Treatment of Distal Renal Tubular Acidosis in Children Under 18 Years
Distal renal tubular acidosis (dRTA) in the paediatric population requires a treatment approach calibrated to the child's age and the degree of acid–base disturbance at presentation. Different patient profiles within this age group — including infants identified through family screening and those presenting with overt acidosis — are managed according to distinct paediatric-specific considerations.
Treatment Goals
The overarching goals are to maintain plasma bicarbonate, chloride, and potassium levels, as well as urinary calcium excretion, within age-appropriate normal ranges. Achieving this supports normal growth and bone mineralisation. In infants, close interval monitoring of bicarbonate levels is used to guide early dose adjustment until a stable level is reached.
Approach
Management is built around alkali supplementation with paediatric-specific dosing. Potassium-containing alkali forms are preferred in this setting to address the concomitant electrolyte disturbance. How starting doses are selected — and how they differ across infant and older-child presentations — is detailed in the full protocol, along with dietary recommendations to minimise acid load.
References
DOI: 10.1093/ndt/gfab171
- We recommend using alkali supplementation for the treatment of dRTA.
- A usual starting dose is 2–3 mEq/kg/day.
- In infants presenting with marked acidosis (HCO3 <15 mmol/L), we recommend a starting dose of around 5 mEq/kg/day of alkali.
- For infants identified by family screening but with normal HCO3 level, a starting dose of 1–2 mEq/kg/day is likely sufficient.
- For children presenting beyond infancy, we recommend a starting dose of 2–3 mEq/kg/day.
- We do not recommend the use of growth hormone in children with dRTA, unless there is persistent growth retardation despite adequate metabolic control.