Bicarbonate therapy improves growth in children with incomplete distal renal tubular acidosis.
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.
Department of Pediatrics, Division of Nephrology, University of Western Ontario, 800, Commissioner's Road E, Children's Hospital, London Health Sciences Centre, London, ON, N6A 5W9, Canada. ajay.sharma@lhsc.on.ca
Ajay P
AP
Sharma
Ram N
RN
Singh
Connie
C
Yang
Raj K
RK
Sharma
Rakesh
R
Kapoor
Guido
G
Filler
D000141:Acidosis, Renal Tubular / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006130:Growth Disorders / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D017693:Sodium Bicarbonate / Q000627:therapeutic use*
D017693:Sodium Bicarbonate