From the Guidelines
Patients with a urostomy and renal tubular acidosis (RTA) should be managed with careful attention to both conditions, prioritizing alkali therapy for RTA and proper urostomy care to prevent complications and maintain quality of life. For urostomy care, it is essential to use appropriate pouching systems that fit well around the stoma, changing them every 3-5 days or when leakage occurs, and cleaning the peristomal skin with water and mild soap, avoiding alcohol-based products 1. Monitoring for complications like skin irritation, stomal stenosis, or urinary tract infections is also crucial. For RTA management, alkali therapy is the cornerstone of treatment, typically with oral sodium bicarbonate or sodium citrate solution, adjusted based on serum bicarbonate levels (target 22-24 mEq/L) 1. Potassium supplementation may be needed for hypokalemic forms of RTA, typically as potassium citrate. Regular monitoring of electrolytes, acid-base status, and renal function is essential, with laboratory checks every 3-6 months once stable. The urostomy diverts urine through an abdominal stoma, which can affect fluid and electrolyte balance, potentially exacerbating the metabolic acidosis of RTA. Adequate hydration is crucial, aiming for 2-3 liters of fluid daily to prevent urinary concentration and crystal formation. Key aspects of management include:
- Proper urostomy care to prevent skin complications and infections
- Alkali therapy for RTA, tailored to the individual's needs and serum bicarbonate levels
- Potassium supplementation as needed for hypokalemic RTA
- Regular monitoring of renal function, electrolytes, and acid-base status
- Adequate hydration to prevent complications associated with urinary concentration and metabolic acidosis. Given the potential for renal disease progression in untreated conditions, such as tyrosinemia type I, which can lead to RTA, it is vital to follow standard therapeutic approaches, including NTBC and dietary restriction of phenylalanine/tyrosine, to prevent or reverse tubulopathy 1.
From the Research
Urostomy and Renal Tubular Acidosis
- Urostomy is not directly mentioned in the provided studies as a treatment or related condition to renal tubular acidosis (RTA) 2, 3, 4, 5, 6.
- Renal tubular acidosis (RTA) is a group of disorders characterized by metabolic acidosis, hyperchloremia, normal anion gap, and potassium imbalance 4.
- The main types of RTA are:
- Diagnosis of RTA involves assessment of urinary acid and bicarbonate secretion, and treatment options include alkali therapy and lowering of serum potassium concentrations 3, 5.
- Complications of untreated RTA can include growth retardation, osteoporosis, rickets, osteomalacia, and renal calculi 4, 5.