Renal tubular acidosis management

Reduced pH of the blood in renal tubules which are distal and proximal convoluted tubules is called tubular acidosis. The pH of the blood when reduced leads to renal tubular acidosis. The urinary pH is reduced and this leads to various complications and various symptoms appear as a signal to denote acidosis. There are 4 types of renal tubular acidosis. In chronic kidney disease, renal failure, catheterization when done. Diet, medications, and pre-existing conditions. It is a serious complication that can lead to life threatening complications or situations. Lack of basic content in blood and abnormal buffering mechanism of the body leads to this condition. The kidney is the main organ that controls the acid base balance and buffering activity. If the kidney is diseased, these conditions are common. The inability of kidneys to remove the acidic content of blood leads to this condition.

Diagnosis and treatment planning for the management of this condition.

  • Urine testing shows low pH.
  • Blood shows more acidity and low pH.
  • The typical smell of the breath.
  • Renal function test.
  • Haematuria.

Immediate management of renal tubular acidosis.

  • Oral or intravenous administration of sodium bicarbonate. Sodium bicarbonate is a basic liquid that buffers or counteracts the acidity in the renal tubules or blood overall.
  • Administration of sodium citrate. It acts by balancing hydrogen ions and hco3 ions in the body and maintains or brings back the lowered pH to normal.
  • Rest and relaxation to the patient are essential.
  • Constant monitoring of the mineral content.
  • Constant evaluation of consciousness, orientation, and breathing.
  • Potassium and sodium supplements to bring back the mineral levels to normal.
  • Reduce the tablets like loop diuretics, spironolactone which are medications for hypertension.

A complication of renal tubular acidosis which requires immediate treatment.

  • Hypokalaemia.
  • Hyponatraemia.
  • Loss of consciousness
  • Bone demineralisation
  • Renal calculi or kidney stones.
  • Aldosterone imbalance.
  • Brittle bones and weakness.
  • Bad breath.
  • Renal failure.
  • Cardiac arrest.
  • Brain damage 
  • Death.

How to manage and treat renal tubular necrosis by dietary means?

  • Eating food that contains basic elements such as cucumber, fruits such as bananas, pomegranate.
  • Avoid or restrict protein in the diet by reducing intake of dal, cereals, meat, fish, eggs, chicken, pork, dry fruits, horse gram, etc.
  • Eat properly cooked food.
  • Avoid food with preservatives.
  • Carbonated drinks like soda and soft drinks have the potential to make a bad impact on the pH of the blood. It can lead to the acidity of the blood and can therefore cause acidosis.
  • Avoid bread, buns, cheese, etc.
  • Eat more salt and basic foods.
  • Leafy vegetables contain potassium and calcium so it is supposed to be consumed with precautions to increase levels of potassium and such elements.
  • Strawberries, bananas, and grapes can be eaten with care.
  • Electrolytes have to be increased in the body so drink more water and with salt and sure. Again, keep in mind with precautions.
  • Oral calcium carbonate and sodium citrate as per doctor’s advice.
  • No heavy meals should be consumed.
  • Stop alcohol consumption as it hinders the buffering action and activities of the kidneys.
  • Smoking and tobacco can also have their own contribution to bringing about this condition. So, stop smoking completely.

Management of renal tubular acidosis by correcting the underlying causes.

  • Treating underlying vitamin D deficiency by oral supplementation and sunlight exposure.
  • Treating hypoaldosteronism by extracting tumors of the adrenal gland or by hormonal therapy.
  • Reducing the usage of anti-hypertensive drugs.
  • Treating HIV infection.
  • Reducing or replacing non-steroidal anti-inflammatory drugs or also known as NSAIDs.
  • Adrenal insufficiency.
  • Potassium sparing diuretics usage.
  • Sjogren’s syndrome.
  • Anemia.

Management of secondary complications of renal tubular acidosis.

  1. Hypokalaemia: potassium bicarbonate or potassium supplements are administered to bring back the levels to normal. Normal potassium is the key to proper cerebral, cerebellar and muscular functioning. Eat leafy vegetables, bananas, almonds, raisins, figs, and so on. If the patient already has a chronic kidney disease, have the above mentioned foods with precaution and in measured ways.
  2. Hyponatremia: hypokalemia and hyponatremia go hand in hand. Sodium bicarbonate usage has shown quick and better results amongst these patients.
  3. Renal failure: this is a deadly complication but can be reversible with early diagnosis and treatment.
  4. Metabolic acidosis: management remains the same.
  5. Pulmonary acidosis: the lung undergoes acidic changes with respect to the blood and the alveoli content. The HCO3 reduces and thus causes acidic breath.

Standard management of renal tubular acidosis in brief.

  • The patient is taken to the hospital emergency.
  • The quick history is taken by the doctors.
  • By clinical presentation of the patient, the treatment protocol is started.
  • Samples of blood and urine are taken beforehand.
  • The patient is given sodium citrate solution orally.
  • Other solutions like sodium bicarbonate, potassium supplement, calcium bicarbonate are administered.
  • Vital monitoring is done throughout.
  • In case the patient is unconscious, these solutions are given through blood.
  • When a patient is oriented and fine, dietary precautions are told. Dos and don’ts are advised.
  • Secondary check-ups are done to check any other underlying condition that exists which needs interventions.
  • The patient is discharged and called for follow-up.
  • The patient has to start a new diet and medication and adopt a new lifestyle.

Physical wellbeing as a management method in preventing renal tubular acidosis (RTA).

  • Walk about 20 minutes after consuming meals.
  • Have proper water and electrolytes in the day. Reduce water intake at night.
  • Reduce stress in life and practice meditation to relax yourself.
  • Do not control the urge to urinate.
  • Jogging, cycling, and swimming are good ways for overall fitness. Consult your doctor and physiotherapist for the exact prescription.
  • Sleep and eat at regular intervals.
  • Avoid pollution, allergens’, drugs that can be stopped.
  • Dialysis if required should be continued without fail.
  • Breathing exercises, strengthening exercises, endurance training, and wellbeing training should be taken as a treatment major.

Community-based rehabilitation as major management for leading a healthy life.

It is the rehabilitation program where after treating the disease the patient is trained and treated in such a way that he or she goes back to their society, culture, and family as before. This is the most important aspect of management because the quality of life matters.

It deals with training the patient for the following:

  • Toileting activities.
  • Walking with various supports and without support after transplant or any other intervention.
  • Physical fitness is brought back.
  • And the patient is trained and treated for all the activities he or she would want to do post hospital stay.