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Renal Tubular Acidosis
Types
Type 1 / Distal
- failure of H+ excretion in distal convoluted tubule
- hypokalaemia (usually)
- inability to lower pH <5.5
- low urinary ammonia
- Causes
- Idiopathic
- Genetic
- Familial
- Marfans
- Ehlers-Danlos
- Nephrocalcinosis
- chronic hypercalcaemia
- medullary sponge kidney
- hypergammaglobulinaemia
- amyloidosis
- cryoglobulinaemia
- cirrhosis
- drugs and toxins
- amphotericin B
- lithium carbonate
- autoimmune
- Sjogrens syndrome
- thyroiditis
- autoimmune hepatitis
- primary biliary cirrhosis
- urinary tract obstruction
- sickle cell anaemia
- systemic lupus erythematosus
- renal transplant rejection
Type 2 / Proximal
- failure of sodium bicarbonate reabsorption in proximal tubule
- metabolic acidosis
- hypokalaemia
- appearance of bicarbonate in urine despite subnormal plasma bicarbonate
- often occure with glycosuria, amino-aciduria
- causes
- cystinosis
- tyosinaemia
- Wilson's disease
- glycogen storage disease Type 1
- pyruvate carboxylase deficiency
- multiple myeloma
- vitamin D deficiency
- Toxins / Drugs
- carbonic anhydrase inhibitors
- lead
- cadmium
- mercury
- uranium
- copper
- outdated tetracycline
- streptozocin
Type 3
- very rare
- combination of Types 1 and 2
Type 4
- hyporeninaemic hypoaldosteronism
- most common form of renal tubular acidosis
- hyperkalaemia
- plasma renin & aldosterone low
- mild chronic renal insufficiency
- reflux
- diabetes
- chronic use of NSAIDs
- Treatment
- fludrocortisone
- sodium bicarbonate
- diuretics
- anion-exchange resins
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