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Old 02-18-2012
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Kidney RTA Clues in Questions!

please some one explain how to make out question of RTA?
there will be metabolic acidosis but then i get all confused...

is this true that all RTA has positive urine anion gap ?

very very confusing...checked other sources..no clear explanations...
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Old 02-18-2012
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Okay let's see,
RTA= normal anion gap metabolic acidosis.
First thing to do when you see blood gases is to calculate the anion gap.

If you have a normal anion gap with a metabolic acidosis here you go this is a case of RTA. remember the Chloride is also elevated.

Next, look at the potassium level, and remember the following :

Hperkalemia= RTA 4
Hypokalemia= RTA 1 or RTA 2

now you know that this case is for renal tubular acidosis and you have a kind of clue of which type but you need further clues so go back to your case and look for other clues :
RTA 1 = most common clue is Nephrolithiasis
RTA 2 = Fanconi syndrome (look for glucoseuria)
RTA 4 = alodosterone antagonism look for a patient that is on ACE inhibitors, spironolactone or NSAIDS.

Commmon associations with RTAs :
RTA 1 = Autoimmune Diseases : Sjogrens, SLE and RA
RTA 2 = MM, Amyloidosis and Heavy metal Poisonings.
RTA 4 = Diabetic Nephropathy

Hope this is useful to you
Best regards,
Sam,
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  #3  
Old 02-21-2012
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thats so nice.

few more things...

diagnostic tests

for type 1=acid load test-> distal tubules wont excrete any acid->urine pH basic
for type 2=alkali load test [NaHCO3 IV]->proximal tubules wont absorb any alkali->urine pH basic
for type 3=salt restriction ->aldosterone cant act->urine sodium still high

treatment
for type 1=potassium,bicarbonate
for type 2=potassium,thiazides,high dose bicarbonate
for type 3=fludrocortisone
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