Diabetes mellitus and hyperkalemic renal tubular acidosis: case reports and
            literature review

Bello, Carlos Henrique Pires Ratto Tavares; Duarte, João Sequeira; Vasconcelos, Carlos

doi:10.5935/0101-2800.20170086

Cited by 5 publications

(4 citation statements)

References 5 publications

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“…Deficiency states lead to hyperkalemia and metabolic acidosis (MA) [2]. In RTA type 4, serum bicarbonate concentration (SBC) is typically not less than 17mmol/l [3].…”

Section: Discussionmentioning

confidence: 99%

Intradialysis Cardiac Arrest in a 40 year old Woman with Diabetic Nephropathy Precipitated by Hyperkalemia Induced by Type 4 Renal Tubular Acidosis.

Nwinne

Adedeji

2022

IJHS

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Purpose: We present a rare case of intra-dialytic cardiac arrest secondary to renal tubular acidosis precipitated by severe hyperkalemia. Renal tubular acidosis (RTA) type 4 results from defective distal tubular (DT) response to aldosterone and could lead to hyperkalemia and metabolic acidosis, conditions which in their severe forms, can precipitate cardiac arrest. Methodology: Here, we present the management of intra-dialysis cardiac arrest precipitated by severe hyperkalemia. Results: Patient was an 18 year old female, diabetic who had 3 episodes of intra-dialysis cardiac arrest requiring cardiac defibrillation. She was dyspneic, drowsy, pale, had flapping tremor and a tunneled internal jugular catheter insitu. Her pulse was 124/min, blood pressure was 166/98 mmHg and the third heart sounds was heard. Urinalysis showed 3 (+++) of protein. Arterial blood gases (ABGs) revealed hyperkalemia (7.0mmol/l), hypobicarbonatemia (12mmol/l), blood PH (7.2) and blood glucose (249mmol). Serum creatinine was 947umol/l and tall tented T waves were seen on electrocardiogram. Unique contribution to theory, practice and policy: With a carefully prescribed dialysis, meal and drug regimen, intra-dialysis cardiac arrest can be prevented, and well managed when it occurs.

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“…Deficiency states lead to hyperkalemia and metabolic acidosis (MA) [2]. In RTA type 4, serum bicarbonate concentration (SBC) is typically not less than 17mmol/l [3].…”

Section: Discussionmentioning

confidence: 99%

Intradialysis Cardiac Arrest in a 40 year old Woman with Diabetic Nephropathy Precipitated by Hyperkalemia Induced by Type 4 Renal Tubular Acidosis.

Nwinne

Adedeji

2022

IJHS

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“…ATR hipercalêmica (ATR IV) -Sua principal causa é o hipoaldosteronismo, que ocasiona redução da síntese, liberação e secreção de aldosterona ou devido à resistência do órgão alvo. A aldosterona também medeia a reabsorção dos íons sódio (Na + ) em troca do íon potássio (K + ) e do íon hidrogênio (H + ) via antiporter; deste modo ocorre redução da excreção de potássio, levando à hipercalemia seguida da redução na excreta de ácidos pelos rins 10 . Apesar das ATRs serem pouco reconhecidas e com quase nenhum dado epidemiológico disponível, elas contribuem para as estatísticas de DRCs, pois estão presentes em pacientes em estado crítico que muitas vezes já apresentam -ou estão evoluindo -para a insuficiência renal 11 .…”

Section: Atr Proximal E Distal (Atr Iii) -Apresentando Propriedades Dasunclassified

Utilização Do Ânion Gap Urinário No Diagnóstico De Acidose Tubular Renal

Marnatti¹,

Lunardelli²

2020

Rev Pat Tocantins

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Introdução: A acidose tubular renal (ATR) é uma doença obscura e de difícil diagnóstico, pois causa uma alteração no balanço acidobásico do organismo. Devido à complexidade dos mecanismos fisiológicos que controlam o pH plasmático e urinário, podendo ser de origem congênita ou adquirida, com sintomas que variam conforme o tipo de acidose presente e acarretam num diagnóstico complexo e muitas vezes demorado. Objetivo: Revisar a literatura quanto a utilização e a importância do ânion gap urinário (AGU) como ferramenta no diagnóstico das ATRs e proporcionar um método investigativo para facilitar a identificação da acidose renal. Materiais e métodos: Trata-se de uma revisão integrativa da literatura onde foram acessadas as bases de dados Medline/Pubmed, Science Direct e Scielo. Utilizou-se os descritores: acidose, tubular, renal e ânion gap urinário, bem como a combinação destas palavras. Resultados: Dos 151 artigos encontrados, foram identificados 6 estudos que utilizam o ânion gap urinário demonstrando o seu potencial como ferramenta diferencial no diagnóstico da acidose tubular renal. Conclusão: O AGU consegue confirmar rapidamente a presença da ATR eliminando a possibilidade de perda extrarrenal do bicarbonato, como problemas gastrointestinais ou em pacientes com acidose metabólica hiperclorêmica. O AGU é uma ferramenta de grande valia diagnóstica para as ATRs, já que necessita de informações de fácil acesso ou previamente obtidas, apresenta um baixo custo e há possibilidade de diagnóstico exato, desde que se leve em conta suas limitações.

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“…Combined proximal and distal RTA (type 3 RTA) is a rare form of RTA that involves defects in both proximal and distal tubular acidification mechanisms with combined features of type 1 and type 2 RTA. Type 4 RTA (RTA 4), also known as RTA due to hyporeninemic hypoaldosteronism, is characterized by impaired renal acidification due to hypoaldosteronism or aldosterone resistance, resulting in reduced secretion of hydrogen ions and impaired potassium excretion[ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Renal calcification in children with renal tubular acidosis: What a paediatrician ‎should ‎know‎

Al-Beltagi,

Saeed,

Bediwy

et al. 2023

World J Clin Pediatr

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Renal tubular acidosis (RTA) can lead to renal calcification in children, which can cause various complications and impair renal function. This review provides pediatricians with a comprehensive understanding of the relationship between RTA and renal calcification, highlighting essential aspects for clinical management. The article analyzed relevant studies to explore the prevalence, risk factors, underlying mechanisms, and clinical implications of renal calcification in children with RTA. Results show that distal RTA (type 1) is particularly associated with nephrocalcinosis, which presents a higher risk of renal calcification. However, there are limitations to the existing literature, including a small number of studies, heterogeneity in methodologies, and potential publication bias. Longitudinal data and control groups are also lacking, which limits our understanding of long-term outcomes and optimal management strategies for children with RTA and renal calcification. Pediatricians play a crucial role in the early diagnosis and management of RTA to mitigate the risk of renal calcification and associated complications. In addition, alkaline therapy remains a cornerstone in the treatment of RTA, aimed at correcting the acid-base imbalance and reducing the formation of kidney stones. Therefore, early diagnosis and appropriate therapeutic interventions are paramount in preventing and managing renal calcification to preserve renal function and improve long-term outcomes for affected children. Further research with larger sample sizes and rigorous methodologies is needed to optimize the clinical approach to renal calcification in the context of RTA in the pediatric population.

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Diabetes mellitus and hyperkalemic renal tubular acidosis: case reports and literature review

Cited by 5 publications

References 5 publications

Intradialysis Cardiac Arrest in a 40 year old Woman with Diabetic Nephropathy Precipitated by Hyperkalemia Induced by Type 4 Renal Tubular Acidosis.

Intradialysis Cardiac Arrest in a 40 year old Woman with Diabetic Nephropathy Precipitated by Hyperkalemia Induced by Type 4 Renal Tubular Acidosis.

Utilização Do Ânion Gap Urinário No Diagnóstico De Acidose Tubular Renal

Renal calcification in children with renal tubular acidosis: What a paediatrician ‎should ‎know‎

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