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Alkali therapy is widely accepted as a treatment for recurrent calcium stone patients with distal renal tubular acidosis (dRTA). Nine patients, five with complete and four with incomplete type of dRTA, were treated with alkali agents for more than three years; an average period of 10.8 years. In five patients, new stone formation and stone growth were completely prevented by this treatment. Among the four failed cases, three did not take enough alkali agents (in spite of our medication), and the other had recurrent urinary tract infection resulting in infectious stone formation. In conclusion, the long-term efficacy of alkali therapy for prevention of recurrent stone formation with dRTA is confirmed when the patient takes enough alkali agents and the urinary tract infection is well controlled.
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A 32-year-old woman of Fanconi syndrome with disorders of amino acid, glucose, uric acid and phosphate reabsorption system in proximal tubule and of renal acid excretion mechanism in distal tubule was reported. By the ammonium chloride loading test, urinary pH could only be decreased by 5.9, and excretion rates of NH4+ and titratable acids were 18.9 and 31.1 mEq/min, respectively. In the bicarbonate loading test, net renal reabsorption of bicarbonate was 2.86 mEq/100 ml GFR when plasma bicarbonate concentration was 29 mEq/L, and threshold of bicarbonate excretion was 24-26 mEq/L. These results suggest that hydrogen ion excretion disorder in distal tubules exists, while bicarbonate reabsorption ability in proximal tubule is normal.