2: Peds RTA

Question 1

What are 4 DDx for RTA?

Answer 1

FTT
Hypothyroidism
Systemic acidosis
Primary vs secondary RTA

Question 2

Renal tubular acidosis (RTA) type 1, 2, or 4?

Defect is in the distal tubule.

Answer 2

1

Question 3

Renal tubular acidosis (RTA) type 1, 2, or 4?

Hyperkalemic RTA.

Answer 3

4

Question 4

RTA is classically seen in children being worked up for _____.

Answer 4

growth failure

Question 5

RTA is typically caught during _____.

Answer 5

an acute illness

Question 6

What is management for RTA?

Answer 6

Correct acidosis by oral alkalizing medication.
Maximize caloric intake.
Closely follow up weight and labs.

Question 7

Renal tubular acidosis (RTA) type 1, 2, or 4?

Classic or distal.

Answer 7

1

Question 8

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 \_\_\_\_\_.

Answer 8

85%
60%
14-16
22-26

Question 9

Renal tubular acidosis (RTA) type 1, 2, or 4?

Problems in the functioning of aldosterone in relation to obstructive uropathy.

Answer 9

4

Question 10

Hyperkalemic RTA (Type 4):
Deficiency in production or responsiveness of \_\_\_\_\_ and \_\_\_\_\_.

Answer 10

aldosterone

ammonia

Question 11

What diagnostics are used for RTA (3)?

Answer 11

Serum electrolytes (CO2, renal function, Ca, phosphorous, alkaline phosphatase).
UA for glucose and pH (if abnormal, 24h-urine for creatinine clearance).
Renal U/S.

Question 12

Which RTA responds quickly to oral alkalizing meds?

Answer 12

Distal RTA (Type 1)

Question 13

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.

Answer 13

excrete hydrogen

15%

Question 14

Which type of RTA is most likely to have constipation?

Answer 14

Distal RTA (Type 1)

Question 15

Which RTA requires higher doses of oral alkalizing meds?

Answer 15

Proximal RTA (Type 2)

Question 16

Caused by a dysfunction in the transport capability of the renal tubules that affects reabsorption of filtered bicarb, excretion of hydrogen ion, or both.

Answer 16

Renal tubular acidosis (RTA)

Question 17

Renal tubular acidosis (RTA) type 1, 2, or 4?

Defect occurs in the proximal tubules.

Answer 17

2

Question 18

Which RTA requires mineralcorticoid treatment?

Answer 18

Hyperkalemic RTA (Type 4)

Question 19

Renal tubular acidosis (RTA) type 1, 2, or 4?

Bicarbonate wasting or proximal RTA.

Answer 19

2

Question 20

Clinical manifestations of RTA (9).

Answer 20

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.