RENAL TUBULAR ACIDOSIS

RENAL TUBULAR ACIDOSIS (RTA)

  • It is a medical condition that involves an accumulation of acid in the body due to a failure of kidneys to appropriately acidify the urine


RTA - 1

  • Distal convoluted tubule (DCT) involved
  • alpha(α) interrelated cells responsible for hydrogen(H+) excretion
  • beta(β) interrelated cells responsible for bicarbonate excretion
- In RTA - 1, α (alpha) interrelated cells are not working

  1. Impaired H+ excretion
  2. impaired NH4CL (ammonium chloride) excretion
  3. salt wasting ➝ increase aldosterone
  4. Hypokalemia
  5. metabolic acidosis which impair tubular reabsorption of calcium leading to NEPHROCALCINOSIS
CAUSES

  • Multiple myeloma
  • Scleroderma
  • Amphotericin B
TREATMENT

  • Oral soda bicarbonate



RTA - 2

  • PCT(Proximal convoluted tubules) involved
  • associated with Fanconi syndrom
  • characterized by
- Bicarbonaturia
- salt wasting
- polyuria
- aminoaciduria
- glucosuria
- phosphaturia


ETIOLOGY
  1. Multiple myeloma
  2. wilsons disease
  3. expiry date tetracycline


TREATMENT
  1. Thiazides: cause volume contraction ⇁ metabolic alkalosis
- GFR decreased : RAAS activation
- Aldosterone increased (leads to increase H+ excretion thus causes alkalosis and neutralizing the acidosis component)

2.    soda bicarbonate




RTA - TYPE 4

most common type RTA

ETIOLOGY
Aldosterone is not able to function ( due to resistance/deficiency)
  1. Diabetes mellitus
  2. AIDS
  3. Chronic tubular interstitial disorders
  4. hypertensive nephrosclerosis

CLINICAL FEATURE
  1. Salt wasting/polyuria
  2. hyperkalemia
  3. inability to excrete H+

TREATMENT
  1. Fludrocortisone
  2. Diet - K+ restriction
  3. Furosemide
  4. Soda Bicarbonate

IMPORTANT POINTS IN RTA

- Normal anion gap metabolic acidosis
- RTA - 1 ➝ Kidney stones
- RTA - 2 ➝ Bicarbonaturia
- RTA - 4 ➝ Hyperkalemia
- Urinary anion gap ➝ positive (blood anion gap - normal)
- oral soda bicarbonate is used to neutralize the acidosis



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