Pediatric Nephrology

, Volume 24, Issue 8, pp 1509–1516 | Cite as

Bicarbonate therapy improves growth in children with incomplete distal renal tubular acidosis

  • Ajay P. SharmaEmail author
  • Ram N. Singh
  • Connie Yang
  • Raj K. Sharma
  • Rakesh Kapoor
  • Guido Filler
Original Article


Incomplete distal renal tubular acidosis (idRTA) has recently been associated with osteoporosis and growth retardation, attributed to the mild persistent metabolic acidosis. We hypothesized a therapeutic benefit from bicarbonate therapy on growth parameters in children with idRTA. In a study group of 40 surgically treated patients with posterior urethral valve (PUV) and normal estimated glomerular filtration rate, we evaluated the change in height standard deviation scores (SDSs) while they were on bicarbonate therapy in the presence of idRTA and complete distal renal tubular acidosis (dRTA). Age- and gender-matched healthy subjects constituted the control group (n = 55). Incomplete dRTA was evaluated by ammonium chloride acidification. The baseline height SDS of −1.94 ± 0.41 and −5.31 ± 1.95 in the groups with idRTA and complete dRTA, respectively, were significantly lower than that of the controls. After a follow-up period of 24.7 ± 8.3 months on sodium bicarbonate therapy, the idRTA patients had a 66% increase in height SDS compared with 26% and 3% increases in the patients with PUV with complete dRTA and without dRTA, respectively. At the end of follow-up, mean height SDS in the group with idRTA no longer remained significantly lower than that of the controls (P = 0.42). We concluded that bicarbonate therapy improves height SDS in idRTA. This issue needs further validation in larger studies.


Growth Height Renal tubular acidosis Bicarbonate Stature 



renal tubular acidosis


distal renal tubular acidosis


incomplete dRTA


standard deviation score


posterior urethral valves


chronic kidney disease


estimated glomerular filtration rate


vesicoureteric reflux


venous blood gas


fractional excretion of urinary sodium

Δ Height SDS

the difference between the height SDS at the end of the follow-up period and the baseline height SDS in the groups with dRTA

Δ Height difference

the difference between the height SDS at the end of the follow-up period in the groups with dRTA and their respective controls


parathyroid hormone



The authors are grateful to Dr. Abeer Yasin, Ph.D., for help with the statistical analysis. They declare no conflict of interest and no financial disclosure.


  1. 1.
    Wrong O, Davies HE (1959) The excretion of acid in renal disease. Q J Med 28:259–313PubMedGoogle Scholar
  2. 2.
    Rodriguez Soriano J (2002) Renal tubular acidosis: the clinical entity. J Am Soc Nephrol 13:2160–2170PubMedCrossRefGoogle Scholar
  3. 3.
    Caruana RJ, Buckalew VM Jr (1988) The syndrome of distal (type 1) renal tubular acidosis. Clinical and laboratory findings in 58 cases. Medicine (Baltimore) 67:84–99Google Scholar
  4. 4.
    Brenner RJ, Spring DB, Sebastian A, McSherry EM, Genant HK, Palubinskas AJ, Morris RC Jr (1982) Incidence of radiographically evident bone disease, nephrocalcinosis, and nephrolithiasis in various types of renal tubular acidosis. N Engl J Med 307:217–221PubMedGoogle Scholar
  5. 5.
    Bajpai A, Bagga A, Hari P, Bardia A, Mantan M (2005) Long-term outcome in children with primary distal renal tubular acidosis. Indian Pediatr 42:321–328PubMedGoogle Scholar
  6. 6.
    Caldas A, Broyer M, Dechaux M, Kleinknecht C (1992) Primary distal tubular acidosis in childhood: clinical study and long-term follow-up of 28 patients. J Pediatr 121:233–241PubMedCrossRefGoogle Scholar
  7. 7.
    Osther PJ, Bollerslev J, Hansen AB, Engel K, Kildeberg P (1993) Pathophysiology of incomplete renal tubular acidosis in recurrent renal stone formers: evidence of disturbed calcium, bone and citrate metabolism. Urol Res 21:169–173PubMedCrossRefGoogle Scholar
  8. 8.
    Konnak JW, Kogan BA, Lau K (1982) Renal calculi associated with incomplete distal renal tubular acidosis. J Urol 128:900–902PubMedGoogle Scholar
  9. 9.
    Weger W, Kotanko P, Weger M, Deutschmann H, Skrabal F (2000) Prevalence and characterization of renal tubular acidosis in patients with osteopenia and osteoporosis and in non-porotic controls. Nephrol Dial Transplant 15:975–980PubMedCrossRefGoogle Scholar
  10. 10.
    Weger M, Deutschmann H, Weger W, Kotanko P, Skrabal F (1999) Incomplete renal tubular acidosis in ‘primary’ osteoporosis. Osteoporos Int 10:325–329PubMedCrossRefGoogle Scholar
  11. 11.
    Sharma AP, Sharma RK, Kapoor R, Kornecki A, Sural S, Filler G (2007) Incomplete distal renal tubular acidosis affects growth in children. Nephrol Dial Transplant 22:2879–2885PubMedCrossRefGoogle Scholar
  12. 12.
    Alpern RJ, Sakhaee K (1997) The clinical spectrum of chronic metabolic acidosis: homeostatic mechanisms produce significant morbidity. Am J Kidney Dis 29:291–302PubMedCrossRefGoogle Scholar
  13. 13.
    Barzel US, Massey LK (1998) Excess dietary protein can adversely affect bone. J Nutr 128:1051–1053PubMedGoogle Scholar
  14. 14.
    Green J, Kleeman CR (1991) Role of bone in regulation of systemic acid-base balance. Kidney Int 39:9–26PubMedCrossRefGoogle Scholar
  15. 15.
    Sharma RK, Sharma AP, Kapoor R, Gupta A (2001) Prognostic significance of distal renal tubular acidosis in posterior urethral valve. Pediatr Nephrol 16:581–585PubMedCrossRefGoogle Scholar
  16. 16.
    Sharma RK, Sharma AP, Kapoor R, Pandey CM, Gupta A (2001) Prognostic factors for persistent distal renal tubular acidosis after surgery for posterior urethral valve. Am J Kidney Dis 38:488–493PubMedCrossRefGoogle Scholar
  17. 17.
    Schwartz GJ, Brion LP, Spitzer A (1987) The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am 34:571–590PubMedGoogle Scholar
  18. 18.
    Yang SC, Wellons MD, Chan JC (1981) The effects of long-term freezing preservation on urinary titratable acid and ammonium. Clin Biochem 14:45–46PubMedCrossRefGoogle Scholar
  19. 19.
    Batlle DC, Hizon M, Cohen E, Gutterman C, Gupta R (1988) The use of the urinary anion gap in the diagnosis of hyperchloremic metabolic acidosis. N Engl J Med 318:594–599PubMedCrossRefGoogle Scholar
  20. 20.
    Rodriguez Soriano J (1992) Renal tubular acidosis. In: Edelmann CM, Bernstein J, Meadow SR, Spitzer A, Travis L (eds) Pediatric Kidney Disease. Little, Brown and Co, Boston, pp 1737–1776Google Scholar
  21. 21.
    Agarwal DK, Agarwal KN (1994) Physical growth in Indian affluent children (birth–6 years). Indian Pediatr 31:377–413PubMedGoogle Scholar
  22. 22.
    Agarwal DK, Agarwal KN, Upadhyay SK, Mittal R, Prakash R, Rai S (1992) Physical and sexual growth pattern of affluent Indian children from 5 to 18 years of age. Indian Pediatr 29:1203–1282PubMedGoogle Scholar
  23. 23.
    Ghazali S, Barratt TM (1974) Urinary excretion of calcium and magnesium in children. Arch Dis Child 49:97–101PubMedCrossRefGoogle Scholar
  24. 24.
    Sweid HA, Bagga A, Vaswani M, Vasudev M, Vasudev V, Ahuja RK, Srivastava RN (1997) Urinary excretion of minerals, oxalate, and uric acid in north Indian children. Pediatr Nephrol 11:189–192PubMedCrossRefGoogle Scholar
  25. 25.
    Sebastian A, Harris ST, Ottaway JH, Todd KM, Morris RC Jr (1994) Improved mineral balance and skeletal metabolism in postmenopausal women treated with potassium bicarbonate. N Engl J Med 330:1776–1781PubMedCrossRefGoogle Scholar
  26. 26.
    Pongchaiyakul C, Domrongkitchaiporn S, Stitchantrakul W, Chailurkit L-o, Rajatanavin R (2004) Incomplete renal tubular acidosis and bone mineral density: a population survey in an area of endemic renal tubular acidosis. Nephrol Dial Transplant 19:3029–3033PubMedCrossRefGoogle Scholar
  27. 27.
    Chesney RW, Kaplan BS, Phelps M, DeLuca HF (1984) Renal tubular acidosis does not alter circulating values of calcitriol. J Pediatr 104:51–55PubMedCrossRefGoogle Scholar
  28. 28.
    Krapf R, Vetsch R, Vetsch W, Hulter HN (1992) Chronic metabolic acidosis increases the serum concentration of 1,25-dihydroxyvitamin D in humans by stimulating its production rate. Critical role of acidosis-induced renal hypophosphatemia. J Clin Invest 90:2456–2463PubMedCrossRefGoogle Scholar
  29. 29.
    Farhat W, McLorie G, Capolicchio G, Khoury A, Bägli D, Merguerian PA (2000) Outcomes of primary valve ablation versus urinary tract diversion in patients with posterior urethral valves. Urology 56:653–657PubMedCrossRefGoogle Scholar
  30. 30.
    Schober JM, Dulabon LM, Woodhouse CR (2004) Outcome of valve ablation in late-presenting posterior urethral valves. BJU Int 94:616–619PubMedCrossRefGoogle Scholar

Copyright information

© IPNA 2009

Authors and Affiliations

  • Ajay P. Sharma
    • 1
    Email author
  • Ram N. Singh
    • 2
  • Connie Yang
    • 3
  • Raj K. Sharma
    • 4
  • Rakesh Kapoor
    • 5
  • Guido Filler
    • 1
  1. 1.Department of Pediatrics, Division of NephrologyUniversity of Western OntarioLondonCanada
  2. 2.Department of Pediatrics, Division of Critical Care MedicineUniversity of Western OntarioLondonCanada
  3. 3.Department of PediatricsUniversity of Western OntarioLondonCanada
  4. 4.Department of NephrologySanjay Gandhi Post Graduate Institute of Medical SciencesLucknowIndia
  5. 5.Department of UrologySanjay Gandhi Post Graduate Institute of Medical SciencesLucknowIndia

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