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Proximal renal tubular acidosis

MedGen UID:
82804
Concept ID:
C0268435
Disease or Syndrome
Synonyms: RTA, PROXIMAL TYPE; RTA, RATE TYPE
SNOMED CT: Proximal renal tubular acidosis (24790002); Renal tubular acidosis, type 2 (24790002); Bicarbonate reabsorption defect (24790002); Renal tubular acidosis, rate type (24790002); Type II renal tubular acidosis (24790002); RTA (renal tubular acidosis) type II (24790002)
Modes of inheritance:
Autosomal recessive inheritance
MedGen UID:
141025
Concept ID:
C0441748
Intellectual Product
Source: Orphanet
A mode of inheritance that is observed for traits related to a gene encoded on one of the autosomes (i.e., the human chromosomes 1-22) in which a trait manifests in individuals with two pathogenic alleles, either homozygotes (two copies of the same mutant allele) or compound heterozygotes (whereby each copy of a gene has a distinct mutant allele).
Autosomal dominant inheritance
MedGen UID:
141047
Concept ID:
C0443147
Intellectual Product
Source: Orphanet
A mode of inheritance that is observed for traits related to a gene encoded on one of the autosomes (i.e., the human chromosomes 1-22) in which a trait manifests in heterozygotes. In the context of medical genetics, an autosomal dominant disorder is caused when a single copy of the mutant allele is present. Males and females are affected equally, and can both transmit the disorder with a risk of 50% for each child of inheriting the mutant allele.
Not genetically inherited
MedGen UID:
988794
Concept ID:
CN307044
Finding
Source: Orphanet
clinical entity without genetic inheritance.
 
HPO: HP:0002049
Monarch Initiative: MONDO:0008369
OMIM®: 179830
Orphanet: ORPHA47159

Definition

A type of renal tubular acidosis characterized by a failure of the proximal tubular cells to reabsorb bicarbonate, leading to urinary bicarbonate wasting and subsequent acidemia. [from HPO]

Clinical features

From HPO
Hypercalciuria
MedGen UID:
43775
Concept ID:
C0020438
Finding
Abnormally high level of calcium in the urine.
Short stature
MedGen UID:
87607
Concept ID:
C0349588
Finding
A height below that which is expected according to age and gender norms. Although there is no universally accepted definition of short stature, many refer to "short stature" as height more than 2 standard deviations below the mean for age and gender (or below the 3rd percentile for age and gender dependent norms).
Osteomalacia
MedGen UID:
14533
Concept ID:
C0029442
Disease or Syndrome
Osteomalacia is a general term for bone weakness owing to a defect in mineralization of the protein framework known as osteoid. This defective mineralization is mainly caused by lack in vitamin D. Osteomalacia in children is known as rickets.
Rickets
MedGen UID:
48470
Concept ID:
C0035579
Disease or Syndrome
Rickets is divided into two major categories including calcipenic and phosphopenic. Hypophosphatemia is described as a common manifestation of both categories. Hypophosphatemic rickets is the most common type of rickets that is characterized by low levels of serum phosphate, resistance to ultraviolet radiation or vitamin D intake. There are several issues involved in hypophosphatemic rickets such as calcium, vitamin D, phosphorus deficiencies. Moreover, other disorder can be associated with its occurrence such as absorption defects due to pancreatic, intestinal, gastric, and renal disorders and hepatobiliary disease. Symptoms are usually seen in childhood and can be varied in severity. Severe forms may be linked to bowing of the legs, poor bone growth, and short stature as well as joint and bone pain. Hypophosphatemic rickets are associated with renal excretion of phosphate, hypophosphatemia, and mineral defects in bones. The familial type of the disease is the most common type of rickets.
Hyperchloremic acidosis
MedGen UID:
43207
Concept ID:
C0085569
Disease or Syndrome
Acidosis (pH less than 7.35) that develops with an increase in ionic chloride.
Proximal renal tubular acidosis
MedGen UID:
82804
Concept ID:
C0268435
Disease or Syndrome
A type of renal tubular acidosis characterized by a failure of the proximal tubular cells to reabsorb bicarbonate, leading to urinary bicarbonate wasting and subsequent acidemia.
Elevated circulating creatinine concentration
MedGen UID:
148579
Concept ID:
C0700225
Finding
An increased amount of creatinine in the blood.

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVProximal renal tubular acidosis

Conditions with this feature

Hereditary fructosuria
MedGen UID:
42105
Concept ID:
C0016751
Disease or Syndrome
Following dietary exposure to fructose, sucrose, or sorbitol, untreated hereditary fructose intolerance (HFI) is characterized by metabolic disturbances (hypoglycemia, lactic acidemia, hypophosphatemia, hyperuricemia, hypermagnesemia, hyperalaninemia) and clinical findings (nausea, vomiting, and abdominal distress; chronic growth restriction / failure to thrive). While untreated HFI typically first manifested when fructose- and sucrose-containing foods were introduced in the course of weaning young infants from breast milk, it is now presenting earlier, due to the addition of fructose-containing nutrients in infant formulas. If the infant ingests large quantities of fructose, the infant may acutely develop lethargy, seizures, and/or progressive coma. Untreated HFI may result in renal and hepatic failure. If identified and treated before permanent organ injury occurs, individuals with HFI can experience a normal quality of life and life expectancy.
Lowe syndrome
MedGen UID:
18145
Concept ID:
C0028860
Disease or Syndrome
Lowe syndrome (oculocerebrorenal syndrome) is characterized by involvement of the eyes, central nervous system, and kidneys. Dense congenital cataracts are found in all affected boys and infantile glaucoma in approximately 50%. All boys have impaired vision; corrected acuity is rarely better than 20/100. Generalized hypotonia is noted at birth and is of central (brain) origin. Deep tendon reflexes are usually absent. Hypotonia may slowly improve with age, but normal motor tone and strength are never achieved. Motor milestones are delayed. Almost all affected males have some degree of intellectual disability; 10%-25% function in the low-normal or borderline range, approximately 25% in the mild-to-moderate range, and 50%-65% in the severe-to-profound range of intellectual disability. Affected males have varying degrees of proximal renal tubular dysfunction of the Fanconi type, including low molecular-weight (LMW) proteinuria, aminoaciduria, bicarbonate wasting and renal tubular acidosis, phosphaturia with hypophosphatemia and renal rickets, hypercalciuria, sodium and potassium wasting, and polyuria. The features of symptomatic Fanconi syndrome do not usually become manifest until after the first few months of life, except for LMW proteinuria. Glomerulosclerosis associated with chronic tubular injury usually results in slowly progressive chronic renal failure and end-stage renal disease between the second and fourth decades of life.
Pyruvate carboxylase deficiency
MedGen UID:
18801
Concept ID:
C0034341
Disease or Syndrome
Pyruvate carboxylase (PC) deficiency is characterized in most affected individuals by failure to thrive, developmental delay, recurrent seizures, and metabolic acidosis. Three clinical types are recognized: Type A (infantile form), in which most affected children die in infancy or early childhood. Type B (severe neonatal form), in which affected infants have hepatomegaly, pyramidal tract signs, and abnormal movement and die within the first three months of life. Type C (intermittent/benign form), in which affected individuals have normal or mildly delayed neurologic development and episodic metabolic acidosis.
Proximal renal tubular acidosis
MedGen UID:
82804
Concept ID:
C0268435
Disease or Syndrome
A type of renal tubular acidosis characterized by a failure of the proximal tubular cells to reabsorb bicarbonate, leading to urinary bicarbonate wasting and subsequent acidemia.
Hypoparathyroidism, deafness, renal disease syndrome
MedGen UID:
374443
Concept ID:
C1840333
Disease or Syndrome
HDR syndrome (HDRS), also known as Barakat syndrome, is a heterogeneous disorder characterized by the triad of Hypoparathyroidism (H), nerve Deafness (D) and/or Renal disease (R). Variable clinical features include hypogonadotrophic hypogonadism, polycystic ovaries, congenital heart disease, retinitis pigmentosa, and cognitive disability (Barakat et al., 2018).
Cleft palate-large ears-small head syndrome
MedGen UID:
357895
Concept ID:
C1867023
Disease or Syndrome
A rare genetic syndrome with characteristics of cleft palate, large protruding ears, microcephaly and short stature (prenatal onset). Other skeletal abnormalities (delayed bone age, distally tapering fingers, hypoplastic distal phalanges, proximally placed thumbs, fifth finger clinodactyly), Pierre Robin sequence, cystic renal dysplasia, proximal renal tubular acidosis, hypospadia, cerebral anomalies on imaging (enlargement of lateral ventricles, mild cortical atrophy), seizures, hypotonia and developmental delay are also observed.
Autosomal recessive proximal renal tubular acidosis
MedGen UID:
370883
Concept ID:
C1970309
Disease or Syndrome
A rare autosomal recessive form of proximal renal tubular acidosis characterized by an isolated defect in the proximal tubule leading to the decreased reabsorption of bicarbonate and consequentially to urinary bicarbonate wastage. Presentation is typically with hyperchloremic acidosis, usually occurring in childhood. Extrarenal manifestations include ocular abnormalities (band keratopathy, glaucoma, and cataracts), intellectual disability and severe growth retardation. Other features like dental enamel defects, basal ganglia calcification and pancreatitis are sometimes present.
Mitochondrial complex III deficiency nuclear type 7
MedGen UID:
862845
Concept ID:
C4014408
Disease or Syndrome
Any mitochondrial complex III deficiency in which the cause of the disease is a mutation in the UQCC2 gene.

Professional guidelines

PubMed

Palmer BF, Kelepouris E, Clegg DJ
Adv Ther 2021 Feb;38(2):949-968. Epub 2020 Dec 26 doi: 10.1007/s12325-020-01587-5. PMID: 33367987Free PMC Article

Recent clinical studies

Etiology

Thakare SB, Jamale TE, Memon SS
Best Pract Res Clin Endocrinol Metab 2024 Mar;38(2):101839. Epub 2023 Nov 10 doi: 10.1016/j.beem.2023.101839. PMID: 38007379
Ramponi G, Folci M, Badalamenti S, Angelini C, Brunetta E
Front Immunol 2020;11:562101. Epub 2020 Sep 17 doi: 10.3389/fimmu.2020.562101. PMID: 33042142Free PMC Article
Alexander RT, Bitzan M
Pediatr Clin North Am 2019 Feb;66(1):135-157. doi: 10.1016/j.pcl.2018.08.011. PMID: 30454739
Finer G, Landau D
Adv Chronic Kidney Dis 2018 Jul;25(4):351-357. doi: 10.1053/j.ackd.2018.05.006. PMID: 30139461
Ram R, Swarnalatha G, Dakshinamurty KV
Am J Nephrol 2014;40(2):123-30. Epub 2014 Aug 20 doi: 10.1159/000365199. PMID: 25171149

Diagnosis

Palmer BF, Kelepouris E, Clegg DJ
Adv Ther 2021 Feb;38(2):949-968. Epub 2020 Dec 26 doi: 10.1007/s12325-020-01587-5. PMID: 33367987Free PMC Article
Alexander RT, Bitzan M
Pediatr Clin North Am 2019 Feb;66(1):135-157. doi: 10.1016/j.pcl.2018.08.011. PMID: 30454739
Finer G, Landau D
Adv Chronic Kidney Dis 2018 Jul;25(4):351-357. doi: 10.1053/j.ackd.2018.05.006. PMID: 30139461
Kitterer D, Schwab M, Alscher MD, Braun N, Latus J
Pediatr Nephrol 2015 Sep;30(9):1407-23. Epub 2014 Nov 5 doi: 10.1007/s00467-014-2958-5. PMID: 25370778
Alon US
Curr Opin Pediatr 1997 Apr;9(2):160-5. PMID: 9204244

Therapy

Kumar B, Prabhakar R, Thangavelu S
J R Coll Physicians Edinb 2020 Sep;50(3):291-294. doi: 10.4997/JRCPE.2020.316. PMID: 32936106
Perrone D, Afridi F, King-Morris K, Komarla A, Kar P
Am J Kidney Dis 2017 Nov;70(5):729-731. Epub 2017 Aug 18 doi: 10.1053/j.ajkd.2017.06.021. PMID: 28823583
Skinner R
Med Pediatr Oncol 2003 Sep;41(3):190-7. doi: 10.1002/mpo.10336. PMID: 12868118
Alon US
Curr Opin Pediatr 1997 Apr;9(2):160-5. PMID: 9204244
Huguenin M, Schacht R, David R
Arch Dis Child 1974 Dec;49(12):955-9. doi: 10.1136/adc.49.12.955. PMID: 4374899Free PMC Article

Prognosis

Cherif A, Maheshwari V, Fuertinger D, Schappacher-Tilp G, Preciado P, Bushinsky D, Thijssen S, Kotanko P
Math Biosci Eng 2020 Jun 23;17(5):4457-4476. doi: 10.3934/mbe.2020246. PMID: 33120513
Kumar B, Prabhakar R, Thangavelu S
J R Coll Physicians Edinb 2020 Sep;50(3):291-294. doi: 10.4997/JRCPE.2020.316. PMID: 32936106
Iacobelli S, Guignard JP
Pediatr Nephrol 2020 Feb;35(2):221-228. Epub 2018 Nov 19 doi: 10.1007/s00467-018-4142-9. PMID: 30456666
Alexander RT, Bitzan M
Pediatr Clin North Am 2019 Feb;66(1):135-157. doi: 10.1016/j.pcl.2018.08.011. PMID: 30454739
Skinner R
Med Pediatr Oncol 2003 Sep;41(3):190-7. doi: 10.1002/mpo.10336. PMID: 12868118

Clinical prediction guides

Kumagai N, Kondoh T, Matsumoto Y, Ikezumi Y
Tohoku J Exp Med 2022 May 28;257(1):73-76. Epub 2022 Mar 31 doi: 10.1620/tjem.2022.J015. PMID: 35354692
Kantaputra P, Guven Y, Aksu B, Kalayci T, Doğan C, Intachai W, Olsen B, Tongsima S, Ngamphiw C, Noppakun K
J Am Dent Assoc 2022 Jul;153(7):668-676. Epub 2022 Mar 5 doi: 10.1016/j.adaj.2021.12.009. PMID: 35260236
Palmer BF, Kelepouris E, Clegg DJ
Adv Ther 2021 Feb;38(2):949-968. Epub 2020 Dec 26 doi: 10.1007/s12325-020-01587-5. PMID: 33367987Free PMC Article
Ramponi G, Folci M, Badalamenti S, Angelini C, Brunetta E
Front Immunol 2020;11:562101. Epub 2020 Sep 17 doi: 10.3389/fimmu.2020.562101. PMID: 33042142Free PMC Article
Iacobelli S, Guignard JP
Pediatr Nephrol 2020 Feb;35(2):221-228. Epub 2018 Nov 19 doi: 10.1007/s00467-018-4142-9. PMID: 30456666

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