Renal tubular acidosis

The goal of treatment in classic distal RTA is correction or near correction of acidosis and hypokalemia. Because alkali solutions and potassium supplements are distasteful and onerous to take, monitoring of the serum bicarbonate and potassium levels is recommended. The same issues exist to a greater extent in proximal RTA.

The ultimate target of treatment in children is to try to restore skeletal growth. Careful follow up by a pediatric nephrologist or endocrine specialist is recommended.

Patients with hyperkalemic distal RTA (type IV) require monitoring of potassium.

If hyperkalemic distal RTA is being treated with mineralocorticoid replacement (fludrocortisone) or with liberal salt diet and furosemide the patient should be monitored for development or worsening of hypertension, edema, heart failure, and pulmonary edema. These risks are higher in cases associated with diabetes and hyporeninemic hypoaldosteronism.

In proximal RTA and Fanconi syndrome, monitoring during treatment is required to determine the effectiveness of the alkali replacement on the acidosis and the effectiveness of phosphate repletion when this is added. Potassium levels also need to be checked during alkali therapy. Precise guidelines for frequency of these measurements do not exist.