Renal tubular acidosis - Revision history

ClaireLewis: /* Etiologies */

2019-09-29T16:38:37Z

Etiologies

← Older revision		Revision as of 16:38, 29 September 2019
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	*Type IV RTA		*Type IV RTA
	**Aldosterone deficiency or resistance		**Aldosterone deficiency or resistance
	**[[Diabetic nephropathy]] (hyporenin/hypoaldosteronism)		**[[DM\|Diabetic nephropathy]] (hyporenin/hypoaldosteronism)
	**Obstructive uropathy		**Obstructive uropathy
	**Chronic tubulointerstitial disease		**Chronic tubulointerstitial disease

ClaireLewis at 16:38, 29 September 2019

2019-09-29T16:38:14Z

← Older revision		Revision as of 16:38, 29 September 2019
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	==Background==		==Background==
	*~~Hyperchloremic~~ [[metabolic acidosis]], non-anion gap		*Class of disorders characterized by impaired reabsorption of filtered bicarbonate or excretion of hydrogen ions
			*Causes hyperchloremic [[metabolic acidosis]], non-anion gap
	*Diagnostic classification starts with low, normal, or high serum potassium		*Diagnostic classification starts with low, normal, or high serum potassium
	*Differentiate from [[uremia]] in which acidosis is anion gap		*Differentiate from [[uremia]] in which acidosis is anion gap

	~~==Differential Diagnosis==~~
	*See [[metabolic acidosis]]

	~~==Workup==~~
	*ABG or VBG
	*BMP, phos, mag
	*Urine pH
	*Urine electrolytes - Na, K, Cl, Ca, Cr
	*Plasma aldosterone and cortisol for type IV RTA
	*Note that when hyperkalemia is present, aldosterone should be elevated, so a "normal" aldosterone level may be relatively low

	==Etiologies==		==Etiologies==
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	**[[Amyloidosis]]		**[[Amyloidosis]]
	**Drugs - ifosfamide, [[acetazolamide]]		**Drugs - ifosfamide, [[acetazolamide]]
	**Heavy metals ([[Lead]], mercury, copper/Wilson's)		**Heavy metals ([[Lead]], [[mercury toxicity\|mercury]], [[copper toxicity\|copper]]/[[wilson's disease\|Wilson's]])
	**[[Vitamin D deficiency]], rickets, hypophosphatemia		**[[Vitamin D deficiency]], [[rickets]], [[hypophosphatemia]]
	**[[Paroxysmal nocturnal hemoglobinuria]]		**[[Paroxysmal nocturnal hemoglobinuria]]
	**Renal transplant		**[[kidney transplant\|Renal transplant]]
	**Fanconi's syndrome		**Fanconi's syndrome
	**Familial		**Familial
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	**[[Cirrhosis]]		**[[Cirrhosis]]
	**Obstructive uropathy		**Obstructive uropathy
	**Renal transplant		**[[kidney transplant\|Renal transplant]]
	**Familial (decreased H+/K+-ATPase, Na+/K+-ATPase activity)		**Familial (decreased H+/K+-ATPase, Na+/K+-ATPase activity)
	*Type IV RTA		*Type IV RTA
	**Aldosterone deficiency or resistance		**Aldosterone deficiency or resistance
	**Diabetic nephropathy (hyporenin/hypoaldosteronism)		**[[Diabetic nephropathy]] (hyporenin/hypoaldosteronism)
	**Obstructive uropathy		**Obstructive uropathy
	**Chronic tubulointerstitial disease		**Chronic tubulointerstitial disease
	**Potassium-sparing diuretics		**Potassium-sparing [[diuretics]]
	**Heparin induced adrenal insufficiency		**[[Heparin]] induced [[adrenal insufficiency]]

			==Differential Diagnosis==
			*See [[metabolic acidosis]]

			==Workup==
			*[[ABG]] or [[VBG]]
			*BMP, phos, mag
			*Urine pH
			*Urine electrolytes - Na, K, Cl, Ca, Cr
			*Plasma aldosterone and cortisol for type IV RTA
			*Note that when hyperkalemia is present, aldosterone should be elevated, so a "normal" aldosterone level may be relatively low

	==Features and Treatment==		==Features and Treatment==
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	*For type I and II RTA, treat all children and infants		*For type I and II RTA, treat all children and infants
	**Generally, 5-15 mEq/kg/day oral bicarbonate		**Generally, 5-15 mEq/kg/day oral bicarbonate
	**May require IV bicarbonate for severe acidosis		**May require IV [[bicarbonate]] for severe acidosis
	**PO potassium supplements		**PO [[potassium]] supplements
	**Treat adults with bicarb < 18-20 mEq/L		**Treat adults with bicarb < 18-20 mEq/L
	**Treat underlying d/o (Vitamin D, etc.)		**Treat underlying d/o (Vitamin D, etc.)
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	**Urine pH < 5.5		**Urine pH < 5.5
	*Serum aldosterone and cortisol levels to determine between:		*Serum aldosterone and cortisol levels to determine between:
	**Adrenal insufficiency, Addison's (low aldosterone, low cortisol)		**[[Adrenal insufficiency]], [[addison's disease\|Addison's]] (low aldosterone, low cortisol)
	**Selective aldosterone deficiency (low aldosterone, normal cortisol)		**Selective aldosterone deficiency (low aldosterone, normal cortisol)
	**Aldosterone resistance (nl to high aldosterone, nl to high cortisol)		**Aldosterone resistance (nl to high aldosterone, nl to high cortisol)

ClaireLewis: /* Etiologies */

2017-08-17T07:30:45Z

Etiologies

← Older revision		Revision as of 07:30, 17 August 2017
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	**Primary metabolic (cystinosis, von Gierke's)		**Primary metabolic (cystinosis, von Gierke's)
	*Type I RTA		*Type I RTA
	**Autoimmune - [[~~Sjogren~~]], [[SLE]], [[RA]]		**Autoimmune - [[Sjögren]], [[SLE]], [[RA]]
	**Drugs - [[Lithium]], [[amphotericin B]], ifosfamide		**Drugs - [[Lithium]], [[amphotericin B]], ifosfamide
	**[[Sickle cell disease]]		**[[Sickle cell disease]]

ClaireLewis: /* Etiologies */

2017-08-17T07:30:32Z

Etiologies

← Older revision		Revision as of 07:30, 17 August 2017
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	**Drugs - ifosfamide, [[acetazolamide]]		**Drugs - ifosfamide, [[acetazolamide]]
	**Heavy metals ([[Lead]], mercury, copper/Wilson's)		**Heavy metals ([[Lead]], mercury, copper/Wilson's)
	**Vitamin D deficiency, rickets, hypophosphatemia		**[[Vitamin D deficiency]], rickets, hypophosphatemia
	**[[Paroxysmal nocturnal hemoglobinuria]]		**[[Paroxysmal nocturnal hemoglobinuria]]
	**Renal transplant		**Renal transplant
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	**Primary metabolic (cystinosis, von Gierke's)		**Primary metabolic (cystinosis, von Gierke's)
	*Type I RTA		*Type I RTA
	**Autoimmune - [[Sjogren's]], [[SLE]], [[RA]]		**Autoimmune - [[Sjogren]], [[SLE]], [[RA]]
	**Drugs - [[Lithium]], [[amphotericin B]], ifosfamide		**Drugs - [[Lithium]], [[amphotericin B]], ifosfamide
	**[[Sickle cell disease]]		**[[Sickle cell disease]]

ClaireLewis: /* Features and Treatment */

2016-07-13T01:53:33Z

Features and Treatment

← Older revision		Revision as of 01:53, 13 July 2016
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	==Features and Treatment==		==Features and Treatment==
	*Mild acidosis in adults with bicarb > 20 mEq/L may not require Tx		*Mild acidosis in adults with bicarb > 20 mEq/L may not require treatment
	*Children should be treated due to impaired growth		*Children should be treated due to impaired growth
	*For type I and II RTA, treat all children and infants		*For type I and II RTA, treat all children and infants

ClaireLewis: /* Background */

2016-07-13T01:52:47Z

Background

← Older revision		Revision as of 01:52, 13 July 2016
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	==Background==		==Background==
	*Hyperchloremic metabolic acidosis, non-anion gap		*Hyperchloremic [[metabolic acidosis]], non-anion gap
	*Diagnostic classification starts with low, normal, or high serum potassium		*Diagnostic classification starts with low, normal, or high serum potassium
	*Differentiate from [[uremia]] in which acidosis is anion gap		*Differentiate from [[uremia]] in which acidosis is anion gap

Neil.m.young: Text replacement - "==Differential==" to "==Differential Diagnosis=="

2016-06-26T17:30:17Z

Text replacement - "==Differential==" to "==Differential Diagnosis=="

← Older revision		Revision as of 17:30, 26 June 2016
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	*Differentiate from [[uremia]] in which acidosis is anion gap		*Differentiate from [[uremia]] in which acidosis is anion gap

	==Differential==		==Differential Diagnosis==
	*See [[metabolic acidosis]]		*See [[metabolic acidosis]]

Neil.m.young: Text replacement - "==Sources==" to "==References=="

2016-06-26T07:06:53Z

Text replacement - "==Sources==" to "==References=="

← Older revision		Revision as of 07:06, 26 June 2016
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	**Aldosterone resistance (nl to high aldosterone, nl to high cortisol)		**Aldosterone resistance (nl to high aldosterone, nl to high cortisol)

	==~~Sources~~==		==References==
	*Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock. Renal Tubular Acidosis Syndromes. South Med J. 2000;93(11). http://www.medscape.com/viewarticle/410658.		*Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock. Renal Tubular Acidosis Syndromes. South Med J. 2000;93(11). http://www.medscape.com/viewarticle/410658.
	*UCSF Education. Renal Tubular Acidosis. Nov 2002. https://medicine.ucsf.edu/education/resed/Chiefs_cover_sheets/renal%20tubular%20acidosis.pdf.		*UCSF Education. Renal Tubular Acidosis. Nov 2002. https://medicine.ucsf.edu/education/resed/Chiefs_cover_sheets/renal%20tubular%20acidosis.pdf.

Kxl328 at 21:57, 2 May 2016

2016-05-02T21:57:13Z

← Older revision		Revision as of 21:57, 2 May 2016
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	==Sources==		==Sources==
	*Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock. Renal Tubular Acidosis Syndromes. South Med J. 2000;93(11). http://www.medscape.com/viewarticle/410658.		*Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock. Renal Tubular Acidosis Syndromes. South Med J. 2000;93(11). http://www.medscape.com/viewarticle/410658.
			*UCSF Education. Renal Tubular Acidosis. Nov 2002. https://medicine.ucsf.edu/education/resed/Chiefs_cover_sheets/renal%20tubular%20acidosis.pdf.
	<references/>		<references/>

	[[Category:FEN]]		[[Category:FEN]]

Kxl328: /* Features and Treatment */

2016-05-02T21:41:22Z

Features and Treatment

← Older revision		Revision as of 21:41, 2 May 2016
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	**Urinary anion gap > 50 mEq/L = Na + K - Cl		**Urinary anion gap > 50 mEq/L = Na + K - Cl
	**[[Nephrolithiasis]], calcium stones from chronic acidosis causing bone resorption and hypercalciuria		**[[Nephrolithiasis]], calcium stones from chronic acidosis causing bone resorption and hypercalciuria


	===Type IV RTA===		===Type IV RTA===