Renal

Question 1

Renal Tubular Acidosis

(Blood gas finding for all, Pathophysiology, Location, Effects on K+, Urine pH, others, treatment or associations of each)

Answer 1

All 3 types causes hyperchloremic metabolic acidosis with normal anion gap

Type 1
- Inability to secrete H+ and generate acidic urine
- Distal tubule
- Low K+, High urine pH (pH>5.3), low urinary citrate, hypercalciuria
- Prone to renal stones
- Associated with SLE and Sjogren’s Syndrome
- Treatment: Bicarbonate and K+ supplements

Type 2
- Decreased HCO3 reabsorption
- Proximal tubule
- As distal tubule working okay, it is able to produce acidic urine
- Low K+, Low urine pH (<5.3)
- Associated with Wilson’s Disease & Fanconi’s syndrome

Type 4
- Due to hypoaldosteronism (Adrenal issue)
- NaK pump does not function. So Na excreted and K+ can’t be excreted
- High K+, Low urine pH (<5.3), Low Na
- Associated with hypoaldosteronism and Diabetes

Question 2

Diuretics - Carbonic Anhydrase Inhibitor

(Example, Action, Side effects)

Answer 2

• Acts on Proximal Convoluted Tubule
• Prevents bicarbonate & Na reabsorption -> Metabolic acidosis
• However, later on in the tubules, Na can be reabsorbed