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Renal Tubular Acidosis (RTA)

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Topic updated on 06/27/17 1:54pm

Overview
  • A net decrease in tubular hydrogen secretion or bicarbonate reabsorptio
    A net decrease in tubular hydrogen secretion or bicarbonate reabsorption
  • Produces a non-ion gap metabolic acidosis
  • There are three main types
  • Produces a non-ion gap acidosis.
    There are three main types
Type 1 - Distal
  • IntroductionRadiograph illustrating patient with nephrocalcinosis resulting from distal RTA.
    • inability of collecting tubule to excrete H+ and regenerate HCO3-
    • associated with hypokalemia and risk for calcium-containing kidney stones
    • causes
      • hereditary
      • drug induced (amphotericin)
      • light chains in multiple myeloma
      • collagen vascular disease
      • cirrhosis
      • nephrocalcinosis
  • Evaluation
    • urine pH > 5.5
    • hypokalemia
  • Treatment
    • oral HCO3-
Type 2 - Proximal
  • Introduction
    • inability of proximal tubule to reabsorb HCO3-
    • associated with hypokalemia and hypophosphatemic rickets
    • causes
      • hereditary
      • nephrotoxic drugs
      • carbonic anhydrase inhibitors
      • hyperparathyroidism
      • Fanconi syndrome
  • Evaluation
    • urine pH < 5.5
    • hypokalemia
      • HCO3- in the urine binds potassium causes ↑ excretion
  • Treatment
    • thiazides
Type 4 - Hyperkalemic
  • Introduction
    • hypoaldosteronism or lack of collecting tubule response to aldosterone (hyporeninemic hypoaldosteronism)
      • due to destruction of JG apparatus
    • leads to inhibition of ammonia excretion in proximal tubule
      • result is ↓ urine pH due to ↓ buffering capacity
    • causes
      • interstitial nephritis (secondary to Legionnaires' disease)
      • HTN
      • hyaline arteriolosclerosis (secondary to DM)
      • aldosterone resistance
  • Evaluation
    • urine pH < 5.5
    • hyperkalemia and hyperchloremia
    • hyponatremia


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