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Proximal renal tubular acidosis with and without Fanconi syndrome

Proximal renal tubular acidosis (RTA) is caused by a defect in bicarbonate (HCO(3)(−)) reabsorption in the kidney proximal convoluted tubule. It usually manifests as normal anion-gap metabolic acidosis due to HCO(3)(−) wastage. In a normal kidney, the thick ascending limb of Henle’s loop and more di...

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Autores principales: Kashoor, Ibrahim, Batlle, Daniel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Society of Nephrology 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6727890/
https://www.ncbi.nlm.nih.gov/pubmed/31474092
http://dx.doi.org/10.23876/j.krcp.19.056
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author Kashoor, Ibrahim
Batlle, Daniel
author_facet Kashoor, Ibrahim
Batlle, Daniel
author_sort Kashoor, Ibrahim
collection PubMed
description Proximal renal tubular acidosis (RTA) is caused by a defect in bicarbonate (HCO(3)(−)) reabsorption in the kidney proximal convoluted tubule. It usually manifests as normal anion-gap metabolic acidosis due to HCO(3)(−) wastage. In a normal kidney, the thick ascending limb of Henle’s loop and more distal nephron segments reclaim all of the HCO(3)(−) not absorbed by the proximal tubule. Bicarbonate wastage seen in type II RTA indicates that the proximal tubular defect is severe enough to overwhelm the capacity for HCO(3)(−) reabsorption beyond the proximal tubule. Proximal RTA can occur as an isolated syndrome or with other impairments in proximal tubular functions under the spectrum of Fanconi syndrome. Fanconi syndrome, which is characterized by a defect in proximal tubular reabsorption of glucose, amino acids, uric acid, phosphate, and HCO(3)(−), can occur due to inherited or acquired causes. Primary inherited Fanconi syndrome is caused by a mutation in the sodium-phosphate cotransporter (NaP(i)-II) in the proximal tubule. Recent studies have identified new causes of Fanconi syndrome due to mutations in the EHHADH and the HNF4A genes. Fanconi syndrome can also be one of many manifestations of various inherited systemic diseases, such as cystinosis. Many of the acquired causes of Fanconi syndrome with or without proximal RTA are drug-induced, with the list of causative agents increasing as newer drugs are introduced for clinical use, mainly in the oncology field.
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spelling pubmed-67278902019-09-09 Proximal renal tubular acidosis with and without Fanconi syndrome Kashoor, Ibrahim Batlle, Daniel Kidney Res Clin Pract Review Article Proximal renal tubular acidosis (RTA) is caused by a defect in bicarbonate (HCO(3)(−)) reabsorption in the kidney proximal convoluted tubule. It usually manifests as normal anion-gap metabolic acidosis due to HCO(3)(−) wastage. In a normal kidney, the thick ascending limb of Henle’s loop and more distal nephron segments reclaim all of the HCO(3)(−) not absorbed by the proximal tubule. Bicarbonate wastage seen in type II RTA indicates that the proximal tubular defect is severe enough to overwhelm the capacity for HCO(3)(−) reabsorption beyond the proximal tubule. Proximal RTA can occur as an isolated syndrome or with other impairments in proximal tubular functions under the spectrum of Fanconi syndrome. Fanconi syndrome, which is characterized by a defect in proximal tubular reabsorption of glucose, amino acids, uric acid, phosphate, and HCO(3)(−), can occur due to inherited or acquired causes. Primary inherited Fanconi syndrome is caused by a mutation in the sodium-phosphate cotransporter (NaP(i)-II) in the proximal tubule. Recent studies have identified new causes of Fanconi syndrome due to mutations in the EHHADH and the HNF4A genes. Fanconi syndrome can also be one of many manifestations of various inherited systemic diseases, such as cystinosis. Many of the acquired causes of Fanconi syndrome with or without proximal RTA are drug-induced, with the list of causative agents increasing as newer drugs are introduced for clinical use, mainly in the oncology field. Korean Society of Nephrology 2019-09 2019-09-30 /pmc/articles/PMC6727890/ /pubmed/31474092 http://dx.doi.org/10.23876/j.krcp.19.056 Text en Copyright © 2019 by The Korean Society of Nephrology This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
Kashoor, Ibrahim
Batlle, Daniel
Proximal renal tubular acidosis with and without Fanconi syndrome
title Proximal renal tubular acidosis with and without Fanconi syndrome
title_full Proximal renal tubular acidosis with and without Fanconi syndrome
title_fullStr Proximal renal tubular acidosis with and without Fanconi syndrome
title_full_unstemmed Proximal renal tubular acidosis with and without Fanconi syndrome
title_short Proximal renal tubular acidosis with and without Fanconi syndrome
title_sort proximal renal tubular acidosis with and without fanconi syndrome
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6727890/
https://www.ncbi.nlm.nih.gov/pubmed/31474092
http://dx.doi.org/10.23876/j.krcp.19.056
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