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Block 19 module 4 > Acute Renal Tubular Acidosis > Flashcards

Acute Renal Tubular Acidosis Flashcards

1
Q

The proximal tubule reabsorbs

A 
HCO3 (90%)
Ca
Glucose
Amino acids
NaCl
H20
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2
Q

Action of carbonic anhydrase inhibitors

A

They block reabsorption of HCO3; useful in alkalinizing urine

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3
Q

Main pathophysio of renal tubular acidosis

A

Transport defects in the reabsorption of bicarbonate and the excrertion of hydrogen ion

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4
Q

Features of Renal tubular acidosis

A

Metabolic acidosis
Normal anion gap
Hyperchloremia
Hypokalemia

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5
Q

Difference in the measured cations and anions in serum, plasma, or urine

A

Anion gap

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6
Q

Normal anion gap

A

12+- 2 mEq/L

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7
Q

Primary physiologic regulator of net acid secretion

A

Extracellular pH

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8
Q

T or F. In RTA there is academia so the urine is also acidic

A

False, urine is basic because there is difficulty in acidification of urine

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9
Q

TorF. For every 1 HCO3 absorbed 1 H secreted

A

True

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10
Q

Transporter used in H secretion into tubular lumen for renal acidification

A

NHE3

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11
Q

Approximately 85% of filtered HCO3 is absorbed by the

A

Proximal tubule

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12
Q

remaining 15% of the filtered HCO3 is reabsorbed in the

A

thick ascending limb and in the outer medullary collecting tubule

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13
Q

How is ammonium produced

A

Catabolism of glutamine in the proximal tubule

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14
Q

Transporter for ammonia

A

None, it passivel diffuses in and out of the cell

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15
Q

Luminal NH4 is partially reabsorbed in the ________

A

Thick ascending limb

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16
Q

The thick ascending limb reabsorbs abt 15% of the filtered HCOR through

A

Na H apical exchange

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17
Q

major site of H+ secretion and is made up of the medullary collecting duct (MCT) and the cortical collecting duct

A

Collecting tubule

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18
Q

main cells involved with H+ secretion in the CT

A

Alpha intercalated cells

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19
Q

Luminal exchanger in beta intercalated cells

A

Cl/HCO3

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20
Q

Most important site of urinary acidification

A

Medullary portion of the collecting duct

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21
Q

T or F: Increased urine ammonium levels is probably a renal cause

A

False: extrarenal

If decreased- renal

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22
Q

Difference of metabolic acidosis in diarrhea and RTA

A

In RTA there’s Low excretion of urinary NH4 as compared to high excretion in diarrhea

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23
Q

Fanconi syndrome is often due to generalized proximal tubular dysfunction manifested by

A

Glycosuria
Generalized aminoaciduria
Phosphaturia

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24
Q

Type of RTA where there’s isolated bicarbonate defect

A

Proximal RTA

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25
Q

Nephrolithiasis, nephrocalcinosis and bone disease are common in this type of RTA

A

Distal RTA (type 1)

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26
Q

Disorder leading to HCMA secondary to impaired proximal reabsorption of filtered bicarbonate

A

pRTA

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27
Q

Most common causes of fanconi syndrome in adults

A

MM

Use of acetazolamide

28
Q

Most common cause of fanconi syndrome In children

A

Cystinosis

29
Q

One of the procedures that will identify a proximal from a distal RTA

A

FEHCO3

30
Q

Generalized proximal tubule dysfunction

A

Fanconi syndrome

31
Q

Drugs that can cause type 2 (proximal) RTA

A

Amphotericin B
6 mercaptopurine
Acetazolamide

32
Q

Why px with pRTA rarely develop nephrosclerosis or nephrolithiasis

A

High citrate excretion (citrate is a crystal inhibitor)

33
Q

Urine pH in pRTA

A

Low <5.5 (but high initially)

34
Q

disorder leading to HCMA secondary to impaired distal H+ secretion

A

Distal RTA (type 1)

35
Q

Type of RTA associated with hypercalciuria, hypocitraturia, nephrocalcinosis and osteomalacia

A

Distal RTA (type 1)

36
Q

Most common cause of dRTA in adults

A

Autoimmune disorders such as SJS and other conditions assoc with chronic hyperglobulinemia

37
Q

Syndrome of osteoporosis, short stature and mental retardation

A

Marble brain disease

38
Q

Low excretion of ammonium as a result of less NH4 leads to a

A

Positive urine anion gap

39
Q

Urine pH in dRTA

A

pH >5.5

40
Q

T or F renal stones are present in dRTA

A

True

41
Q

disorder is characterized by modest HCMA with normal AG (anion gap) and association with hyperkalemia

A

Type 4 Hyperkalemic RTA

42
Q

Type 4 RTA is primarily due to

A

Decreased urinary ammonium excretion

43
Q

Most common etiology of type 4 RTA

A

Hypoaldosteronism

44
Q

Cause of hyperkalemic RTA with decreased renin

A

Diabetic nephropathy
NSAID
Interstitial nephritis

45
Q

Causes of type 4 RTA with normal renin, decreased aldosterone

A

ACEi, ARB
Heparin
Primary adrenal response

46
Q

Type 4 RTA occurs primarily due to

A

Decreased urinary ammonium excretion

47
Q

Urine pH in type 4 RTA

A

pH <5.5

48
Q

T or F there’s impaired fxn of NA/K/H exchange mechanism in type 4 RTA

A

True

49
Q

Genetic defect in type 3 RTA

A

Defect in type 2 carbonic anhydrase

50
Q

Electrolytes you want to request in a patient with metabolic acidosis

A

NA K Cl and ABG

51
Q

Factors you need to rule out in history if you want to consider RTA

A

GI bicarbonate losses and intake of acetazolamide or ingestion of exogenous acid

52
Q

FEHCO3 is increased in

A

Proximal RTA >15% low in other forms

53
Q

T or F. It is ok to measure anion gap even if the patient has a low creatinine or impaired kidney function

A

False, make sure px has normal crea or kidney fxn

54
Q

2 settings where urine anion gap cannot be used

A

when px volume is depleted with a Na conc below 25 mEq/L

when there’s increased excretion of unmeasured anions

55
Q

Measure of distal acid secretion

A

Urine PCO2

56
Q

This is important when trying to evaluate the role of aldosterone

A

Transtubular potassium gradient (TTKG)

57
Q

This part of the nephron reabsorbs most of the filtered citrate

A

Proximal tubule

58
Q

Plays to most cignificant role in citrate excretion

A

Acid base status

59
Q

T or F: alkalosis decreases citrate excretion while acidosis increases it

A

False. Alkalosis – increases citrate excretion

Acidosis – decreases

60
Q

Treatment for pRTA

A

Mixture of Na and K salts (esp. citrate)
Thiazide diuretics
Vit D

61
Q

Mainstay of treatment of RTA

A

Bicarbonate therapy

62
Q

Treatment for distal RTA

A

1-2 meq/kg sodium citrate or bicarbonate

High sodium, low K diet plus thiazide diuretics (hyperkalemic distal)

63
Q

Identify which type of RTA: renal stones, hypercalciuria, high urine pH despite met acidosis

A

Type 1

64
Q

Identify which type of RTA: aldosterone deficiency and hyperkalemia

A

Type 4

65
Q

Identify which type of RTA :Acetazolamide and bicarb wasting, fanconi syndrome

A

Type 2

Block 19 module 4 (1 decks)

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