renal tubular acidosis Flashcards
what is renal tubular acidosis
metabolic acidosis due to pathology in the tubules of the kidneys
RTA type 1
distal tubule cannot excrete hydrogen ions
urinary pH high
serum potassium low
RTA type 2
proximal tubule cannot reabsorb bicarbonate
urinary pH high
serum potassium low
RTA type 4
low aldosterone or impaired aldosterone function
urinary pH low
serum potassium high
most common type of RTA
TYPE 4
conditions that cause RTA type 1
Genetic (there are both autosomal dominant and autosomal recessive forms)
Systemic lupus erythematosus
Sjögren’s syndrome
Primary biliary cholangitis
Hyperthyroidism
Sickle cell anaemia
Marfan’s syndrome
presentation of RTA type 1
Failure to thrive in children
Recurrent UTIs (due to alkaline urine)
Bone disease (rickets or osteomalacia)
Muscle weakness
Arrhythmias (due to hypokalaemia)
treatment of RTA type 1
oral bicarbonate- corrects the acidosis
causes of RTA type 2
inherited
multiple myeloma
faconi’s syndrome
treatment of RTA type 2
oral bicarbonate
how does aldosterone work in kidneys
stimulates sodium reabsorption and potassium and hydrogen ion excretion in the distal tubules
low aldosterone- insufficient potassium and hydrogen ion excretion
causes of low aldosterone
adrenal insufficiency
diabetic nephropathy
medication (ACEi, spironolactone, eplerenone)
management of RTA type 4
treat underlying
fludrocortisone (mineralocorticoid steroid)
oral bicarbonate and treatment of hyperkalaemia
