RTA

Question 1

What is renal tubular acidosis

Answer 1

Hyperchloremic acidosis, normal anion gap, normal GFR, absence of diarrhea
inability to excrete H+ and synthesize HCO3

Question 2

What is the formula for urinary anion gap

Answer 2

(Na +K) - CL

Question 3

What is type I RTA

Answer 3

Distal RTA
Caused by deficiency in H secretion at collecting duct. Urine cannot be acidified so the body excretes more K to compensate

Question 4

Causes of Type I RTA

Answer 4

Paraproetinemia
Autoimmune disease
Drugs/toxins

Question 5

What are the clinical electrolyte manifestations of Type I RTA

Answer 5

• Nephrocalcinosis
• Nephrolithiasis
• Hypercalciuria
• Alkaline urine
• Hypokalemia
• Positive urinary anion gap

Question 6

Treatment plan for type I RTA

Answer 6

Sodium Bicarbonate 1-3 mEq/kg/day

Question 7

What is the mechanism behind Type II RTA

Answer 7

Selective defect in proximal tubule
• Inability filtered HCO3- reabsorption
• Bicarbonaturia
• Metabolic acidosis
• Decline in HCO3- delivery
• Decrease in plasma HCO3-
Mechanism
• Carbonic anhydrase inhibitors
• Fanconi syndrome
• Multiple myeloma

Question 8

Type II RTA K, urinary anion gap, and urinary pH

Answer 8

Causes
• Hypokalemia
• Variable urinary pH
• Positive anion gap

Question 9

Treatement of type II RTA

Answer 9

• HCO3- 10-15 mEq/kg/day
• Thiazide diuretic

Question 10

What is the mechanism behind type IV RTA

Answer 10

• Aldosterone deficiency or antagonism
• Impairs distal nephron
• Na+ reabsorption
• K+ and H+ excretion
• Causes
• Diabetic nephropathy
• Tubulointerstitial renal diseases
• Hypertensive nephrosclerosis
• AIDs

Question 11

Clinical manifestations of IV RTA

Answer 11

• Renal salt wasting
• Hyperkalemia
• Variable urinary pH
• Positive urinary anion gap

Question 12

Treatment plan for IV RTA

Answer 12

• Treatment Plan
• Fludrocortisone 0.1-0.5 mg/day
• Dietary K+ restriction
• Lasix 40-160 mg/day
• HCO3- 1-3 mEq/kg/day