What is included in the treatment of proximal renal tubular acidosis (pRTA)?

Updated: Oct 18, 2018
  • Author: Sai-Ching Jim Yeung, MD, PhD, FACP; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

In cases of pRTA, multitherapy with large quantities of alkali, vitamin D, and potassium supplementation is required. (Depending on the degree of renal dysfunction, renal activation of vitamin D to the active calcitriol metabolite may be impaired, and administration of calcitriol may be preferred over other vitamin D preparations.)

The usual range of bicarbonate administration is 5-15 mEq/kg/d, and the administration must be accompanied or preceded by the administration of large amounts of potassium.

Proximal RTA can be difficult to treat, because alkali administration results in prompt and marked bicarbonaturia and potassium wasting.

The use of diuretics to induce extracellular volume depletion that enhances proximal tubular bicarbonate reabsorption can be effective but is usually accompanied by worsening of the hypokalemia. Thus, diuretics must be used with caution, and they require additional potassium or the addition of potassium-sparing agents.


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