29. Renal tubular acidosis Flashcards Preview

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Flashcards in 29. Renal tubular acidosis Deck (14):
1

Renal tubular acidosis- definirion

disorder of the renal tubules that leads to normal annion gap ( hyperchloremic ) metabolic acidosis )

2

Renal tubular acidosis types

1. Distal renal tubular acidosis (type 1)
2.Proximal renal tubularacidosis (type 2)
3. Combined proximal and distal renal tubular acidosis type (3)
4.Hyperkalemic renal tubular acidosis
(type 4)

3

Distal renal tubular acidosis (type 1) - mechanism

defect in ability of α intercaleted cells to secret H+ --> no new HCO3 is generated ( CL / HCO3- exchanger in the basolateral membrane ) --> metabolic acidosis and urine ph mor tha 5.5

4

Distal renal tubular acidosis (type 1) is associated with ( an mechanism)

1. hypokalemia ( α- cell cannot secret H+ , and cannot reabsorb K+ , maybe because H+/K+ pump)
2. high risk for calcium phosphate kidney stones ( due to increased urine pH and increased bone turnover )

5

CAUSES Distal renal tubular acidosis (type 1)

1. amphotericin B toxicity
2. analgesic nephropathy
3. congenital anomalies ( obstruction of urinary tract

6

Causes Proximal renal tubularacidosis (type 2)

1. Fanconi syndrome
2. Carbonic anhydrase inhibitors

7

Proximal renal tubularacidosis (type 2) is associated with

1. hypokalemia
2. high riskfor hypophosphatemic rickets ( low phosphate - maybe from Fanconi)

8

Proximal renal tubularacidosis (type 2) - mechanism

Urine pH increased excretion of HCO3 − in urine and
subsequent metabolic acidosis. Urine is acidified by α-intercalated cells in collecting tubule.

9

.Hyperkalemic renaltubular acidosis
(type 4)

Hypoaldosterinism ---> hypekalemia ---> low NH3 synthesis in PCT --> low NH4 + excretion --> urine ph less than 55

10

.Hyperkalemic renal tubular acidosis
(type 4)

1. low aldosterone production
2. aldosterone resistance

11

example of low aldosterone production causes

1. diabetic hyporeninism
2. ACE inhibitors
3. Angiotensin receptor blockers
4. NSAID
5. Heparin
6. Cyclosporine
7. Adrenal insufficiency

12

exmple of aldosterone resistance causes

1. K+ sparing diuretics
2. nephropathy due to obstruction
3. TMP/SXM

13

Renal tubular acidosis - types / urine ph/ sodium concentration

1. Distal renal tubular acidosis (type 1)
urine ph more tha 5.5- hypokalemia
2.Proximal renal tubularacidosis (type 2) - urine ph less than 5.5 - hypokalemia

4.Hyperkalemic renal tubular acidosis (type 4) - urine ph less than 5.5 - hyperkalemia

14

Renal tubular acidosis - causes of every type

1. Distal renal tubular acidosis (type 1)
a. amphotericin B toxicity
b. analgesic nephropathy
c. congenital anomalies ( obstruction of urinary tract
2.Proximal renal tubularacidosis (type 2)
a. Fanconi syndrome
b. Carbonic anhydrase inhibitors
4.Hyperkalemic renal tubular acidosis
(type 4) --> decreased aldosterone production (1. diabetic hyporeninism
2. ACE inhibitors
3. Angiotensin receptor blockers
4. NSAID
5. Heparin
6. Cyclosporine
7. Adrenal insufficiency ) or aldosterone resistance (1. K+ sparing diuretics
2. nephropathy due to obstruction
3. TMP/SXM)

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