Rneal Tubular Acidosis Flashcards
Which type of RTA has hyperkalemia?
Type 4
-> low, low MORE
Which RTA has low urinary pH?
Type IV RTA with metabolic acidosis and hyperkalemia
Which RTA has high urinary pH?
Type I
Type II
What is type I RTA underlying pathophysiology?
Reduced H+ excretion in DCT, with high urinary pH and low serum bicarbonate.
What is a complication of Type I RTA?
Chronic acidosis can cause bone buffering, which is release of calcium carbonate and calcium phosphate.
This can case osteomalacia or osteomporprsis/rickets
What are the causes of RTA?
Sjogren syndrome
Systemic lupus primary biliary cirrhosis
Which medications can cause Type I RTA?
Lithium
High ibuprofen dose
Amphotericin B
What is Type II RTA?
Impaired bicarbonate reabsorption in PCT, whic causes secondary hyperaldosteronism.
What is the cause of Type II RTA?
Wilson’s disease
Amyloidosis
Multiple myeloma
Franconia syndrome
What is Fanconi syndrome?
Fanconi syndrome affecting PCT causing excessive urinary losses of amino acids, glucose, phosphate and other solutes as well as bicarbonate.
Causes Type II RTA
What is Type IV RTA?
Occurs due to hpyoaldosteronism with insufficient ammonium and potassium excretion causing metabolic acidosis an hyperkalemia
What is the causes of type IV RTA?
Hypoaldosternoism with:
Adrenal insufficiency
Diabetic nephropathy
Medications like ACE inhibitors
Chronic interstitial nephritis
Obstructive nephropathy
What does nephrocalcinoiss or renal calcium point towards?
Type 1 RTA
WHAT is the gold standard diagnosis test?
Bicarbonate or ammonium chloride loading test
What are the findings in Type I RTA tes?
IV sodium bicarbonate causes rapid rise in urinary bicarbonate and pH
What are the findings for the test in Type II RTA?
Administration of ammonium chloride has no effect on acidification of urine
How can type I RTA be corrected?
Bicarbonate treatment
-> improves hpyokaelmia
How can type II RTA be treated?
Bicarbonate
Thiazide diuretic
-> risk of worsened hypokaelmia
What SHOULD be used as alternative in nephrocalcinosis?
Potassium citrate
What is the treatment of type IV RTA?
Lifelong mineralcorticoid and glucocorticoids replacement
What is the cause of Fanconi syndrome?
Sjogren’s syndrome
multiple myeloma
nephrotic syndrome
Wilson’s disease
What is the most common cause of Fanconi syndrome in children?
Cystinosis
