Bicarbonate therapy improves growth in children with incomplete distal renal tubular acidosis

Area of Science:

• Pediatric Nephrology
• Endocrinology
• Metabolic Disorders

Background:

• Incomplete distal renal tubular acidosis (idRTA) is linked to growth retardation and osteoporosis due to persistent metabolic acidosis.
• Posterior urethral valve (PUV) is a common cause of urinary tract issues in children, sometimes leading to idRTA.

Purpose of the Study:

• To investigate the therapeutic effect of bicarbonate therapy on growth parameters in children diagnosed with idRTA.
• To compare growth outcomes in idRTA patients receiving bicarbonate with those having complete dRTA or no dRTA.

Main Methods:

• A cohort of 40 surgically treated PUV patients with normal GFR were assessed for changes in height standard deviation scores (SDS) during bicarbonate therapy.
• Patients included those with idRTA, complete distal renal tubular acidosis (dRTA), and no dRTA. A control group of 55 healthy children was used for comparison.
• Incomplete dRTA was diagnosed using ammonium chloride acidification tests.

Main Results:

• Baseline height SDS was significantly lower in idRTA and complete dRTA groups compared to healthy controls.
• After 24.7 months of sodium bicarbonate therapy, idRTA patients showed a 66% increase in height SDS.
• Patients with PUV and complete dRTA or no dRTA showed smaller increases in height SDS (26% and 3%, respectively).

Conclusions:

• Bicarbonate therapy demonstrates a significant positive impact on improving height SDS in children with idRTA.
• The findings suggest that addressing metabolic acidosis through bicarbonate supplementation is crucial for normalizing growth in these pediatric patients.
• Further validation in larger studies is recommended to confirm these therapeutic benefits.