La acidosis tubular renal distal y la litiasis. Nuevo enfoque diagnóstico-terapeútico

Resumo

Renal Tubular Acidosis (RTA) is a group of diseases characterized by inability to control the pH, originated in the nephron. There are the three types, type I or distal is managed by the urologist more often because stone formation and nephrocalcinosis is constant in absence of treatment. Distal renal tubular acidosis (dRTA) is a rare disease, with primary or secondary origin. dTRA can be due to treatments or systemic diseases. When it has a primary origin, can be sporadic or inherited, with or without hearing loss. Progress in understanding the genome will help us to understand the genes directly involved in the disease and its association with other diseases such as ovalocytosis. The electrolyte disorder is characterized by acidemia and permanently alkaline urine. The anion gap in blood and urine help the diagnosis. Hypokalemia is commonly in blood and hypercalciuria and hypocitraturia are typical findings in the urine. The diagnosis of complete form is done in childhood, because the electrolyte disorder causes a lack of development and growth. The diagnosis of incomplete is made in adulthood by recurrent lithiasis or nephrocalcinosis. The diagnosis is complex, always rested on the clinical and laboratory values. There are several diagnostic tests, each with advantages and disadvantages. Of these, the easiest and most complete is to measure the pCO2 gradient between urine and blood, after overloading 10 g of bicarbonate and 500 mg of acetazolamide. Treatment, mainly with alkali, should be closely monitored in children. In adults we have to take special care with high blood pressure, hyperkalemia and hypercalicuria when the correct choice of treatment. We must not forget dietary measures.