Chonnam Med J.  2011 Dec;47(3):170-172. 10.4068/cmj.2011.47.3.170.

Incomplete Distal Renal Tubular Acidosis with Nephrocalcinosis

• Choi JS
• Kim CS
• Park JW
• Bae EH
• Ma SK
• Kim SW

• KMID: 2172227
• DOI: http://doi.org/10.4068/cmj.2011.47.3.170

Abstract

We report the case of a female patient with incomplete distal renal tubular acidosis with nephrocalcinosis. She was admitted to the hospital because of acute pyelonephritis. Imaging studies showed dual medullary nephrocalcinosis. Subsequent evaluations revealed hypokalemia, hypocalcemia, hypercalciuria, and hypocitraturia with normal acid-base status. A modified tubular acidification test with NH4Cl confirmed a defect of urine acidification, which is compatible with incomplete distal tubular acidosis. We treated our patient with potassium citrate, which corrects hypokalemia and prevents further deposition of calcium salts.

Keyword

Renal tubular acidosis; Nephrocalcinosis; Kidney

MeSH Terms

Acidosis
Acidosis, Renal Tubular
Calcium
Female
Humans
Hypercalciuria
Hypocalcemia
Hypokalemia
Kidney
Nephrocalcinosis
Potassium Citrate
Pyelonephritis
Salts
Calcium
Potassium Citrate
Salts

Figure

• 

  FIG. 1 (A) Renal ultrasound showed a hyperechogenic region in the medulla and postacoustic shadowing beyond the region. (B) Abdominal computed tomography confirmed medullary calcification.

• 

  FIG. 2 Protocol for a modified tubular acidification test with NH4Cl.

Reference

1. Arampatzis S, Röpke-Rieben B, Lippuner K, Hess B. Prevalence and densitometric characteristics of incomplete distal renal tubular acidosis in men with recurrent calcium nephrolithiasis. Urol Res. 2011. [Epub ahead of print].

2. Alon US. Nephrocalcinosis. Curr Opin Pediatr. 1997. 9:160–165.

3. Kitiyakara C, Yamwong S, Cheepudomwit S, Domrongkitchaiporn S, Unkurapinun N, Pakpeankitvatana V, et al. The metabolic syndrome and chronic kidney disease in a Southeast Asian cohort. Kidney Int. 2007. 71:693–700.

4. Weger W, Kotanko P, Weger M, Deutschmann H, Skrabal F. Prevalence and characterization of renal tubular acidosis in patients with osteopenia and osteoporosis and in non-porotic controls. Nephrol Dial Transplant. 2000. 15:975–980.