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Renal Tubular Acidosis

Created: 18/1/2006

 

RENAL TUBULAR ACIDOSIS

Definition
Group of uncommon disorders in which the kidney is unable to adequately acidify the urine

Type 4 (hyperkalaemic)

  • The most common
  • Mineralocorticoid deficiency decreases H+ secretion in the distal nephron thereby decreasing NH4+ excretion

Associations
Diabetes, Addisons, tubulointerstitial disease

Presentation

  • Hyperkalaemia
  • Mild renal failure
  • Urinary pH <5.4
  • Hyperchloraemic metabolic acidosis

Treatment

  • Fludrocortisone (if acidotic or hyperkalaemic)
  • Diuretics
  • Sodium bicarb
  • Calcium resonium to reduce serum potassium

Type 2 (proximal)
Failure of bicarb reabsorption in the proximal convoluted tubule

Association
Can occur alone but usually associated with Fanconi syndrome
(Syndrome of generalised tubular dysfunction with glycosuria, phosphaturia, amino aciduria, rickets/osteomalacia and type 2 RTA)

Presentation

  • Polyuria
  • Polydipsia
  • Bone pain (due to rickets or osteomalacia)
  • NB Renal calculi and nephrocalcinosis rarely seen

Diagnosis

  • Hypoklaemia
  • Hyperchloraemic metabolic acidosis

Treatment

  • High dose Sodium bicarb

Type 1 (distal)
Failure of H+ excretion in the distal convoluted tubule

Associations
Autoimmune disorders, SLE and nephrocalcinosis

Presentation:

  • Renal calculi related to hypercalciuria, low urinary citrate (citrate prevents precipitation of calcium phosphate) and an alkaline urine (leads to precipitation of calcium phosphate)
  • Recurrent UTI
  • Hyperventilation
  • Bone pain (due to rickets or osteomalacia)
  • Muscle weakness (due to hypokalaemia)
  • Renal failure

Diagnosis

  • Hypokalaemia
  • Urine pH >6 despite systemic acidosis
  • Hyperchloraemic metabolic acidosis
  • Hypercalciuria
  • Nephrocalcinosis

Treatment

  • Correct hypokalaemia before acidosis
  • Sodium bicarb

ArticleDate:20060118
SiteSection: Article
 
   
    
                                            



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