RTAs Flashcards
Distal RTA (Type 1)
Distal tubule is damaged and unable to generate new bicarb to exchange with H+. Urine becomes basic.
Alkaline urine increases the risk for_____
kidney stones from calcium oxalate
best initial test to diagnose Distal RTA (type 1) is?
UA looking for high pH > 5.5
most accurate test for type I distal RTA diagnosis?
Infuse ammonium chloride acid into the blood. Healthy person can excrete the acid and decrease urine pH.
Treatment for distal RTA Type I
Give bicarb. It will be absorbed by the proximal tubule and correct the urine alkalosis and non-anion gap acidosis
Proximal RTA (Type II)
damage to proximal tubule decreases kidney ability to reabsorb bicarb. bicarb is lost in the urine until body is so depleted that distal tubule absorbs the rest. urine pH becomes low. chronic acidosis leaches calcium out of bones (osteomalacia)
most accurate test for RTA II proximal type?
give bicarb and teset for malabsorption in the kidney. urine pH should rise.
Potassium levels in proximal and distal RTAs?
hypokalemic
how to treat type II RTA?
thiazide diuretics cause volume depletion. this enhances bicarb reabsorption
Type IV RTA
hyporeninemia, hypoaldo. loss of sodium and retention of K and H+.
Type IV RTA occurs most often in what disease?
Diabetes
Test for type IV RTA?
persistently high urine Na despite Na depleted diet
steroid with highest mineralocorticoid or aldo effect?
fludrocortisone
Treatment for type IV RTA
fludrocortisone
How can you distinguish between diarrhea and RTA as a cause of normal anion gap acidosis?
Describe pathophys
urine anion gap. (Na - Cl)
RTA has a positive UAG.
Acid excreted by kidney is buffered as NH4Cl. more acid excreted = more chloride excreted.
In RTA there is a defect in acid excretion in urine so less chloride!
