RTA
Type 1 RTA
- pt: sjogren, RA, kid, amphotericin B
- cause: distal tubule cannot excrete H or absorb K
- sx:
- recurrent bilateral stones
- rickets disease
- growth failure in children
- dx:
- non AG metabolic acidosis but high urine pH (can't excrete H)
- acidosis increases Ca excretion (stones)
- hypokalemia (can't absorb K)
- hyperchloremia
- positive urine AG
- rx: Na bicarb
Type 2 RTA
- pt
- cause: can't absorb HCO3 absorption in proximal tubule. Fanconi syndrome
- sx
- dx
- milder metabolic acidosis bicarb 12-20
- hypokalemia from increased aldosterone from volume contraction
- urine pH < 5.3
Type 4 RTA
- pt:
- cause: aldosterone deficiency or resistance
- diabetes, ace, arb, nsaids, adrenal insufficiency
- bactrim, K sparing diuretics
- sx
- dx
- hyperkalemia from decreased K excretion
- pH < 5.4
- rx: mineralocorticoid or fludrocortisone
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