RENAL TUBULAR ACIDOSIS

RENAL TUBULAR ACIDOSIS (RTA) describes a number of pathophysiologically distinct entities of tubular function whose common feature is the presence of a non-anion-gap metabolic acidosis. Diarrhea, CKD, and RTA together constitute the vast majority of cases of non-anion-gap metabolic acidosis. Patients with earlier stages of CKD typically develop a non-anion-gap acidosis, with a superimposed increase in the anion gap at later stages.

Renal tubular acidosis (RTA) occurs when the kidneys do not remove acids from the blood into the urine as they should. The acid level in the blood then becomes too high, a condition called acidosis. Some acid in the blood is normal, but too much acid can disturb many bodily functions.

There are three main types of RTA.

• Type 1 RTA, or distal RTA, occurs when there is a problem at the end or distal part of the tubules.
• Type 2 RTA, or proximal RTA, occurs when there is a problem in the beginning or proximal part of the tubules.
• Type 4 RTA, or hyperkalemic RTA, occurs when the tubules are unable to remove enough potassium, which also interferes with the kidney’s ability to remove acid from the blood.

Type 3 RTA is rarely used as a classification now because it is thought to be a combination of type 1 and type 2 RTA.

COMPLICATIONS OF RENAL TUBULAR ACIDOSIS

Type 1 RTA

Untreated type 1 RTA causes children to grow more slowly and adults to develop progressive kidney disease and bone diseases. Adults and children with untreated type 1 RTA may develop kidney stones because of abnormal calcium deposits that build up in the kidneys. These deposits prevent the kidneys from working properly.

Other diseases and conditions related to type 1 RTA include

• a hereditary form of deafness
• renal medullary cystic disease
• sickle cell anemia
• Ehlers-Danlos syndrome
• urinary tract infections

Type 2 RTA

Untreated type 2 RTA may cause children to grow more slowly. In addition, type 2 RTA may cause rickets—a bone disease—and dental disease in both children and adults.⁶ A very low potassium level can develop during treatment of type  RTA with alkali.

Type 4 RTA

In people with type 4 RTA, high levels of potassium in the blood can lead to muscle weakness or heart problems, such as slow or irregular heartbeats and cardiac arrest.

 SIGNS AND SYMPTOMS OF RENAL TUBULAR ACIDOSIS

The major signs of type 1 RTA and type 2 RTA are low levels of potassium and bicarbonate—a waste product produced by your body—in the blood. The potassium level drops if your kidneys send too much potassium into your urine instead of returning it to the blood.

Because potassium helps regulate your nerve and muscle health and heart rate, low potassium levels can cause

• extreme weakness
• irregular heartbeat
• paralysisNIH external link
• death

The major signs of type 4 RTA are high potassium and low bicarbonate levels in the blood. Symptoms of type 4 RTA include⁹

• abdominal pain
• fatigueNIH external link that does not go away
• weak muscles
• not feeling hungry
• weight change

CAUSES OF RENAL TUBULAR ACIDOSIS

Type 1 RTA

Type 1 RTA may be inherited. Researchers have identified at least three different genes that may cause the inherited form of the disease. People with sickle cell anemia or Ehlers-Danlos syndrome, which are also inherited, may develop type 1 RTA later in life.

However, type 1 RTA may develop because of an autoimmune disease, such as Sjögren's syndrome or lupus, that can affect many parts of the body. These diseases may interfere with the removal of acid from your blood.

Type 1 RTA can also be caused by certain medications, including some used for pain and bipolar disorder, conditions causing high calcium in the urine, blocked urinary tract, or rejection of a transplanted kidney.

Type 2 RTA

Type 2 RTA may be inherited or caused by other inherited conditions such as

• cystinosis, a rare disease in which cystine crystals are deposited in bones and other tissues
• hereditary fructose intolerance
• Wilson disease

Type 2 RTA can also be caused by acute lead poisoning or chronic exposure to cadmium. It can also occur in people treated with certain medications used in chemotherapy and to treat HIV, viral hepatitis, glaucoma, migraines, and seizures.

Type 2 RTA almost always occurs as part of Fanconi syndrome. The main features of Fanconi syndrome include

• abnormal excretion of glucose, amino acids, citrate, bicarbonate, and phosphate into the urine
• low blood potassium levels
• low levels of vitamin D

Type 4 RTA

Type 4 RTA can occur when blood levels of the hormone aldosterone are low or when the kidneys do not respond to the hormone. Aldosterone directs the kidneys to regulate the level of sodium, which also affects the levels of chloride and potassium, in the blood.

Certain medicines that interfere with the kidney’s task of moving electrolytes between your blood and urine may also cause type 4 RTA. Some of these include

• blood pressure medicines called angiotensin-converting enzyme (ACE) inhibitorsand angiotensin receptor blockers (ARBs)
• certain diuretics used to treat congestive heart failure that do not decrease potassium in the blood
• certain medicines to prevent blood from clotting
• some immunosuppressive medicines that prevent the rejection of transplanted organs
• painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs)
• antibiotics used to treat pneumonia, urinary tract infections, and traveler’s diarrhea

Type 4 RTA can also occur when diseases or an inherited disorder affect how the kidneys work, such as

• Addison's disease, due to disease or removal of the adrenal glands
• congenital adrenal insufficiency
• aldosterone synthase deficiency
• Gordon syndrome 
• amyloidosis
• diabetic kidney disease
• HIV/AIDS
• kidney transplant rejection
• lupus
• sickle cell disease
• urinary tractobstruction

HOMOEOPATHIC TREATMENT FOR RENAL TUBULAR ACIDOSIS

Homoeopathy today is a rapidly growing system and is being practiced all over the world.Its strength lies in its evident effectiveness as it takes a holistic approach towards the sick individual through promotion of inner balance at mental, emotional, spiritual and physical levels. When RENAL TUBULAR ACIDOSIS   is concerned there are many effective medicines are available in Homoeopathy, but the selection depends upon the individuality of the patient, considering the mental and physical symptoms.

Few medicine in homoeopathy like berberies vul., causticum, merc. Cor., sarsaparilla, terebenthine are effective in treatment of renal tubular acidosis.