Environmental distal renal tubular acidosis in Thailand: an enigma

Am J Kidney Dis. 1999 Jun;33(6):1180-6. doi: 10.1016/S0272-6386(99)70162-9.


Distal renal tubular acidosis is a common health problem in northeastern Thailand, with the population background of the low potassium intake, low urine citrate, and decreased red blood cell Na-K adenosine triphosphatase (ATPase) activity and the environment of the high soil vanadium. The disease is usually seen in the people with low socioeconomic status in summer. The patients have decreased gastric acidity and low urine potassium. There are varying degrees of renal function from normal to impairment. Gastric hypoacidity is an important clue. Defects in H-K ATPase and anion exchange (AE2) mechanism are considered. The urine vanadium is higher in the patients than that of normal rural northeastern villagers. Inhibition of H-K ATPase by vanadium seems possible and requires more supporting evidence. AE1 gene mutation is noted in few patients. The cause of dRTA is not apparent. The AE2 gene and H-K ATPase gene remain to be studied. Both environmental and genetic factors could contribute to the pathogenesis of the disease.

MeSH terms

  • Acidosis, Renal Tubular / epidemiology
  • Acidosis, Renal Tubular / etiology*
  • Acidosis, Renal Tubular / genetics
  • Adolescent
  • Adult
  • Aged
  • Antiporters / metabolism
  • Citrates / urine
  • Erythrocytes / enzymology
  • Gossypol / adverse effects
  • H(+)-K(+)-Exchanging ATPase / genetics
  • H(+)-K(+)-Exchanging ATPase / metabolism
  • Humans
  • Middle Aged
  • Potassium / administration & dosage
  • Potassium / urine
  • Potassium Deficiency / complications
  • Seasons
  • Socioeconomic Factors
  • Sodium-Potassium-Exchanging ATPase / blood
  • Soil
  • Thailand / epidemiology
  • Vanadium / analysis
  • Vanadium / urine


  • Antiporters
  • Citrates
  • Soil
  • Vanadium
  • H(+)-K(+)-Exchanging ATPase
  • Sodium-Potassium-Exchanging ATPase
  • Gossypol
  • Potassium