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Renal tubular acidosis in salt-losing syndromes of congenital adrenal hyperplasia (CAH).

ABSTRACT In a 22-month-old patient with the salt-losing form of CAH, renal contribution to acid-base balance was assessed both in a decompensated state 5 days after withholding 9-alpha-fluorohydrocortisone and in the compensated state one week after reinstitution of therapy. Renal bicarbonate threshold was 13 mmoles serum in decompensation and 20.5 mmoles serum in compensation. Acidification of the urine was appropriate in both states, although a slight quantitative difference in the 2 situations was observed. The data suggest that the renal acidosis in decompensated salt-losing form of CAH is mainly proximal tubular in origin.