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Renal tubular acidosis
HCO3-
reabsorpti
on failure
Normal hyperchlo
GFR remic
RTA
Metabolic Normal
acidosis anion gap
Acid base balance
Lung and kidney have a role in maintainig acid
base balance
CO2
NH4
HCO3
Physiology of nephron
filtration
glucose
HCO3-
reabsorption
Amino acids
electrolytes
secretion
H+ electrolytes
NH4+
http://www.buzzle.com/articles/labeled-diagram-of-nephron.html
Proximal tubule
Arizpe RM, Escobar L, Medeiros M. Renal tubular acidosis in children: state of the
art, diagnosis and treatment. Bol Med Hosp Infant Mex 2013;70(3): p 178-193.
Distal tubule
Arizpe RM, Escobar L, Medeiros M. Renal tubular acidosis in children: state of the
art, diagnosis and treatment. Bol Med Hosp Infant Mex 2013;70(3): p 178-193.
H+
NH4+
H+
HCO3- Aldosterone
RTA pathophysiology
Figure above demonstrate the location of RTA type. The proximal
tubule(green) is the main location for bicarbonate reabsorption and it is
impaired in type 2 RTA causing bicarbonate loss. The distal tubule (purple)
has small role in bicarbonate reabsorption and mainly excrete acid. It is
impaired in type 1 RTA. The distal tubule and collecting duct (yellow) are
the places where aldosterone, the main problem of type 4 RTA, work.
Unable to excrete K+, amoniogenesis disturbed and H+ and NH4+ http://biologymayhem.blogspot.com/2
excretion also decreased. 011/01/on-kidneys_03.html
Types of Renal Tubular Acidosis
Type 1 : distal tubule
Type 2 : proximal tubule
Type 3 : combination of type 1 & 2
Type 4 : hypoaldosteronism
Polyuria
Polydipsia
RTA type 1
Causes Characteristic
autoimmune Hypokalemia
Amphotericine Nephrolithiasis
B
Hyperchloremic
metabolic
acidosis
RTA type 2
Causes Characteristic
Fanconi Hypokalemia
syndrome
Serum HCO3
Acetazolamide
14-20 mg/dL
Hyperchloremic
Amyloidosis metabolic
acidosis
RTA type 4
Causes Characteristic
hypoladosteronism Hyperkalemic
Mild metabolic
acidosis
Metabolic
acidosis
pH, HCO3, BE
Anion gap
High
Normal (>16mEq/L)
(8-16 mEq/L) Unmeasured
anion
Ketoacidosis
Calycilate
GI tract RTA
poisoning
disorder:
Diarrhea
ileostomy
Urine anion
gap
Positive
Negative
Cl < (Na+K)
Cl > (Na+K)
pRTA K+ serum
pH <5.5
FE HCO3- >
10-15%
Low K+ Hi K+
serum serum
Albar H. Asidosis Tubular Ginjal Pada Anak.
pH > 5.5 pH <5.5
Maj Kedokt Indon. 2005; 55 : p 67-78
dRTA Hyperkalemi
RTA
Type Type 1 Type 2 Type 4
location Distal tubule Proximal tubule adrenal
acidosis Yes (severe) Yes Yes (mild)
potassium hypokalemia hypokalemia hyperkalemia
pathophysiology Failure of H+ Failed HCO3 Deficiency of
secretion by the reabsorption from aldosterone, or a
intercalated cells the urine by the resistance to its
and reclaim K proximal tubular effects,
cells (hypoaldosteronism
or
pseudohypoaldoste
ronism)