2: Peds RTA Flashcards
What are 4 DDx for RTA?
FTT
Hypothyroidism
Systemic acidosis
Primary vs secondary RTA
Renal tubular acidosis (RTA) type 1, 2, or 4?
Defect is in the distal tubule.
1
Renal tubular acidosis (RTA) type 1, 2, or 4?
Hyperkalemic RTA.
4
RTA is classically seen in children being worked up for _____.
growth failure
RTA is typically caught during _____.
an acute illness
What is management for RTA?
Correct acidosis by oral alkalizing medication.
Maximize caloric intake.
Closely follow up weight and labs.
Renal tubular acidosis (RTA) type 1, 2, or 4?
Classic or distal.
1
Proximal RTA (Type2): Proximal tubule normally absorbs \_\_\_\_\_ percent of bicarbonate. In RTA, this drops to being able to reabsorb only \_\_\_\_\_ percent of bicarb from urine. Distal tubule reabsorbs 15 percent of bicarb normally and urine is acidified. Large amount of bicarb is wasted. Body resets threshold for bicarb to \_\_\_\_\_. Normal threshold is between \_\_\_\_\_.
85%
60%
14-16
22-26
Renal tubular acidosis (RTA) type 1, 2, or 4?
Problems in the functioning of aldosterone in relation to obstructive uropathy.
4
Hyperkalemic RTA (Type 4): Deficiency in production or responsiveness of \_\_\_\_\_ and \_\_\_\_\_.
aldosterone
ammonia
What diagnostics are used for RTA (3)?
Serum electrolytes (CO2, renal function, Ca, phosphorous, alkaline phosphatase).
UA for glucose and pH (if abnormal, 24h-urine for creatinine clearance).
Renal U/S.
Which RTA responds quickly to oral alkalizing meds?
Distal RTA (Type 1)
Distal RTA (Type 1): Defect in distal renal tubule to \_\_\_\_\_. Complete loss of reabsorption of the final \_\_\_\_\_ of bicarbonate. Inability to acidify urine. Becomes more alkaline.
excrete hydrogen
15%
Which type of RTA is most likely to have constipation?
Distal RTA (Type 1)
Which RTA requires higher doses of oral alkalizing meds?
Proximal RTA (Type 2)
Caused by a dysfunction in the transport capability of the renal tubules that affects reabsorption of filtered bicarb, excretion of hydrogen ion, or both.
Renal tubular acidosis (RTA)
Renal tubular acidosis (RTA) type 1, 2, or 4?
Defect occurs in the proximal tubules.
2
Which RTA requires mineralcorticoid treatment?
Hyperkalemic RTA (Type 4)
Renal tubular acidosis (RTA) type 1, 2, or 4?
Bicarbonate wasting or proximal RTA.
2
Clinical manifestations of RTA (9).
Failure to thrive, including poor linear growth.
Polyuria and polydipsia.
Muscle weakness if hypokalemic.
If they get very hypokalemic, cardiac changes.
Feeding problems.
Vomiting/diarrhea.
Constipation (particularly with distal RTA).
Preference for liquids over solids.
Poor appetite.
