RTA

• related: nephrology
• tags: #nephrology

Type 1 RTA

• pt: sjogren, RA, kid, amphotericin B
• cause: distal tubule cannot excrete H or absorb K
• sx:
  • recurrent bilateral stones
  • rickets disease
  • growth failure in children
• dx:
  • non AG metabolic acidosis but high urine pH (can't excrete H)
  • acidosis increases Ca excretion (stones)
  • hypokalemia (can't absorb K)
  • hyperchloremia
  • positive urine AG
• rx: Na bicarb

Type 2 RTA

• pt
• cause: can't absorb HCO3 absorption in proximal tubule. Fanconi syndrome
• sx
  • no stones
• dx
  • milder metabolic acidosis bicarb 12-20
  • hypokalemia from increased aldosterone from volume contraction
  • urine pH < 5.3

Type 4 RTA

• pt:
• cause: aldosterone deficiency or resistance
  • diabetes, ace, arb, nsaids, adrenal insufficiency
  • bactrim, K sparing diuretics
• sx
• dx
  • hyperkalemia from decreased K excretion
  • pH < 5.4
• rx: mineralocorticoid or fludrocortisone