Department of Paediatrics, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
Ital J Pediatr. 2010 Aug 11;36:54. doi: 10.1186/1824-7288-36-54.
In the Sub Saharan Africa Rickets has now been established to be due primarily to calcium deficiency and sometimes in combination with vitamin D deficiency. The main thrust of management is calcium supplementation with or without vitamin D. An observation was made that some children with nutritional rickets do not respond to this management modality. The recently reported high prevalence of Incomplete Distal Renal Tubular Acidosis (idRTA) in adults with osteoporosis as brought to fore the possibility of this being a possible cause of calcium wastage and therefore the poor response in these group of children with rickets.
To determine the prevalence of idRTA amongst a cohort of subjects with ricketsTo show a relationship between rickets and incomplete distal renal acidosisTo determine the response of children with rickets and idRTA to addition of Shohl's solution to therapy
Two separate cohorts of children with rickets performed the ammonium chloride loading test to detect those with incomplete renal tubular acidosis. Following identification for idRTA, Shohl's solution was added to therapy of calcium and vitamin D supplementation and their response compared to those without idRTA on calcium and vitamin D supplementation solely.
50 children with rickets aged from two to six years of age and composed of 29 females and 21males were investigated. Incomplete renal tubular acidosis was found in 38% of them. Prevalence of idRTA was highest amongst those aged 3-6 years of age. Those with idRTA had worse limb deformities, biochemical and radiological parameters than those who hadn't. Rate of response on those with idRTA treated with Shohl's solution was at par with those without idRTA.
Incomplete idRTA exist amongst children with rickets and should be looked out for in severe rickets and older children. Treatment of idRTA will lead to optimal response and healing of rickets.
在撒哈拉以南非洲，佝偻病已被确定主要是由于钙缺乏，有时与维生素 D 缺乏有关。治疗的主要方法是补充钙，有时还补充维生素 D。有人观察到，一些患有营养性佝偻病的儿童对这种治疗方法没有反应。最近报道的成年人骨质疏松症中不完全远端肾小管酸中毒（idRTA）的高患病率引起了人们的关注，认为这可能是钙流失的一个原因，因此，佝偻病儿童的治疗效果较差。
确定佝偻病患者队列中 idRTA 的患病率；显示佝偻病与不完全远端肾小管酸中毒的关系；确定伴有 idRTA 的佝偻病儿童对 Shohl 溶液添加到治疗中的反应。
对两组不同的佝偻病患儿进行氯化铵负荷试验，以检测不完全性肾小管酸中毒。在确定 idRTA 后，将 Shohl 溶液添加到钙和维生素 D 补充治疗中，并与仅接受钙和维生素 D 补充治疗的无 idRTA 患儿进行比较。
研究了 50 名年龄在 2 至 6 岁之间的佝偻病患儿，其中包括 29 名女性和 21 名男性。他们中有 38%存在不完全性肾小管酸中毒。3-6 岁年龄组 idRTA 的患病率最高。患有 idRTA 的患儿的四肢畸形、生化和影像学参数比没有 idRTA 的患儿更差。在接受 Shohl 溶液治疗的 idRTA 患儿中，其反应率与无 idRTA 的患儿相当。
佝偻病患儿中存在不完全性 idRTA，应在严重佝偻病和大龄儿童中寻找。治疗 idRTA 将导致佝偻病的最佳反应和愈合。
