Renal Tubular Acidosis Flashcards
What is renal tubular acidosis?
Metabolic acidosis due to pathology in the tubules of the kidney
What is renal tubular acidosis due to?
Impaired acid excretion leads to hyperchloremic metabolic acidosis
What does renal tubular acidosis lead to?
Activation of the Renin Angiotensin system
What does renal tubular acidosis result in?
Potassium wasting and hypokalaemia
What is type 1 renal tubular acidosis characterised by?
The distal tubule is unable to excrete hydrogen ions.
What are the hereditary causes of type 1 renal tubular acidosis?
Marfan’s
Ehler’s Danlos
What are the autoimmune causes of type 1 renal tubular acidosis?
Sjogren’s
SLE
Thyroiditis
Where is the pathology with type 1 renal tubular acidosis?
Distal tubule
What are possible complications of type 1 renal tubular acidosis?
Nephrocalcinosis
Renal stones
Osteomalacia
What are the main features type 1 renal tubular acidosis?
Hypokalaemia
Metabolic acidosis
High urinary pH (above 6)
What is the management of type 1 renal tubular acidosis?
Oral bicarbonate.
What can nephrocalcinosis lead to?
End stage renal failure
How is type 1 renal tubular acidosis diagnosed?
Failure to acidify urine (pH >5.5) despite acid load
Where is the pathology in type 2 renal tubular acidosis?
Pathology in the proximal tubule
What is type 2 renal tubular acidosis due to?
It is due to a defect in HCO3 reabsorption into the blood from the urine in the proximal tubule
How is type 2 renal tubular acidosis diagnosed?
Urine will acidify with an acid load (pH <5.5)
What is the main cause of renal tubular acidosis?
Idiopathic associated with Falconi syndrome
What does type 2 renal tubular acidosis result in?
Hypokalaemia
Metabolic acidosis
High urinary pH (above 6)
What is the management of type 2 renal tubular acidosis?
Oral bicarbonate
What is a possible complication of type 2 renal tubular acidosis?
Osteomalacia
What is type 3 renal tubular acidosis?
Combination of type 1 and type 2
Where is the pathology with type 3 renal tubular acidosis?
In the proximal and distal collecting ducts
What is type 4 renal tubular acidosis due to?
Reduced aldosterone.
What is the most common type of renal tubular acidosis?
Type 4 renal tubular acidosis
What does a reduction in aldosterone lead to?
A reduction in proximal tubular ammonium excretion
What are the main causes of type 4 renal tubular acidosis?
Hypoaldosteronism
Diabetes
What does type 4 renal tubular acidosis result in?
Hyperkalaemia
High chloride
Metabolic acidosis
Low urinary pH
What is the management of type 4 renal tubular acidosis?
Fludrocortisone
