Sri Kesumaastuti,Hertanti Indah Lestari,Eka Intan Fitriana
Departement of Child Health Faculty of Medicine of Sriwijaya University Moh Hoesin Hospital Palembang
Background : The renal tubule plays an important role in fluid and electrolyte homeostasis. Diagnosis of renal tubular disorders is often too late because of the unspecific clinical symptoms. Early diagnosis and prompt therapeutic interventions can improve overall clinical outcome. Knowledge about their natural history is particularly important. The aim of this study to describe profile of renal tubular disorders.
Material : This study was a descriptive study of children with renal tubular disorders treated in pediatric ward of Mohammad Hoesin Hospital from January 2015 to March 2018. Data were obtained from medical record.
Results : There were 16 children with renal tubular disorders from 579 hospitalized nephrology disorders; two were excluded because of incomplete data. Seven of 14 subjects were boys. The disorders encountered were Bartter syndrome in 8/14 and renal tubular acidosis (RTA) in 6/14. The median age at diagnosis for RTA was 7.3 (range 2-14) years, for Bartter syndrome 14.1 (range 8-17) years. The clinical presentations were paresis in 9/14, short stature in 7/14, vomiting in 4/14 and polyuria in 2/14. Failure to thrive was the presenting feature in 100% of children under 5 years with RTA. Eight subjects had initial presentation of wasted, five subjects severely wasted and one subject well nourished. Three patients were initially diagnosed as dyspepsia and other three were admitted because of paresis that was consulted to nephrology because of refractory electrolyte disturbances. Laboratory features of children with RTA were normal anion gap hyperchloremic metabolic acidosis with HCO3? value between 12-19.3 mmol/L, five of 6 children had hypokalemia and 1/6 children with hyperkalemia. All patients with Bartter syndrome showed hypokalemic metabolic alkalosis with HCO3? value between 26.9-39.7 mmol/L.
Conclusions : Tubular dysfunction should be considered in children with paresis, vomiting, polyuria, electrolyte disturbances accompanied by short stature, failure to thrive, metabolic acidosis and metabolic alkalosis.
Keywords: renal tubular disorders paresis short stature electrolyte disturbances
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