RTA Renal Tubular acidosis Test Questions With Correct Answers

What is Renal Tubular acidosis? - Answer A medical condition that involves an accumulation of acid in the body due to a failure of the kidneys to appropriately acidify the urine or reabsorb bicarbonate. Pathophysiology of renal tubular acidosis - Answer a. Normally, when blood is filtered by the kidney, the filtrate passes through the tubules of the nephron, allowing for exchange of salts, acid equivalents and other solutes before it drains into the bladder as urine. b. In renal tubular acidosis, there is -failure of the kidneys to appropriately reabsorb bicarbonate from the filtrate in the early portion of the nephron (proximal tubule) or by -failure of the kidneys to appropriately acidify the urine by secretion of hydrogen ions into the latter portion of the nephron (distal tubule) c. This results in metabolic acidosis - (a normal anion gap acidosis) In RTA are the kidneys involved in causing metabolic acidosis? - Answer In renal tubular acidosis there is metabolic acidosis in a well functioning kidneys (because the glomerulus is not involved. if the glomerulus is involved, you would see aberrations in urea and creatinine) Normal blood PH 7.35 - 7.45 pH < 7.35 is_______ - Answer acidemia What is acidosis? - Answer Acidemia (pH < 7.35) with symptoms is acidosis what type of acidosis is seen in renal tubular acidosis - Answer A normal anion gap acidosis AKA hyperchloremic metabolic acidosis (due to decrease plasma bicarbonate concentration and increase chloride concentration) -increased chloride -decreased bicarbonate causes of normal anion gap acidosis - Answer Renal tubular acidosis, carbonic anhydrase inhibitors, lysine or arginine HCl, pancreatic fistula, diarrhea, ammonium chloride, & ureterosigmoidostomy. Types of RTA include - Answer a. Type 1 b. Type 2 c. Type 3 d. Type 4 Type 1 renal tubular acidosis - Answer AKA Distal renal tubular acidosis Definition This is the classical form and It is characterized by a failure of kidneys to acidity urine by secretion of H+ into the collecting ducts and distal tubules. Events a. Failure of H+ secretion b. Inability to acidify urine to PH <5.5. c. Acidemia + d. Hypokalemia e. Formation of stones Events in Distal renal tubular acidosis - Answer a. Failure of H+ secretion b. Inability to acidify urine The failure of H+ secretion leads to inability of the individual to acidify urine to a PH <5.5. c. Acidemia Because renal excretion is the primary means of eliminating H+ from the body, there is tendency of acidemia. d. Hypokalemia There is an inability to excrete H+ while K+ cannot be reclaimed leading to acidemia and hypokalemia. The H+/K+ antiporter is non functional e. Formation of stones Since calcium phosphate stones deposits in alkaline urine, the kidney develops stones, this does not occur in other types of RTA. What type of renal tubular acidosis is the classical form - Answer Distal RTA(type 1) is the classical form Cause of Type 1 renal tubular acidosis - Answer i) Primary ii) Secondary. Cause of Type 1 renal tubular acidosis can either be Primary or secondary. Primary causes include - Answer sporadic, hereditary Cause of Type 1 renal tubular acidosis can either be Primary or secondary. Secondary causes include - Answer ORGAN PROBLEMS i. Renal disease MEDICATIONS (Nephrotoxic) i. Amphotericin B ii. Lithium iii. NSAIDs HORMONAL i. hyperparathyroidism ii. Hypercalcemia AUTO IMMUNE i. Sjogren syndrome, an autoimmune disorder in which lacrimal and salivary glands are destroyed ii. Systemic lupus erythematosus HEREDITARY i. Sickle cell disease ii. Amyloidosis, a build up of abnormal protein called amyloid in the tissues and organs iii. Wilson disease Clinical features of Type 1 renal tubular acidosis include - Answer a. Normal anion gap metabolic acidosis/ acidemia b. Hypokalemia, hypocalcemia, hyperchloremia c. Urinary stones (alkaline urine, hypercalciuria, low urinary citrate) d. Nephrocalcinosis (due to calcium deposition) e. Bone demineralization (due to acidosis causing ricketts and osteomalacia) f. Growth deficiency Type 1 renal tubular acidosis vs all the other types - Answer In type 1 renal tubular acidosis, there is formation of calcium phosphate stones