If the RTA is related to another illness, such as lupus or Sjogren's disease, treatment of the underlying disease may improve the acidosis. RTA caused by medications may require cessation of the offending drug.12 Type 4 RTA may require treatment with steroid hormones (such as fludrocortisone or Florinef) to act in place of the deficient aldosterone.
Potassium supplementation may be required for patients with associated low potassium, while potassium lowering treatments may be needed in patients with high potassium. Regardless of the treatment regimen, adherence to therapy is critical to prevent the complications of prolonged RTA. For example, kidney stone formation, if uncontrolled, can eventually lead to chronic kidney failure requiring dialysis.
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Alkali therapy is the mainstay of treatment in all forms of
RTA. High doses are required (10-20meq/kg/day) due to urinary loss. Treatment
worsens hypokalemia and K+ supplement required. Treatment will result in bicarbonaturia
and high urine pH. If hyperkalemic distal RTA is due to mineralocorticoid
deficiency, fludrocortisone can be given unless it is contraindicated due to
the presence of fluid overload or uncontrolled hypertension.
How RTA is treated depends on what's causing it. If it's a
reaction to a certain drug, treatment may involve stopping use of the drug or
changing the dosage. If an underlying disease or other condition is causing
RTA, it will be treated until that condition resolves. Urocit-K (Potassium
Citrate) extended-release tablets for oral use had been approved in the U.S. in
1985 for the for the management of Renal tubular acidosis (RTA) with calcium
stones.
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