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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

Abstract

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.

Keywords

Growth Height Renal tubular acidosis Bicarbonate Stature 

Abbreviations

RTA

renal tubular acidosis

dRTA

distal renal tubular acidosis

idRTA

incomplete dRTA

SDS

standard deviation score

PUV

posterior urethral valves

CKD

chronic kidney disease

eGFR

estimated glomerular filtration rate

VUR

vesicoureteric reflux

VBG

venous blood gas

FeNa

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

PTH

parathyroid hormone

Notes

Acknowledgment

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.

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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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