Case History, Investigations and Pictures of Renal Rickets

This is a case summary of renal rickets with renal tubular acidosis, most probably distal RTA.

Shehrin, 6 years old female child, immunized as per EPI schedule, 1st issue of her non consanguineous parents of low socioeconomic condition, hailing from Demra, Dhaka with the complaints of not growing well according to her age since 2 years of her age. Frequent micturition and excessive water intake for 2 and half years, bowing of leg, and history of frequent fall during walking for the last 5 months. She had no history of increased appetite for food, hearing or visual problems, fever, vomiting, constipation, pneumonia, or diarrhea.

On examination, she is well alert, not anemic, edema and dehydration was absent, her height is 93 cm, BMI 17.1. On locomotor system examination, bowing of leg was present, muscle, bulk, power tone was normal. Alimentary system examination reveals no organomegaly, other system examination reveals no abnormality.

On examination:

Height: 93 cm

Weight: 15 Kg

Anemia: Absent

No Rachitic rosary or Harrison’s sulcus.\

Investigations:

Complete Blood Count:

• Hb: 13.5 gm/dl\
• ESR: 18 mm Hg in 1^st
• Platelets: 360 000/cmm
• WBC: 12000/cmm

PBF: Non specific findings.

Urine Bence Jones Protein: Absent

Urine R/E:

• Reaction PH: 8.0?
• Protein: Trace
• Ex Phosphate: Nil
• Casts: absent
• Epithelial cells: Nil

Serum Electrolytes:

• Na= 138 mmol/l
• K= 3.2 mmol/l
• Chloride=114 mmol/l

Serum inorganic Phosphate: 2.3 mg/dl (N=2.3-4.7)

Serum Calcium: 8.7 mg/dl

Alkaline Phosphatase: 578 U/L (N= 30-120 U/L)

Urine culture: No growth

Urinary Potassium: 9.5 mmol/day (N= 25-125)

Urinary Sodium: 66 mmol/day (N= 40-220)

Serum Urea: 25 mg/dl

Serum Creatinine: 0.46 mg/dl

This patient was discharged with advice for follow up after 1 week.

Important Links:

Renal Tubular Acidosis Syndromes Medscape

Distal Renal Tubular Acidosis with Severe Bony Deformities and Multiple Fractures Indian Pediatrics

Renal rickets-practical approach NCBI

PDF Download:

Renal Tubular Disorder

Renal Tubular Acidosis

Renal Rickets [Must Download]

This patient was previously diagnosed with Renal Rickets and came to us for Follow up. As it is a good academic case, i have just made a record. I really dont know much about it. Thanks. Hope you have enjoyed it.