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Kunchur MG, Mauch TJ, Parkanzky M, Rahilly LJ. A review of renal tubular acidosis. J Vet Emerg Crit Care (San Antonio) 2024; 34:325-355. [PMID: 39023331 DOI: 10.1111/vec.13407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 10/14/2022] [Accepted: 11/11/2022] [Indexed: 07/20/2024]
Abstract
OBJECTIVE To review the current scientific literature on renal tubular acidosis (RTA) in people and small animals, focusing on diseases in veterinary medicine that result in secondary RTA. DATA SOURCES Scientific reviews and original research publications on people and small animals focusing on RTA. SUMMARY RTA is characterized by defective renal acid-base regulation that results in normal anion gap hyperchloremic metabolic acidosis. Renal acid-base regulation includes the reabsorption and regeneration of bicarbonate in the renal proximal tubule and collecting ducts and the process of ammoniagenesis. RTA occurs as a primary genetic disorder or secondary to disease conditions. Based on pathophysiology, RTA is classified as distal or type 1 RTA, proximal or type 2 RTA, type 3 RTA or carbonic anhydrase II mutation, and type 4 or hyperkalemic RTA. Fanconi syndrome comprises proximal RTA with additional defects in proximal tubular function. Extensive research elucidating the genetic basis of RTA in people exists. RTA is a genetic disorder in the Basenji breed of dogs, where the mutation is known. Secondary RTA in human and veterinary medicine is the sequela of diseases that include immune-mediated, toxic, and infectious causes. Diagnosis and characterization of RTA include the measurement of urine pH and the evaluation of renal handling of substances that should affect acid or bicarbonate excretion. CONCLUSIONS Commonality exists between human and veterinary medicine among the types of RTA. Many genetic defects causing primary RTA are identified in people, but those in companion animals other than in the Basenji are unknown. Critically ill veterinary patients are often admitted to the ICU for diseases associated with secondary RTA, or they may develop RTA while hospitalized. Recognition and treatment of RTA may reverse tubular dysfunction and promote recovery by correcting metabolic acidosis.
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Affiliation(s)
| | - Teri Jo Mauch
- University of Nebraska Medical Center and Children's Hospital, Omaha, Nebraska, USA
- University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | | | - Louisa J Rahilly
- Cape Cod Veterinary Specialists, Buzzards Bay, Massachusetts, USA
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2
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Hassan MO, Arogundade FA, Osasan SA, Gbadegesin BA, Omotoso BA, Okunola OO, Sanusi AA, Adelusola KA, Akinola NO, Akinsola A. Clinicopathologic Study of Sickle Cell-associated Kidney Disease: A Nigerian Experience. Niger Postgrad Med J 2024; 31:53-61. [PMID: 38321797 DOI: 10.4103/npmj.npmj_213_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/02/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Improvements in sickle cell disease (SCD) care have resulted in the survival of many patients into adulthood, although this is accompanied by the increased incidence of end-organ damage, including chronic kidney disease (CKD). OBJECTIVES This study assessed the prevalence, pattern and predictors of renal dysfunction in SCD patients and investigated the associated renal histopathologic changes. METHODS We evaluated 105 patients with SCD, for proteinuria, estimated glomerular filtration rate (eGFR), and tubular dysfunction. Renal biopsy was conducted on 22 patients who qualified. Data were analysed using SPSS package version 23. RESULTS Thirty-seven (35.2%) of the 105 patients had CKD, as defined by an eGFR of 60 ml/min/1.73 m2 and/or proteinuria. The fractional excretion of potassium (FEK) was elevated in all patients, whereas the fractional excretion of sodium (FENa) was elevated in 98.1%. Glomerular filtration rate was negatively correlated with irreversible percentage sickle cell count (r = -0.616, P = 0.0001), FEK (r = -0.448, P = 0.0001) and FENa (r = -0.336, P = 0.004). Age, irreversible percentage sickle cell count, haemoglobin levels and FENa were the major predictors of CKD. The histological pattern in the 22 patients who had biopsies was consistent with mesangioproliferative glomerulonephritis 11 (50%), minimal change disease 6 (27.3%), focal segmental glomerulosclerosis 3 (13.6%) and interstitial nephritis 2 (9.1%). CONCLUSIONS CKD was prevalent in SCD patients, and it was characterised by tubular dysfunction and mesangioproliferative glomerulonephritis. The main predictors of CKD were increased age, severity of vaso-occlusive crisis, worsening anaemia and tubular dysfunction.
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Affiliation(s)
- Muzamil Olamide Hassan
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Medicine, Renal Unit, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | - Fatiu Abiola Arogundade
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Medicine, Renal Unit, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | - Stephen Adebayo Osasan
- Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Babajide A Gbadegesin
- Department of Internal Medicine, LAUTECH Teaching Hospital, Ogbomoso, Osun State, Nigeria
| | - Bolanle Aderonke Omotoso
- Department of Medicine, Renal Unit, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
- Department of Medical Pharmacology and Therapeutics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Oluyomi Oluseun Okunola
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Medicine, Renal Unit, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | - Abubakr Abefe Sanusi
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Medicine, Renal Unit, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | - Kayode A Adelusola
- Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Norah O Akinola
- Department of Haematology and Blood Transfusion, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Adewale Akinsola
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
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3
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Saraf SL, Derebail VK, Zhang X, Machado RF, Gordeuk VR, Lash JP, Little J. Hyperkalemia and Metabolic Acidosis Occur at a Higher eGFR in Sickle Cell Disease. KIDNEY360 2022; 3:608-614. [PMID: 35721605 DOI: 10.34067/kid.0006802021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/27/2022] [Indexed: 11/27/2022]
Abstract
Background People with sickle cell disease (SCD) have an elevated estimated glomerular filtration rate (eGFR) compared with the general population, and this may alter the usual creatinine-based eGFR cutoffs for which physiologic evidence of kidney dysfunction is apparent. This study aimed to identify eGFR thresholds for hyperkalemia and metabolic acidosis in patients with SCD. Methods This was a cross-sectional analysis of 733 patients with severe (hemoglobin SS or Sβ 0-thalassemia) SCD genotype, 238 patients with moderate (hemoglobin SC or Sβ +-thalassemia) SCD genotype, and 1333 age- and sex-matched African Americans from the National Health and Nutrition Examination Survey (NHANES). The prevalence rates of hyperkalemia and metabolic acidosis were compared by eGFR category. Cutoffs for hyperkalemia and metabolic acidosis were determined using generalized additive models. Results Hyperkalemia and metabolic acidosis were more common in those with severe SCD genotype (13% and 21%, respectively) compared with the NHANES (0.3% and 5%, respectively); the prevalence rates in the moderate SCD genotype were intermediate for hyperkalemia (3%) and metabolic acidosis (11%). The proportion of patients with hyperkalemia and metabolic acidosis progressively increased with lower eGFR category in both SCD genotype groups. The eGFR thresholds for hyperkalemia and metabolic acidosis were higher in the severe (85 and 91 ml/min per 1.73 m2, respectively) and moderate (52 and 102 ml/min per 1.73 m2, respectively) SCD genotypes compared with the NHANES (34 and 46 ml/min per 1.73 m2). Conclusions We demonstrate that hyperkalemia and metabolic acidosis are more common and occur at higher eGFR values in patients with SCD compared with age- and sex-matched African Americans, including in eGFR ranges considered to be normal. Future studies using redefined creatinine-based eGFR thresholds for abnormal kidney function may identify high-risk patients for earlier intervention strategies and referral for specialized renal care in SCD.
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Affiliation(s)
- Santosh L Saraf
- Department of Medicine, Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, Illinois
| | - Vimal K Derebail
- Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Xu Zhang
- Department of Medicine, Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, Illinois
| | - Roberto F Machado
- Department of Medicine, Division of Pulmonary Medicine, University of Indiana, Indianapolis, Indiana
| | - Victor R Gordeuk
- Department of Medicine, Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, Illinois
| | - James P Lash
- Department of Medicine, Division of Nephrology, University of Illinois at Chicago, Chicago, Illinois
| | - Jane Little
- Department of Medicine, Division of Hematology & Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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4
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Cazenave M, Audard V, Bertocchio JP, Habibi A, Baron S, Prot-Bertoye C, Berkenou J, Maruani G, Stehlé T, Cornière N, Ayari H, Friedlander G, Galacteros F, Houillier P, Bartolucci P, Courbebaisse M. Tubular Acidification Defect in Adults with Sickle Cell Disease. Clin J Am Soc Nephrol 2020; 15:16-24. [PMID: 31822527 PMCID: PMC6946065 DOI: 10.2215/cjn.07830719] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/29/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Metabolic acidosis is a frequent manifestation of sickle cell disease but the mechanisms and determinants of this disorder are unknown. Our aim was to characterize urinary acidification capacity in adults with sickle cell disease and to identify potential factors associated with decreased capacity to acidify urine. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Among 25 adults with sickle cell disease and an eGFR of ≥60 ml/min per 1.73 m2 from a single center in France, we performed an acute acidification test after simultaneous administration of furosemide and fludrocortisone. A normal response was defined as a decrease in urinary pH <5.3 and an increase in urinary ammonium excretion ≥33 µEq/min at one or more of the six time points after furosemide and fludrocortisone administration. RESULTS Of the participants (median [interquartile range] age of 36 [24-43] years old, 17 women), 12 had a normal and 13 had an abnormal response to the test. Among these 13 participants, nine had normal baseline plasma bicarbonate concentration. Plasma aldosterone was within the normal range for all 13 participants with an abnormal response, making the diagnosis of type 4 tubular acidosis unlikely. The participants with an abnormal response to the test were significantly older, more frequently treated with oral bicarbonate, had a higher plasma uric acid concentration, higher hemolysis activity, lower eGFR, lower baseline plasma bicarbonate concentration, higher urine pH, lower urine ammonium ion excretion, and lower fasting urine osmolality than those with a normal response. Considering both groups, the maximum urinary ammonium ion excretion was positively correlated with fasting urine osmolality (r 2=0.34, P=0.002), suggesting that participants with sickle cell disease and lower urine concentration capacity have lower urine acidification capacity. CONCLUSIONS Among adults with sickle cell disease, impaired urinary acidification capacity attributable to distal tubular dysfunction is common and associated with the severity of hyposthenuria. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_12_10_CJN07830719.mp3.
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Affiliation(s)
- Maud Cazenave
- Nephrology and Renal Transplantation Department, Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Vincent Audard
- Nephrology and Renal Transplantation Department, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Henri Mondor Hospital, AP-HP, Paris Est Créteil University, Créteil, France
| | - Jean-Philippe Bertocchio
- Physiology Department, European Georges Pompidou University Hospital, AP-HP, Paris Descartes University, INSERM U1138, Centre National de la Recherche Scientifique (CNRS) ERL8228, Paris, France
| | - Anoosha Habibi
- Sickle Cell Referral Center, Internal Medicine Unit, IMRB team 2, UPEC, Labex GRex, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Stéphanie Baron
- Physiology Department, European Georges Pompidou University Hospital, AP-HP, Paris Descartes University, INSERM U1138, Centre National de la Recherche Scientifique (CNRS) ERL8228, Paris, France
| | - Caroline Prot-Bertoye
- Physiology Department, European Georges Pompidou University Hospital, AP-HP, Paris Descartes University, INSERM U1138, Centre National de la Recherche Scientifique (CNRS) ERL8228, Paris, France
| | - Jugurtha Berkenou
- Sickle Cell Referral Center, Internal Medicine Unit, IMRB team 2, UPEC, Labex GRex, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Gérard Maruani
- Physiology Department, European Georges Pompidou University Hospital, AP-HP, Paris Descartes University, Necker-Enfants Malades Institute, INSERM U1151-CNRS UMR8253, Paris, France; and
| | - Thomas Stehlé
- Nephrology and Renal Transplantation Department, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Henri Mondor Hospital, AP-HP, Paris Est Créteil University, Créteil, France
| | - Nicolas Cornière
- Nephrology Department, Felix Guyon Hospital, Saint-Denis, Réunion Island, France
| | - Hamza Ayari
- Physiology Department, European Georges Pompidou University Hospital, AP-HP, Paris Descartes University, INSERM U1138, Centre National de la Recherche Scientifique (CNRS) ERL8228, Paris, France
| | - Gérard Friedlander
- Physiology Department, European Georges Pompidou University Hospital, AP-HP, Paris Descartes University, Necker-Enfants Malades Institute, INSERM U1151-CNRS UMR8253, Paris, France; and
| | - Frédéric Galacteros
- Sickle Cell Referral Center, Internal Medicine Unit, IMRB team 2, UPEC, Labex GRex, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Pascal Houillier
- Physiology Department, European Georges Pompidou University Hospital, AP-HP, Paris Descartes University, INSERM U1138, Centre National de la Recherche Scientifique (CNRS) ERL8228, Paris, France
| | - Pablo Bartolucci
- Sickle Cell Referral Center, Internal Medicine Unit, IMRB team 2, UPEC, Labex GRex, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Marie Courbebaisse
- Physiology Department, European Georges Pompidou University Hospital, AP-HP, Paris Descartes University, Necker-Enfants Malades Institute, INSERM U1151-CNRS UMR8253, Paris, France; and
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5
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Antwi-Boasiako C, Kusi-Mensah YA, Hayfron-Benjamin C, Aryee R, Dankwah GB, Abla KL, Owusu Darkwa E, Botchway FA, Sampene-Donkor E. Serum Potassium, Sodium, and Chloride Levels in Sickle Cell Disease Patients and Healthy Controls: A Case-Control Study at Korle-Bu Teaching Hospital, Accra. Biomark Insights 2019; 14:1177271919873889. [PMID: 31523130 PMCID: PMC6728659 DOI: 10.1177/1177271919873889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 11/21/2022] Open
Abstract
The activity of Na+-K+ ATPase is altered in sickle cell
disease (SCD), which affects serum electrolyte levels. This alteration is
associated with several complications in sickle cell patients. This study
evaluated the serum levels of sodium, potassium, and chloride in patients with
SCD. The study was a case-control cross-sectional study involving 120 SCD
patients in the steady state and 48 ‘healthy’ controls. The SCD patients were
made up of 69 HbSS patients and 41 HbSC patients. Serum electrolyte levels
(Na+, K+, and Cl−) were measured using a
Flame Atomic Absorption Spectrometer (Variant 240FS; Varian Australia Pty Ltd).
Serum sodium levels were significantly lower in the sickle cell patients,
compared with their ‘healthy’ counterparts (P = .0001).
Although the study found significantly higher serum levels of potassium in the
SCD patients (P = .0001), there was no significant difference
in serum chloride levels between patients with SCD and the controls
(P = .098). Serum sodium and chloride levels were not
significantly different in both HbSS and HbSC patients
(P = .197 and P = .553, respectively). The
level of serum potassium in the HbSS patients was, however, significantly higher
compared with those with the HbSC genotype (P = .0001). There
is higher efflux of K+ from the intracellular into the extracellular
space in HbSS patients, which may lead to red cell membrane dysfunction and
associated complications.
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Affiliation(s)
- Charles Antwi-Boasiako
- Department of Physiology, School of
Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
- Charles Antwi-Boasiako, Department of
Physiology, School of Biomedical and Allied Health Sciences, College of Health
Sciences, University of Ghana, P.O. Box 143, Korle-Bu, Accra 00233, Ghana.
| | - Yaw A Kusi-Mensah
- Department of Physiology, School of
Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
- Department of Anaesthesia, School of
Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Charles Hayfron-Benjamin
- Department of Physiology, School of
Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
- Department of Anaesthesia, School of
Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Robert Aryee
- Department of Physiology, School of
Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Gifty Boatemaah Dankwah
- Department of Physiology, School of
Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Kwawukume Lim Abla
- Department of Physiology, School of
Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
- Department of Internal Medicine,
Korle-Bu Teaching Hospital, Accra, Ghana
| | - Ebenezer Owusu Darkwa
- Department of Anaesthesia, School of
Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Felix Abekah Botchway
- Department of Chemical Pathology, School
of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Eric Sampene-Donkor
- Department of Medical Microbiology,
School of Biomedical and Allied Health Sciences, University of Ghana, Accra,
Ghana
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Proteinuria in adults with sickle-cell disease: the role of hydroxycarbamide(hydroxyurea) as a protective agent. Int J Clin Pharm 2014; 36:766-70. [DOI: 10.1007/s11096-014-9955-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 04/30/2014] [Indexed: 01/13/2023]
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