All::Nephrology::Diseases::Renal tubular acidosis

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Intro

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What is Renal tubular acidosis?

involves an accumulation of acid in the body due to a failure of the kidneys to appropriately acidify the urine

Renal tubular acidosis

What are the investigations findings in Renal tubular acidosis?

  • hyperchloraemic metabolic acidosis (normal anion gap)
  • hypokalaemia (apart from Type IV which has hyperkalaemia)

Renal tubular acidosis

Renal tubular acidosis type I

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What are the main causes of Renal tubular acidosis type I?

  • idiopathic
  • rheumatoid arthritis
  • SLE
  • Sjogren's
  • amphotericin B toxicity
  • analgesic nephropathy

Renal tubular acidosis

What is the pathophysiology of Renal tubular acidosis type I?

inability to generate acid urine (secrete H+) in distal tubule

Renal tubular acidosis

What are the common complications of Renal tubular acidosis type I?

  • nephrocalcinosis
  • renal stones

Renal tubular acidosis

Renal tubular acidosis type II

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What are the main causes of Renal tubular acidosis type II?

  • idiopathic
  • as part of Fanconi syndrome
  • Wilson's disease
  • cystinosis
  • outdated tetracyclines
  • carbonic anhydrase inhibitors (acetazolamide, topiramate)

Renal tubular acidosis

What is the pathophysiology of Renal tubular acidosis type II?

decreased HCO3- reabsorption in proximal tubule

Renal tubular acidosis

What are the common complications of Renal tubular acidosis type II?

osteomalacia

Renal tubular acidosis

Renal tubular acidosis type III

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What is the pathophysiology of Renal tubular acidosis type III?

caused by carbonic anhydrase II deficiency

Renal tubular acidosis

Which is the rarest type of Renal tubular acidosis?

Type III

Renal tubular acidosis

Renal tubular acidosis type IV

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What are the main causes of Renal tubular acidosis type IV?

  • hypoaldosteronism
  • diabetes

Renal tubular acidosis

What is the pathophysiology of Renal tubular acidosis type IV?

reduction in aldosterone leads in turn to a reduction in proximal tubular ammonium excretion

Renal tubular acidosis