Common RTAs - Pediatric Oncall

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Question
My 4 year old niece has a kidney stone that is 3 to 4 cm. The doctor tried to break it up with lasers to no avail. They have also told her parents that the stone is due to Renal Tubular Acidosis. Is it possible the RTA is a result of the kidney stone or is the kidney stone a result of the RTA? What is the best treatment for her at this time? Is it best to treat the stone first? Please let me know as much information about this you can. I need to help my brother understand what he and his family are about to face. Thank you.
Answer
The 2 common RTAs are distal and proximal. Distal RTA is associated with calcification in the kidneys and stones. Sometimes, excessive calcium and Vitamin D intake (in toxic doses) can lead to calcification in the kidneys and can lead to RTA. Thus if there is a history of excessive intake of calcium, it would not be possible to say what came first - the RTA or the stone. Regarding the stone, one first has to determine the type of the stone i.e. calcium stone, oxalate stone and uric acid stone. 24 hours urine for calcium, oxalate and uric acid would be required. Treatment would depend on the type of stone. If the stone is too large and obstructing the flow of the urine from the kidney, it would required to be removed. Lithotripsy of surgery would be the best option for such as large stone. For further information read the articles on "RENAL STONE" and "RENAL TUBULAR ACIDOSIS" on www.pediatriconcall.com or from the link given below: http://www.pediatriconcall.com/forpatients/CommonChild/Kidney_problems/ Urinary_renal.asp http://www.pediatriconcall.com/forpatients/CommonChild/Kidney_problems/ renal_tubular.asp Back to All Questions

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