A bit about RTA (Panopto Video Link)

Question 1

Describe the pathophysiology of uraemia.

Answer 1

There is a loss of functioning nephrons +/- injury to the glomerulus and/or tubules, reducing EGFR. This leads to a reduced ability of the kidneys to clear acid anions, potentially leading to uraemic acidosis

Question 2

Describe the pathophysiology of uraemia.

Answer 2

There is a loss of functioning nephrons +/- injury to the glomerulus and/or tubules, reducing EGFR. This leads to a reduced ability of the kidneys to clear acid anions, potentially leading to uraemic acidosis

Question 3

Describe the pathophysiology of uraemia.

Answer 3

There is a loss of functioning nephrons +/- injury to the glomerulus and/or tubules, reducing EGFR. This leads to a reduced ability of the kidneys to clear acid anions, potentially leading to uraemic acidosis

Question 4

What is a commonly implicated cause of high anion gap acidosis?

Answer 4

Uraemia

Question 5

What is a commonly implicated cause of high anion gap acidosis?

Answer 5

Uraemia

Question 6

What is renal tubular acidosis?

Answer 6

A group of syndromes of renal tubular dysfunction characterised by either an impaired bicarbonate absorption or hydrogen ion excretion that is out of proportion with the glomerular filtration rate

Question 7

What is renal tubular acidosis?

Answer 7

A group of syndromes of renal tubular dysfunction characterised by either an impaired bicarbonate absorption or hydrogen ion excretion that is out of proportion with the glomerular filtration rate

Question 8

What is renal tubular acidosis?

Answer 8

A group of syndromes of renal tubular dysfunction characterised by either an impaired bicarbonate absorption or hydrogen ion excretion that is out of proportion with the glomerular filtration rate

Question 9

What is renal tubular acidosis?

Answer 9

A group of syndromes of renal tubular dysfunction characterised by either an impaired bicarbonate absorption or hydrogen ion excretion that is out of proportion with the glomerular filtration rate

Question 10

What are the 3 types of renal tubular acidosis?

Answer 10

1. Type I (distal RTA [dRTA])
2. Type II (proximal RTA [pRTA])
3. Type IV (hyperkalaemic RTA)

Question 11

What are the 3 types of renal tubular acidosis?

Answer 11

1. Type I (distal RTA [dRTA])
2. Type II (proximal RTA [pRTA])
3. Type IV (hyperkalaemic RTA)

Question 12

What are the 3 types of renal tubular acidosis?

Answer 12

1. Type I (distal RTA [dRTA])
2. Type II (proximal RTA [pRTA])
3. Type IV (hyperkalaemic RTA)

Question 13

Where does ammonium production occur?

Answer 13

In the proximal tubule of the kidney

Question 14

What is the only organ which excrete hydrogen ions?

Answer 14

The kidneys

Question 15

Where is 85% of bicarbonate reabsorbed?

Answer 15

In the proximal tubule of the kidney

Question 16

Where does ammonium production occur?

Answer 16

In the proximal tubule of the kidney

Question 17

What is the result of bicarbonate reabsorption from the proximal tubule of the kidney?

Answer 17

Proximal tubular acidification

Question 18

What is the result of bicarbonate reabsorption from the proximal tubule of the kidney?

Answer 18

Proximal tubular acidification

Question 19

What is the result of bicarbonate reabsorption from the proximal tubule of the kidney?

Answer 19

Proximal tubular acidification

Question 20

Where does acid excretion mainly occur?

Answer 20

In the distal tubule and cortical collecting tubule of the kidney

Question 21

Where does acid excretion mainly occur?

Answer 21

In the distal tubule and cortical collecting tubule of the kidney

Question 22

Where does acid excretion mainly occur?

Answer 22

In the distal tubule and cortical collecting tubule of the kidney

Question 23

Where does acid excretion mainly occur?

Answer 23

In the distal tubule and cortical collecting tubule of the kidney

Question 24

Where does acid excretion mainly occur?

Answer 24

In the distal tubule and cortical collecting tubule of the kidney

Question 25

Where does acid excretion mainly occur?

Answer 25

In the distal tubule and cortical collecting tubule of the kidney

Question 26

Can acid be excreted from the body as free hydrogen ions?

Answer 26

No

Question 27

How are hydrogen ions excreted from the body?

Answer 27

By binding to other buffers, such as HPO4(2-) and creatinine, or NH3 to form NH4+

Question 28

How are hydrogen ions excreted from the body?

Answer 28

By binding to other buffers, such as HPO4(2-) and creatinine, or NH3 to form NH4+

Question 29

How are hydrogen ions excreted from the body?

Answer 29

By binding to other buffers, such as HPO4(2-) and creatinine, or NH3 to form NH4+

Question 30

Where does reabsorption of HCO3- which has escaped proximal reabsorption occur?

Answer 30

In the distal tubule of the kidney

Question 31

Where is bicarbonate extensively reabsorbed in the kidney?

Answer 31

At the proximal tubule

Question 32

Describe the expected concentration of bicarbonate in the urine if the proximal tubule is functioning healthily

Answer 32

Bicarbonate concentrations in the urine should be low

Question 33

What is the mechanism leading to acid-base imbalance in proximal renal tubular acidosis?

Answer 33

The proximal tubule loses its ability to reabsorb bicarbonate and potassium, so its excretion in the urine increases

Question 34

What is the mechanism leading to acid-base imbalance in proximal renal tubular acidosis?

Answer 34

The proximal tubule loses its ability to reabsorb bicarbonate and potassium, so its excretion in the urine increases

Question 35

What is the overarching concept of distal renal tubular acidosis?

Answer 35

The body loses its ability to excrete hydrogen ions

Question 36

What is the overarching concept of distal renal tubular acidosis?

Answer 36

The body loses its ability to secrete hydrogen ions

Question 37

What is hyperkalaemic distal renal tubular acidosis characterised by?

Answer 37

Severe hyperkalaemia

Question 38

How may urinary pH be used in investigating acid-base disorders?

Answer 38

If the urine is inappropriately alkaline despite the body being acidotic, this is indicative of distal renal tubular acidosis

Question 39

Describe the expected anion gap with all types of renal tubular acidosis

Answer 39

They all usually have a normal anion gap as they are chronic conditions

Question 40

How may urinary pH be used in investigating acid-base disorders?

Answer 40

If the urine is inappropriately alkaline despite the body being acidotic, this is indicative of distal renal tubular acidosis

Question 41

What are urinary stones composed of?

Answer 41

98% crystalline material (which have very limited solubility in urine) and 2% mucoprotein

Question 42

Are urinary stones more likely with acidic or alkaline urinary pH?

Answer 42

Alkaline (increased) urinary pH

Question 43

How is serum bicarbonate affected in proximal renal tubular acidosis?

Answer 43

Serum bicarbonate will be reduced

Question 44

Which form of renal tubular acidosis leads to the more severe acidosis?

Answer 44

Distal renal tubular acidosis

Question 45

How is anion gap affected in proximal renal tubular acidosis (inability to reabsorb bicarbonate)?

Answer 45

Anion gap will be normal

Question 46

How will urinary pH be affected in proximal renal tubular acidosis (inability to reabsorb bicarbonate)?

Answer 46

Urinary pH will still be acidic as you can still excrete hydrogen into the urine

Question 47

How will urinary pH be affected by distal renal tubular acidosis (inability to clear hydrogen in the urine)?

Answer 47

The pH of urine will be alkaline

Question 48

Which form of renal tubular acidosis leads to the more severe acidosis?

Answer 48

Distal renal tubular acidosis

Question 49

What is distal renal tubular acidosis caused by?

Answer 49

Inability to clear hydrogen in the urine

Question 50

From what site in the kidney is most bicarbonate reabsorbed?

Answer 50

The proximal tubule