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Type 3 renal tubular acidosis associated with growth hormone deficiency

  • Yin Ping Liew , Timothy A. Rogers , Jane L. Garb , Holley F. Allen , Edward O. Reiter , Thomas J. Campfield , Vikas R. Dharnidharka and Gregory L. Braden EMAIL logo
Published/Copyright: September 9, 2017
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 30 Issue 10

Abstract

Background:

We identified two boys with type 3 renal tubular acidosis (RTA) and growth hormone deficiency and we sought to differentiate them from children with classic type 1 distal RTA.

Methods:

We reviewed all children <6 years of age with RTA referred over a 13-year period and compared the growth response to alkali therapy in these two boys and in 28 children with only type 1 distal RTA.

Results:

All children with type 1 RTA reached the 5th percentile or higher on CDC growth charts within 2 years of alkali therapy. Their mean height standard deviation score (SDS) improved from −1.4 to −0.6 SDS and their mean mid-parental height (MPH) SDS improved from −0.6 to 0 SDS after 2 years. In contrast, the boys with growth hormone deficiency had a height SDS of −1.4 and −2.4 SDS after 2 years of alkali and the MPH SDS were both −2.6 SDS after 2 years of alkali therapy. Growth hormone therapy accelerated their growth to normal levels and led to long-term correction of RTA.

Conclusions:

A child with type 1 RTA whose height response after 2 years of alkali therapy is inadequate should undergo provocative growth hormone testing.

Keywords: growth hormone deficiency; renal tubular acidosis
Corresponding author: Gregory L. Braden, MD, Chief, Department of Medicine, Renal Division, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, USA, Phone: +413-567-7864/413-733-0010, Fax: +413-417-2978

Acknowledgments

We thank Debbie Bibeau and then Cheyenne Ferro for their assistance in typing this manuscript and we thank Maureen Sullivan for developing the figures.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. Morris RC Jr. Renal tubular acidosis: mechanisms, classification, and implications. N Engl J Med 1969;281:1405–13.10.1056/NEJM196912182812508Search in Google Scholar PubMed

2. Rodriguez-Soriano J, Vallo A, Garcia-Fuentes M. Distal renal tubular acidosis in infancy: A bicarbonate wasting state. J Pediatr 1975;86:524–32.10.1016/S0022-3476(75)80141-7Search in Google Scholar PubMed

3. McSherry E, Sebastian A, Morris RC. Renal tubular acidosis in infants: the several kinds, including bicarbonate-wasting, classic renal tubular acidosis. J Clin Invest 1972;51:499–514.10.1172/JCI106838Search in Google Scholar PubMed

4. McSherry E. Acidosis and growth in nonuremic renal disease. Kidney Int 1978;14:349–54.10.1038/ki.1978.135Search in Google Scholar PubMed

5. Chan JC, Alon U. Tubular disorders of acid-base and phosphate metabolism. Nephron 1985;40:257–79.10.1159/000183478Search in Google Scholar PubMed

6. Rodriguez-Soriano J. Renal tubular acidosis: the clinical entity. J Am Soc Nephrol 2002;13:2160–70.10.1097/01.ASN.0000023430.92674.E5Search in Google Scholar PubMed

7. Karet FE. Inherited distal renal tubular acidosis. J Am Soc Nephrol 2002;13:2178–84.10.1097/01.ASN.0000023433.08833.88Search in Google Scholar PubMed

8. Blazer-Yost BL, Cox M, Furlane R. Insulin and IGF-1 receptor-mediated Na+ transport in toad urinary bladders. Am J Physiol 1989;257:C612–20.10.1152/ajpcell.1989.257.4.C612Search in Google Scholar PubMed

9. Staruschenko A, Pochynyuk O, Vandewalle A, Bugaj V, Stockand J. Acute regulation of the epthilial Na+ channel by phosphatidylinositide-3-OH kinase signaling in native collecting duct principal cells. J Am Soc Nephrol 2007;18:1652–61.10.1681/ASN.2007010020Search in Google Scholar PubMed

10. Welbourne TC, Cronin MJ. Growth hormone accelerates tubular acid secretion. Am J Physiol 1991;260:R1036–42.10.1152/ajpregu.1991.260.6.R1036Search in Google Scholar PubMed

11. Donckerwolcke RA. Diagnosis and treatment of renal tubular disorders in children. Pediatr Clin North Am 1982;29:895–906.10.1016/S0031-3955(16)34219-5Search in Google Scholar PubMed

12. Alon U, Hellerstein S, Warady BA. Oral acetazolamide in the assessment of (urine-blood) PCO2. Pediatr Nephrol 1985;5:307–11.10.1007/BF00867488Search in Google Scholar

13. Ranke MB, Price DA, Reiter EO. Growth hormone therapy. In pediatrics – 20 years of KIGS. Basel, Switzerland: Karger, 2007;1–520.10.1159/isbn.978-3-318-01447-1Search in Google Scholar

14. Rose SR, Shulman DI, Larsson P, Wakley LR, Wills S, et al. Gender does not influence prepubertal growth velocity during standard growth hormone therapy – analysis of United States KIGS data. J Pediatr Endocrinol Metab 2005;18:1045–51.10.1515/JPEM.2005.18.11.1045Search in Google Scholar PubMed

15. Loftus J, Heatley R, Walsh C, Dimitri P. Systematic review of the clinical effectiveness of Genotropin (somatropin) in children with short stature. J Pediatr Endocrinol Metab 2010;23:535–51.10.1515/jpem.2010.092Search in Google Scholar PubMed

16. Lanes R, Hurtado E. Oral clonidine: an effective growth hormone – releasing agent in prepubertal subjects. J Pediatr 1982;100:710–6.10.1016/S0022-3476(82)80569-6Search in Google Scholar PubMed

17. Fass B, Lippe BM, Kaplan SA. Relative usefulness of three growth hormone stimulation screening tests. Am J Dis Child 1979;133:931–8.10.1001/archpedi.1979.02130090059010Search in Google Scholar PubMed

18. Rosenfeld RG, Cohen P. Disorders of growth hormone/insulin-like growth factor. In: Sperling MA, editor. Pediatric Endocrinology. Philadelphia, PA: WB Saunders, 2002;254–65.Search in Google Scholar

19. Haque SK, Ariceta G, Batlle D. Proximal renal tubular acidosis: a not so rare disorder of multiple etiologies. Nephrol Dial Transplant 2012;27:4273–87.10.1093/ndt/gfs493Search in Google Scholar PubMed PubMed Central

20. Gil-Pena H, Mejia N, Santos F. Renal Tubular Acidosis. Pediatr 2014;164:691–8.10.1016/j.jpeds.2013.10.085Search in Google Scholar PubMed

21. Edvardsson VO, Goldfarb DS, Lieske JC, Beara-Lasic L, Anglani F, et al. Hereditary causes of kidney stones and chronic kidney disease. Pediatr Nephrol 2013;28:1923–42.10.1007/s00467-012-2329-zSearch in Google Scholar PubMed PubMed Central

22. Loi M. Lowe syndrome. Orphanet J Rare Dis 2006;1:16.10.1186/1750-1172-1-16Search in Google Scholar PubMed

23. Domrongkitchaiporn S, Khositseth S, Stitchantrakul W, Tapayena-Olarn W, Radinahamed P. Dosage of potassium citrate in the correction of urinary abnormalities in pediatric distal renal tubular acidosis patients. Am J Kidney Dis 2002;39:383–91.10.1053/ajkd.2002.30560Search in Google Scholar PubMed

24. Rodriguez-Soriano J, Vallo A, Castillo G, Oliveros R. Natural history of primary distal renal tubular acidosis treated since infancy. J Pediatr 1982;101:669–76.10.1016/S0022-3476(82)80288-6Search in Google Scholar PubMed

25. Caldas A, Broyer M, Cechaux M, Kleinkhecht C. Primary distal tubular acidosis in childhood: clinical study and long-term follow-up in 28 patients. J Pediatr 1992;121:233–41.10.1016/S0022-3476(05)81194-1Search in Google Scholar PubMed

26. Glaser NS, Shirali AC, Styne DM, Jones KL. Acid-based homeostasis in children with growth hormone deficiency. Pediatrics 1998;102:1407–14.10.1542/peds.102.6.1407Search in Google Scholar PubMed

27. McSherry E, Weberman J, Kaplens, Greenbach MM. Effect of acidosis on human growth hormone release in children with non-azotemia and renal tubular acidosis (Abstract). Clin Res 1980;28:535A.Search in Google Scholar

28. Challa A, Chan W, Kreig Jr R, Thabot MA, Liuf, et al. Effect of metabolic acidosis on the expression of insulin like growth factor and growth hormone receptor. Kidney Int 1993;44:1224–7.10.1038/ki.1993.372Search in Google Scholar PubMed

29. Brungger M, Hulter H, Krapf R. Effect of chronic metabolic acidosis on the growth hormone/IGF-1 endocrine axis: new cause of growth hormone insensitivity in humans. Kidney Int 1997;51:216–21.10.1038/ki.1997.26Search in Google Scholar PubMed

30. Sicuro A, Mahlbacher K, Hulter H, Krapf R. Effect of growth hormone on renal and systemic acid-base homeostasis in humans. Am J Physiol 1998;274:F650–7.10.1152/ajprenal.1998.274.4.F650Search in Google Scholar PubMed

31. Jenle S, Hulter H, Krapf R. On the mechanisms of growth hormone – induced stimulation of renal acidification in humans: effect of NaC1. Clin Sci 2000;99:47–56.10.1042/cs0990047Search in Google Scholar

32. Johnson DW, Brew BK, Poronnik P, Cook DL, Field MJ, et al. Insulin-like growth factor I stimulates apical sodium/hydrogen exchange in human proximal tubule cells. Am J Physiol 2000;272:F484–90.10.1152/ajprenal.1997.272.4.F484Search in Google Scholar PubMed

33. Quigley R, Baum M. Effects of growth hormone and insulin-like growth factor 1 on rabbit proximal convoluted tubule transport. J Clin Invest 1991;88:368–74.10.1172/JCI115312Search in Google Scholar PubMed PubMed Central

34. Hamm LL, Nakhovl NL. Renal Acidification. In: Brenner BM, editor. The Kidney. Philadelphia PA: Saunders Elsevier, 2008:248–79.Search in Google Scholar

Received: 2016-12-9
Accepted: 2017-7-24
Published Online: 2017-9-9
Published in Print: 2017-10-26

©2017 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. Individualised growth response optimisation (iGRO) tool: an accessible and easy-to-use growth prediction system to enable treatment optimisation for children treated with growth hormone
  4. Original Articles
  5. Relation of insulin resistance to neurocognitive function and electroencephalography in obese children
  6. Body weight misperception and health-related factors among Iranian children and adolescents: the CASPIAN-V study
  7. Do sufficient vitamin D levels at the end of summer in children and adolescents provide an assurance of vitamin D sufficiency at the end of winter? A cohort study
  8. Type 3 renal tubular acidosis associated with growth hormone deficiency
  9. Serum α-klotho levels are not informative for the evaluation of growth hormone secretion in short children
  10. Evaluation of neurodevelopment of children with congenital hypothyroidism by the Denver Developmental Screening Test
  11. Pediatric differentiated thyroid carcinoma: trends in practice and outcomes over 40 years at a single tertiary care institution
  12. Physical activity and bone mineral density at the femoral neck subregions in adolescents with Down syndrome
  13. A pilot study on the utility of reduced urine collection frequency protocols for the assessment of reproductive hormones in adolescent girls
  14. MODY in Ukraine: genes, clinical phenotypes and treatment
  15. A retrospective review of initial bisphosphonate infusion in an inpatient vs. outpatient setting for bisphosphonate naïve patients
  16. Molecular genetic and clinical delineation of 22 patients with congenital hypogonadotropic hypogonadism
  17. Letter to the Editor
  18. Rare cases of galactose metabolic disorders: identification of more than two mutations per patient
  19. Case Reports
  20. When one disease is not enough: succinyl-CoA: 3-oxoacid coenzyme A transferase (SCOT) deficiency due to a novel mutation in OXCT1 in an infant with known phenylketonuria
  21. Pseudohypoparathyroidism type 1B associated with assisted reproductive technology
  22. Long QT syndrome diagnosed in two sisters with propionic acidemia: a case report
  23. Delayed diagnosis of proopiomelanocortin (POMC) deficiency with type 1 diabetes in a 9-year-old girl and her infant sibling
https://doi.org/10.1515/jpem-2016-0460
Keywords for this article
growth hormone deficiency; renal tubular acidosis

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. Individualised growth response optimisation (iGRO) tool: an accessible and easy-to-use growth prediction system to enable treatment optimisation for children treated with growth hormone
  4. Original Articles
  5. Relation of insulin resistance to neurocognitive function and electroencephalography in obese children
  6. Body weight misperception and health-related factors among Iranian children and adolescents: the CASPIAN-V study
  7. Do sufficient vitamin D levels at the end of summer in children and adolescents provide an assurance of vitamin D sufficiency at the end of winter? A cohort study
  8. Type 3 renal tubular acidosis associated with growth hormone deficiency
  9. Serum α-klotho levels are not informative for the evaluation of growth hormone secretion in short children
  10. Evaluation of neurodevelopment of children with congenital hypothyroidism by the Denver Developmental Screening Test
  11. Pediatric differentiated thyroid carcinoma: trends in practice and outcomes over 40 years at a single tertiary care institution
  12. Physical activity and bone mineral density at the femoral neck subregions in adolescents with Down syndrome
  13. A pilot study on the utility of reduced urine collection frequency protocols for the assessment of reproductive hormones in adolescent girls
  14. MODY in Ukraine: genes, clinical phenotypes and treatment
  15. A retrospective review of initial bisphosphonate infusion in an inpatient vs. outpatient setting for bisphosphonate naïve patients
  16. Molecular genetic and clinical delineation of 22 patients with congenital hypogonadotropic hypogonadism
  17. Letter to the Editor
  18. Rare cases of galactose metabolic disorders: identification of more than two mutations per patient
  19. Case Reports
  20. When one disease is not enough: succinyl-CoA: 3-oxoacid coenzyme A transferase (SCOT) deficiency due to a novel mutation in OXCT1 in an infant with known phenylketonuria
  21. Pseudohypoparathyroidism type 1B associated with assisted reproductive technology
  22. Long QT syndrome diagnosed in two sisters with propionic acidemia: a case report
  23. Delayed diagnosis of proopiomelanocortin (POMC) deficiency with type 1 diabetes in a 9-year-old girl and her infant sibling
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