Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Rheumatology International
Published in: Rheumatology International 8/2014

Open Access 01-08-2014 | Review Article

Everything you need to know about distal renal tubular acidosis in autoimmune disease

Authors: Tim Both, Robert Zietse, Ewout J. Hoorn, P. Martin van Hagen, Virgil A. S. H. Dalm, Jan A. M. van Laar, Paul L. A. van Daele

Published in: Rheumatology International | Issue 8/2014

Login to get access

Abstract

Renal acid–base homeostasis is a complex process, effectuated by bicarbonate reabsorption and acid secretion. Impairment of urinary acidification is called renal tubular acidosis (RTA). Distal renal tubular acidosis (dRTA) is the most common form of the RTA syndromes. Multiple pathophysiologic mechanisms, each associated with various etiologies, can lead to dRTA. The most important consequence of dRTA is (recurrent) nephrolithiasis. The diagnosis is based on a urinary acidification test. Potassium citrate is the treatment of choice.
Literature
1.
Aygen B, Dursun FE, Dogukan A, Ozercan IH, Celiker H (2008) Hypokalemic quadriparesis associated with renal tubular acidosis in a patient with Sjogren’s syndrome. Clin Nephrol 69(4):306–309PubMedCrossRef
2.
Moutsopoulos HM, Cledes J, Skopouli FN, Elisaf M, Youinou P (1991) Nephrocalcinosis in Sjogren’s syndrome: a late sequela of renal tubular acidosis. J Intern Med 230(2):187–191PubMedCrossRef
3.
Gera C, Mohapatra D, Calton N (2011) Hypokalaemic paralysis secondary to distal renal tubular acidosis as the presenting symptom of systemic lupus erythematosus. Singapore Med J 52(1):e1–e3PubMed
4.
Bossini N, Savoldi S, Franceschini F, Mombelloni S, Baronio M, Cavazzana I, Viola BF, Valzorio B, Mazzucchelli C, Cattaneo R, Scolari F, Maiorca R (2001) Clinical and morphological features of kidney involvement in primary Sjogren’s syndrome. Nephrol Dial Transplant 16(12):2328–2336PubMedCrossRef
5.
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(2):84–99CrossRef
6.
Poux JM, Peyronnet P, Le Meur Y, Favereau JP, Charmes JP, Leroux-Robert C (1992) Hypokalemic quadriplegia and respiratory arrest revealing primary Sjogren’s syndrome. Clin Nephrol 37(4):189–191PubMed
7.
Pun KK, Wong CK, Tsui EY, Tam SC, Kung AW, Wang CC (1989) Hypokalemic periodic paralysis due to the Sjogren syndrome in Chinese patients. Ann Intern Med 110(5):405–406PubMedCrossRef
8.
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(4):217–221. doi:10.​1056/​NEJM198207223070​403 PubMedCrossRef
9.
Arampatzis S, Ropke-Rieben B, Lippuner K, Hess B (2012) Prevalence and densitometric characteristics of incomplete distal renal tubular acidosis in men with recurrent calcium nephrolithiasis. Urol Res 40(1):53–59. doi:10.​1007/​s00240-011-0397-3 PubMedCrossRef
10.
Pak CY, Poindexter JR, Adams-Huet B, Pearle MS (2003) Predictive value of kidney stone composition in the detection of metabolic abnormalities. Am J Med 115(1):26–32PubMedCrossRef
11.
Domrongkitchaiporn S, Pongskul C, Sirikulchayanonta V, Stitchantrakul W, Leeprasert V, Ongphiphadhanakul B, Radinahamed P, Rajatanavin R (2002) Bone histology and bone mineral density after correction of acidosis in distal renal tubular acidosis. Kidney Int 62(6):2160–2166. doi:10.​1046/​j.​1523-1755.​2002.​00656.​x PubMedCrossRef
12.
Jehle S, Hulter HN, Krapf R (2012) Effect of potassium citrate on bone density, microarchitecture, and fracture risk in healthy older adults without osteoporosis: a randomized controlled trial. J Clin Endocrinol Metab. doi:10.​1210/​jc.​2012-3099 PubMed
13.
Walsh SB, Shirley DG, Wrong OM, Unwin RJ (2007) Urinary acidification assessed by simultaneous furosemide and fludrocortisone treatment: an alternative to ammonium chloride. Kidney Int 71(12):1310–1316. doi:10.​1038/​sj.​ki.​5002220 PubMedCrossRef
14.
15.
Halperin ML, Jungas RL (1983) Metabolic production and renal disposal of hydrogen ions. Kidney Int 24(6):709–713PubMedCrossRef
16.
17.
18.
19.
20.
Nowik M, Picard N, Stange G, Capuano P, Tenenhouse HS, Biber J, Murer H, Wagner CA (2008) Renal phosphaturia during metabolic acidosis revisited: molecular mechanisms for decreased renal phosphate reabsorption. Pflugers Arch 457(2):539–549. doi:10.​1007/​s00424-008-0530-5 PubMedCrossRef
21.
22.
Kinsella JL, Aronson PS (1981) Interaction of NH4+ and Li+ with the renal microvillus membrane Na+ -H+ exchanger. Am J Physiol 241(5):C220–C226PubMed
23.
Jans F, Balut C, Ameloot M, Wouters P, Steels P (2007) Investigation of the Ba2+ -sensitive NH4 +transport pathways in the apical cell membrane of primary cultured rabbit MTAL cells. Nephron Physiol 106(3):p45–p53. doi:10.​1159/​000103909 PubMedCrossRef
24.
25.
Blanchard A, Eladari D, Leviel F, Tsimaratos M, Paillard M, Podevin RA (1998) NH4+ as a substrate for apical and basolateral Na(+)-H +exchangers of thick ascending limbs of rat kidney: evidence from isolated membranes. J Physiol 506(Pt 3):689–698PubMedCentralPubMedCrossRef
26.
27.
28.
29.
30.
31.
Winter C, Kampik NB, Vedovelli L, Rothenberger F, Paunescu TG, Stehberger PA, Brown D, John H, Wagner CA (2011) Aldosterone stimulates vacuolar H(+)-ATPase activity in renal acid-secretory intercalated cells mainly via a protein kinase C-dependent pathway. Am J Physiol Cell Physiol 301(5):C1251–C1261. doi:10.​1152/​ajpcell.​00076.​2011 PubMedCentralPubMedCrossRef
32.
33.
34.
35.
Higashihara E, Nutahara K, Tago K, Ueno A, Niijima T (1984) Medullary sponge kidney and renal acidification defect. Kidney Int 25(2):453–459PubMedCrossRef
36.
Takemoto F, Hoshino J, Sawa N, Tamura Y, Tagami T, Yokota M, Katori H, Yokoyama K, Ubara Y, Hara S, Takaichi K, Yamada A, Uchida S (2005) Autoantibodies against carbonic anhydrase II are increased in renal tubular acidosis associated with Sjogren syndrome. Am J Med 118(2):181–184. doi:10.​1016/​j.​amjmed.​2004.​07.​049 PubMedCrossRef
37.
38.
Douglas JB, Healy JK (1969) Nephrotoxic effects of amphotericin B, including renal tubular acidosis. Am J Med 46(1):154–162PubMedCrossRef
39.
40.
Rosen S (1970) The turtle bladder. II. Observations on the epithelial cytotoxic effect of amphotericin B. Exp Mol Pathol 12(3):297–305PubMedCrossRef
41.
Steinmetz PR, Lawson LR (1971) Effect of luminal pH on ion permeability and flows of Na+ and H+ in turtle bladder. Am J Physiol 220(6):1573–1580PubMed
42.
43.
Sleeper RS, Belanger P, Lemieux G, Preuss HG (1982) Effects of in vitro potassium on ammoniagenesis in rat and canine kidney tissue. Kidney Int 21(2):345–353PubMedCrossRef
44.
Good DW, Knepper MA, Burg MB (1984) Ammonia and bicarbonate transport by thick ascending limb of rat kidney. Am J Physiol 247(1 Pt 2):F35–F44PubMed
45.
Krieger NS, Frick KK, Bushinsky DA (2004) Mechanism of acid-induced bone resorption. Curr Opin Nephrol Hypertens 13(4):423–436PubMedCrossRef
46.
Bushinsky DA, Chabala JM, Gavrilov KL, Levi-Setti R (1999) Effects of in vivo metabolic acidosis on midcortical bone ion composition. Am J Physiol 277(5 Pt 2):F813–F819PubMed
47.
48.
49.
Pongchaiyakul C, Domrongkitchaiporn S, Stitchantrakul W, Chailurkit LO, 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(12):3029–3033. doi:10.​1093/​ndt/​gfh534 PubMedCrossRef
50.
Shearn MA, Tu WH (1965) Nephrogenic diabetic insipidus and other defects of renal tubular function in Sjoergren’s syndrome. Am J Med 39:312–318PubMedCrossRef
51.
Ren H, Wang WM, Chen XN, Zhang W, Pan XX, Wang XL, Lin Y, Zhang S, Chen N (2008) Renal involvement and followup of 130 patients with primary Sjogren’s syndrome. J Rheumatol 35(2):278–284PubMed
52.
Baburaj P, Khanna L (2007) Secondary Sjogren’s syndrome and scleroderma presenting as renal tubular acidosis. J Assoc Physicians India 55:78–79PubMed
53.
Bouchhima C, Mnif M, Jarraya F, Rekik N, Hachicha J, Abid M (2003) Association of distal tubular acidosis, Hashimoto’s thyroiditis and Gougerot–Sjogren’s syndrome. Presse Med 32(30):1410–1412PubMed
54.
Li SL, Liou LB, Fang JT, Tsai WP (2005) Symptomatic renal tubular acidosis (RTA) in patients with systemic lupus erythematosus: an analysis of six cases with new association of type 4 RTA. Rheumatology (Oxford) 44(9):1176–1180. doi:10.​1093/​rheumatology/​keh705 CrossRef
55.
Komatsuda A, Wakui H, Ohtani H, Masai R, Okuyama S, Nimura T, Suzuki N, Sawada K (2010) Tubulointerstitial nephritis and renal tubular acidosis of different types are rare but important complications of primary biliary cirrhosis. Nephrol Dial Transplant 25(11):3575–3579. doi:10.​1093/​ndt/​gfq232 PubMedCrossRef
56.
57.
Takemoto F, Katori H, Sawa N, Hoshino J, Suwabe T, Sogawa Y, Nomura K, Nakanishi S, Higa Y, Kanbayashi H, Kosuga M, Sasaki M, Tomioka S, Yamashita M, Ubara Y, Yamada A, Takaichi K, Uchida S (2007) Induction of anti-carbonic-anhydrase-II antibody causes renal tubular acidosis in a mouse model of Sjogren’s syndrome. Nephron Physiol 106(4):p63–p68. doi:10.​1159/​000104873 PubMedCrossRef
58.
Bae EH, Han CW, Lee JH, Park JW, Ma SK, Choi KC, Kim SW (2009) The case. Hypokalemia associated with nephrocalcinosis. Distal renal tubular acidosis associated with Sjogren’s syndrome. Kidney Int 75(4):443–444. doi:10.​1038/​ki.​2008.​530 PubMedCrossRef
59.
Espinosa A, Hennig J, Ambrosi A, Anandapadmanaban M, Abelius MS, Sheng Y, Nyberg F, Arrowsmith CH, Sunnerhagen M, Wahren-Herlenius M (2011) Anti-Ro52 autoantibodies from patients with Sjogren’s syndrome inhibit the Ro52 E3 ligase activity by blocking the E3/E2 interface. J Biol Chem 286(42):36478–36491. doi:10.​1074/​jbc.​M111.​241786 PubMedCentralPubMedCrossRef
Metadata
Title
Everything you need to know about distal renal tubular acidosis in autoimmune disease
Authors
Tim Both
Robert Zietse
Ewout J. Hoorn
P. Martin van Hagen
Virgil A. S. H. Dalm
Jan A. M. van Laar
Paul L. A. van Daele
Publication date
01-08-2014
Publisher
Springer Berlin Heidelberg
Published in
Rheumatology International / Issue 8/2014
Print ISSN: 0172-8172
Electronic ISSN: 1437-160X
DOI
https://doi.org/10.1007/s00296-014-2993-3

Other articles of this Issue 8/2014

Rheumatology International 8/2014 Go to the issue

Letter to the Editor

Critique and appraisal of a study on sex disparities in systemic lupus erythematosus

Original Article

Markers of endothelial damage and repair in Takayasu arteritis: Are they associated with disease activity?

Original Article

Fibromyalgia in patients with axial spondyloarthritis: epidemiological profile and effect on measures of disease activity

Original Article

Morning melatonin serum values do not correlate with disease activity in rheumatoid arthritis: a cross-sectional study

Short Communication

Serum resistin levels: a possible correlation with pulmonary vascular involvement in patients with systemic sclerosis

Original Article

Quality of life, depression, and sexual dysfunction in spouses of female patients with fibromyalgia
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits