to clinical practice. In order to better interpret ammonium excretion, one needs an estimate of dietary acid load to understand the driving forces for ammonium excretion. Sulfate is also included in some kidney stone panels and functions as an estimate of diet acid load. Combining these analytes with urine pH, the clinician can quickly estimate dietary stone risk as well as potential bowel disease, acidification disorders, and the presence of urease producing bacteria; all of which can affect stone risk.

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Metabolic Evaluation and Prevention of Kidney Stone Disease

Goldfarb

2022

Evidence‐Based Nephrology

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Refining Diagnostic Approaches in Nephrolithiasis: Incomplete Distal Renal Tubular Acidosis

Cited by 6 publications

References 15 publications

Distal renal tubular acidosis: a systematic approach from diagnosis to treatment

Distal renal tubular acidosis: a systematic approach from diagnosis to treatment

Neglected analytes in the 24-h urine: ammonium and sulfate

Metabolic Evaluation and Prevention of Kidney Stone Disease

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