Acidose tubular renal distal em crianças e adolescentes

Abstract

Distal renal tubular acidosis (RTA) refers to a heterogeneous group of diseases that result from distal tubular dysfunction and can lead to growth retardation, nephrocalcinosis, bone disease and, rarely, chronic kidney disease. This study aimed to describe the clinical course of distal RTA series and to analyze somatic growth by identifying possibly predictive factors of growth improvement. Patients were followed-up from 1984 to 2008 according to our standard protocol. Paired t test was used for comparison between pre and post-treatment results. A logistic regression model was applied to identify variables that were independently associated with the gain of at least one standard deviation (SD) in Z-score for height and weight. A total of 33 distal RTA patients (15 males) were analyzed. Primary disease was the commonest form (60.6%). The mean age at the diagnosis was 2.7±3.1 years and the mean duration of follow-up was 10.8±6.1 years. Based on weight/age and stature/age curves, 58.3% of the patients completely recovered growth after treatment. Bicarbonate levels at admission were independent predictors of stature gain at last visit and the male sex negatively affected the final weight gain. Metabolic acidosis, electrolyte disturbances, hypercalciuria and nephrocalcinosis also improved during follow-up (p<0.05). Our data showed the great impact of treatment on metabolic control and further indicated predictive factors of growth catch-up.