Renal Tubular Acidosis

From Anvita Health Wiki

Contents 1 More Specific Terms 2 Classification 3 Etiology 4 Laboratory 5 Differential-diagnosis 6 Management 7 More General Terms 8 References

More Specific Terms

• autosomal dominant distal renal tubular acidosis
• autosomal recessive distal renal tubular acidosis
• renal tubular acidosis (RTA) type I (hyperchloremic acidosis)
• renal tubular acidosis (RTA) type II
• renal tubular acidosis (RTA) type III
• renal tubular acidosis (RTA) type IV

Classification

• Type 1 ( distal)
• serum HCO3- 5-15 meq/L
• urine pH > 6.0
• low serum K+
• Type II ( proximal)
• serum HCO3- 14-20 meq/L
• urine pH < 5.0
• normal or mildly decreased serum K+
• increased HCO3- in urine
• Type III (rare)
• Type IV ( distal)
• serum HCO3- 14-20 meq/L
• urine pH < 5.5, but may be > 6.0 with obstruction
• high serum K+
• high serum chloride
• associated with diabetes

• pharmacologic causes:

• acetazolamide
• amphotericin B
• tetracycline (degraded)

Etiology

• diabetes mellitus
• hypercalcemia

Laboratory

• arterial blood gas
• chem7:

• serum Na+, serum K+. serum choride, serum bicarbonate
• calculate anion gap

Differential-diagnosis

• Fanconi's syndrome:

• glucosuria, aminoaciduria, hyperphosphaturia, hyperuricosuria
• normal serum glucose

Management

• see specific type
• distal RTA:

• bicarbonate
• loop diuretic for hyperkalemia

• proximal RTA: thiazide diuretic to reduce bicarbonate loss

More General Terms

• metabolic acidosis
• renal tubular disease

References

1. Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 829-39
2. Renal Tubular Acidosis [1]

renal tubular acidosis (RTA)