RTA

Question 1

what is the cause of proximal tubule renal acidosis?

Answer 1

the proximal tubule is not reabsorbing the bicarbonate

Question 2

what is the main goal of the PCT in acid base balance?

Answer 2

reabsorption of bicarbonate

Question 3

type II RTA is a problem with what tubule?

Answer 3

proximal tubule

Question 4

what is fanconi syndrome?

Answer 4

when there is major problem with the PCT and there is RTA type II and you get amino acids and glucose in urine but have normal serum glucose

Question 5

in fanconi syndrome..where is the issue? what is the serum glucose what about urine glucose

Answer 5

PCT

Serum is normla

urine is high

Question 6

will patients with type II RTA have hyper or hypokalemia? explain why

Answer 6

hypokalemia…because sodium stays out in lumen with bicrb and you get a volume loss and crank up the RAAS so the K+ is secreted more distally

Question 7

will patients with type II RTA or PCT RTA have acidic or alkalotic urine?

Answer 7

acidic urine

Question 8

what are three common MSK issues associated with type II RTA?

Answer 8

weakness
bone fracture
delayed growth

Question 9

what is the most common association with fanconi syndrome or type II RTA?

Answer 9

multiple myeloma

Question 10

what two moelcules in the PCT can issues that lead to type II RTA?

Answer 10

carbonic anhydrase
and
NBC-1 channel…sodium bicarb channel

Question 11

what is the goal of the distal portion of the nephron is acid base balance?

Answer 11

excrete H+

Question 12

how is the DCT affected in type I RTA?

Answer 12

DCT cannot excrete the H+

Question 13

is urine pH low or high in type I RTA?

Answer 13

urine pH is high because cannot secrete H+ at DCT

Question 14

does type I RTA lead to hyper or hypokalemia?

Answer 14

hypokalemia

Question 15

what are two MSK symptoms associated with type I RTA?

Answer 15

weakness and slowed growth

Question 16

since the type I RTA leads to increased H+ in serum, what happens in the PCT to help correct this?

Answer 16

reabsorbs all the bicarb and citrate

Question 17

does type I RTA have low or high urine citrate?

Answer 17

low urine citrate

Question 18

what is a risk with really low urine citrate in type I RTA?

Answer 18

calcium phosphate kidney stones

Question 19

what is type IV RTA?

Answer 19

hyperkalemic RTA with aldo issues

Question 20

what is the problem in type 4 RTA?

Answer 20

aldosterone activity is down

Question 21

in type 4 RTA, aldo activity is down…what happens to the K+ and H+?

Answer 21

they are not excreted as much so you get hyperkalemia and acidosis

Question 22

does type 4 RTA lead to hyper or hypokalemia?

Answer 22

hyperkalemia

Question 23

the increased potassium in type 4 RTA, can lead to inhibition of what in the PCT?

Answer 23

inhibition of ammonia synthesis

Question 24

in type 4 RTA…high potassium inhibits ammonia synthesis in the PCT…what affect does this have on the urine?

Answer 24

ammonia is used as a buffer so now there is more free H+

Question 25

type 4 RTA has acidotic or alkalotic urine?

Answer 25

acidotic

Question 26

what is the difference in voltage dependent hyperkalemic type 4 RTA and regular type 4 RTA?

Answer 26

regular type 4 is underactivity of ENaC channels whereas voltage type 4 is total dysfunction or lack of ENaC channels

Question 27

what will urine pH be in voltage type 4 RTA?

Answer 27

it will be higher because no H+ is going into tubule at all since Na is totally stuck there

Question 28

type 4 RTA reg or voltage tpe 4 RTA ha higher tubular positive charge?

Answer 28

voltage type 4 RTA

Question 29

name four causes of voltage dependent hyperkal RTA?

Answer 29

severe hypovolemia
urinary tract obstruction
sickle cell disease
ENaC block by amiloride or triamterene

Question 30

why does severe hypovolemia lead to voltage dependent type 4 RTA?

Answer 30

because the sodium does not even get to the DCT so there is NO ENaC activity