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