Q) How should a patient with RTA be monitored on follow up? How often should he be followed up?
A) Initially after starting oral soda- bicarb, the dose should be adjusted to correct acidosis by examining blood for HCO₃ and blood pH and serum potassium if required every week till the lab tests reach normal values. Then onwards once in 2-3 months is enough. Monitoring of weight & height are important to assess clinical improvement. There is an impressive improvement in appetite, activity etc within few days of treatment.

Q) Can RTA be cured? What are its causes?
A) RTA in children in majority of cases is congenital (from birth) and can be inherited as recessive or dominant trait. Hence it needs life long treatment with oral alkali therapy. A small number of cases are acquired due to drugs like outdated tetracyclines, heavy metals, amphotericin B or diseases like medullary sponge kidney etc and withdrawal of the causative agent can result in cure.

Q) Can the patient eventually go into chronic renal failure?
A) Chronic renal failure can occur in distal RTA due to tubulointerstial damage caused by nephrocalcinosis / nephrolithiasis.

Q) Can omitting acidic foods in diet help the patient?
A) No dietetic manipulation helps the patient.

Q) How do you prevent it from occurring in the next sibling?
A) Inherited form of RTA is known to occur in brothers/sisters. Prenatal diagnosis is not possible. Early detection in siblings and early institution of alkali therapy are the only measures to prevent complications of RTA.

Q) What is the prognosis of a child with RTA?
A) Prognosis of a child with RTA is good if diagnosis made below 1-2 years and continuous oral alkali therapy with good monitoring is followed. Use of calcium and Vit D are responsible for nephrocalcinosis and accelerated tubulointerstitial damage. Short stature and bony deformities are the sequelae with which many children with RTA are left with eventually.

Last updated on 14-03-2001