Aidan at 14:51, 24 March 2024

2024-03-24T14:51:54Z

← Older revision		Revision as of 14:51, 24 March 2024
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	== Types ==		== Types ==

	=== Type I: ~~hypokalemic~~ ~~distal~~ ===		=== Type I: Hypokalemic Distal ===

	* Caused by defects in distal tubular H+ secretion		* Caused by defects in distal tubular H+ secretion
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	* Etiology		* Etiology
	** Hereditary		** Hereditary
	** Genetic: sickle cell; Fabry disease; Wilson disease; elliptocytosis		** Genetic: [[Sickle cell disease\|sickle cell]]; [[Fabry disease]]; [[Wilson disease]]; [[elliptocytosis]]
	** Medullary cystic kidney disease		** [[Medullary cystic kidney disease]]
	** Autoimmune: Sjögren syndrome, systemic lupus erythematosus		** Autoimmune: [[Sjögren syndrome]], [[systemic lupus erythematosus]]
	** Nephrocalcinosis/hypercaliuria		** [[Nephrocalcinosis]]/[[hypercaliuria]]
	** Dysproteinemias: amyloidosis, cryoglobulinemia, hypergammaglobulinemia		** Dysproteinemias: [[amyloidosis]], [[cryoglobulinemia]], [[hypergammaglobulinemia]]
	** Drugs: amphotericin B, lithium, analgesic abuse		** Drugs: [[amphotericin B]], [[Lithium toxicity\|lithium]], analgesic abuse
	** Tubulointerstitial disease: reflux nephropathy, ~~obstrctive~~ uropathy, kidney transplant rejection		** Tubulointerstitial disease: [[reflux nephropathy]], [[obstructive uropathy]], kidney transplant rejection

	=== Type II: ~~proximal~~ ===		=== Type II: Proximal ===

	* Caused by proximal tubular bicarbonate reabsorption		* Caused by proximal tubular bicarbonate reabsorption
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	* Etiology		* Etiology
	** Primary (hereditary or sporadic)		** Primary (hereditary or sporadic)
	** Hereditary carbonic anhydrase deficiency		** [[Hereditary carbonic anhydrase deficiency]]
	** Fanconi syndrome		** [[Fanconi syndrome]]

	=== Type IV: ~~hyperkalemic~~ ~~distal~~ ===		=== Type IV: Hyperkalemic Distal ===

	* Caused by impaired ammoniagenesis, often caused by hypoaldosteronism		* Caused by impaired ammoniagenesis, often caused by hypoaldosteronism
	* Hyperkalemia, positive urine anion gap, urine pH <5.5		* Hyperkalemia, positive urine anion gap, urine pH <5.5
	* Etiology		* Etiology
	** Primary aldosterone deficiency (Addison disease)		** [[Primary aldosterone deficiency]] ([[Addison disease]])
	** '''Hyporeninemic hypoaldosteronism'''		** '''Hyporeninemic hypoaldosteronism'''
	*** Acute glomerulonephritis		*** Acute [[glomerulonephritis]]
	*** Chronic nephropathy		*** Chronic nephropathy
	**** '''Diabetes''' (most common cause)		**** '''[[Diabetes mellitus\|Diabetes]]''' (most common cause)
	**** Systemic lupus erythematosus		**** [[Systemic lupus erythematosus]]
	**** ~~AIDS~~		**** [[HIV]]
	** Aldosterone resistance:		** Aldosterone resistance:
	*** Tubulointerstitial disease: urinary obstruction, sickle cell disease, medullary cystic kidney disease, and kidney transplant rejection		*** Tubulointerstitial disease: [[urinary obstruction]], [[sickle cell disease]], [[medullary cystic kidney disease]], and kidney transplant rejection
	** Drugs: ACE inhibitors, cyclooxygenase inhibitors, trimethoprim, heparin		** Drugs: [[ACE inhibitors]], cyclooxygenase inhibitors, [[trimethoprim]], [[heparin]]
	* Mixed proximal/distal		* Mixed proximal/distal
	** Carbonic anhydrase mutations		** Carbonic anhydrase mutations
	** Drugs: topiramate		** Drugs: [[topiramate]]

	== Risk Factors ==		== Risk Factors ==

	* Type IV: diabetes		* Type IV: [[Diabetes mellitus\|diabetes]]

	== Investigations ==		== Investigations ==
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	* Urine pH		* Urine pH

			{\| class="wikitable"
	{\|
	!		!
	! Type 1		! Type 1
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	\|-		\|-
	\| Serum K		\| Serum K
	\| ↓ / ↑*		\| ↓ / ↑†
	\| ↓		\| ↓
	\| ↑		\| ↑
	\|-		\|-
	\| Serum HCO<s>3</s>		\| Serum HCO<sub>3</sub>
	\| Variable		\| Variable
	\| 10-20		\| 10-20
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	\|}		\|}

	* a hyperkalemic Type 1 RTA is possible with urinary obstruction, sickle cell, lupus, and renal transplant		* † a hyperkalemic Type 1 RTA is possible with [[urinary obstruction]], [[Sickle cell disease\|sickle cell]], [[lupus]], and renal transplant

	[[Category:Nephrology]]		[[Category:Nephrology]]

Maintenance script: Imported from text file

2020-07-04T01:17:54Z

Imported from text file

New page

== Definition ==

* Group of diseases characterized by non-anion gap metabolic acidosis and preserved renal function

== Types ==

=== Type I: hypokalemic distal ===

* Caused by defects in distal tubular H+ secretion
* Hypokalemia, positive urine anion gap, urine pH >5.5
* Etiology
** Hereditary
** Genetic: sickle cell; Fabry disease; Wilson disease; elliptocytosis
** Medullary cystic kidney disease
** Autoimmune: Sjögren syndrome, systemic lupus erythematosus
** Nephrocalcinosis/hypercaliuria
** Dysproteinemias: amyloidosis, cryoglobulinemia, hypergammaglobulinemia
** Drugs: amphotericin B, lithium, analgesic abuse
** Tubulointerstitial disease: reflux nephropathy, obstrctive uropathy, kidney transplant rejection

=== Type II: proximal ===

* Caused by proximal tubular bicarbonate reabsorption
* Hypokalemia, negative urine anion gap, urine pH variable
* Etiology
** Primary (hereditary or sporadic)
** Hereditary carbonic anhydrase deficiency
** Fanconi syndrome

=== Type IV: hyperkalemic distal ===

* Caused by impaired ammoniagenesis, often caused by hypoaldosteronism
* Hyperkalemia, positive urine anion gap, urine pH <5.5
* Etiology
** Primary aldosterone deficiency (Addison disease)
** '''Hyporeninemic hypoaldosteronism'''
*** Acute glomerulonephritis
*** Chronic nephropathy
**** '''Diabetes''' (most common cause)
**** Systemic lupus erythematosus
**** AIDS
** Aldosterone resistance:
*** Tubulointerstitial disease: urinary obstruction, sickle cell disease, medullary cystic kidney disease, and kidney transplant rejection
** Drugs: ACE inhibitors, cyclooxygenase inhibitors, trimethoprim, heparin
* Mixed proximal/distal
** Carbonic anhydrase mutations
** Drugs: topiramate

== Risk Factors ==

* Type IV: diabetes

== Investigations ==

* Serum electrolytes
** Normal anion gap metabolic acidosis
** Hyperkalemia (type IV)
* Urine anion gap: UNa + UK - UCl
** If positive, suggests presence of ammonium
** If kidneys are responding properly, the UAG should be negative
** If defect in acid excretion, UAG should be positive
* Urine pH

{|
!
! Type 1
! Type 2
! Type 4
|-
| Acidosis
| Severe
| Moderate
| Mild
|-
| Serum K
| ↓ / ↑*
| ↓
| ↑
|-
| Serum HCO<s>3</s>
| Variable
| 10-20
| >17
|-
| Urine pH
| >5.3
| <5.3
| <5.3
|-
| Urine AG
| +
| ±
| +
|}

* a hyperkalemic Type 1 RTA is possible with urinary obstruction, sickle cell, lupus, and renal transplant

[[Category:Nephrology]]

Renal tubular acidosis - Revision history

Aidan at 14:51, 24 March 2024

Maintenance script: Imported from text file