TUBULAR DISORDERS

Tubular disorders can be congenital or be the result of shock or toxins. Congenital variety tends to be associated with acidosis (renal tubular acidosis – RTA) and renal rickets.

Acute tubular necrosis has three phases:

  • Oliguric
  • Diuretic
  • Recovery phases.

The whole cycle may take a few days to weeks and some patients may never recover.

Investigations

  • Urine pH: Suggestive if it is low (<5.8).
  • Serum electrolytes: Low bicarbonate, low potassium and high chloride suggestive.
  • Specific tests of tubular function may be needed to identify the abnormality.

Management

  • For acute tubular necrosis:
    • Maintain intravascular volume.
    • Monitor urine output.
    • Correct any electrolyte or acid base disturbances.
    • Order dialysis if due to dialysable toxin.
  • For renal tubular acidosis:
    • Correct acidosis using oral sodium bicarbonate or sodium citrate.
    • Use potassium citrate if patient is hypokalaemic.
    • Give high dose vitamin D and calcium if child has rickets.
  • Refer/consult specialist as required.