study_ing
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distinguish btw
RTA type 1, 2 and 4
based on the following
urine pH
plasma HCO3
K+ levels
any other significant can be included 
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| study_ing
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1. easiest clue..
hyperkalemia occurs in type 4 RTA
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| sunny2
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RTA-1 :
distal tubule can't excrete acid
Urine alkaline
Blood aciidic
Low K+
Rx:oral bicarbonate
clinical: Sjogren, SLE, Sickle cell, amphotericin toxicity, fabry ,Renal caculi
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RTA-2:
Proximal tubule can't absorb HCO3
Urine alkaline
Blood acidic
Low K+
Rx:Volume restriction
Clinical:Multiple myeloma ,Amyloidosis ,Bone lesion,osteomalacia,Rickets
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RTA-4:
Adrenal/aldosterone deficiency
Increased Urine Na with K+,H+retention
High K+
Rx:salt restriction, Fludocortisone
clinical-- Diabetes, by effect of NSAID's, cyclosporine, ACE inhibitors
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Study_ing , Thanks for this topic....please add any other point or clinical significance that is worth knowing, this is really important stuff...
enjoy 
Edited by sunny2 on 09/22/06 - 09:15 AM. Reason: wrong punctuation
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| saadtazjam
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Any way to remember these,i lways get these q's wrong?any help is appreciated
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| sunny2
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you are right saadtazjam , these are tricky questions, but once you do 15-20 questions of this type mixed diagnosis then you tend to start recalling the above details, they are not that very difficult....try not to look them as a difficult thingh to remember.....because as per our psychology....thinghs we tend to think are difficult gets even more dificult to absorb....you can try mixing the information by yourself ---make 10-15 scenarios and then figure out the correct diagnosis
we all are in the same boat so just keep on movin
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| study_ing
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"alFOURsterone deficiency in type 4 RTA"
u can predict the eletrolytes hence forth.
aldosterone cozes K excretion. hence in its deficiecy, hyperkalemia will result
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| study_ing
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HCO3 is reabsorbed primarily in the proximal tubule. majrity of renal stuff is reabsorbed in the proximal tubule.
the distal is responsible for fine tuning-->h+ secretion
type 1 is d1stal.
hence acidosis is severe. the urinary pH is alkaline coz there is defective H= secretion in the acid.
serum K is low ( coz remember type 4 is the only one with hyperkalemia)
type 2 involves the proximal tubule. ( thats left!!)
now 66% of reabsorption occurs in the proximal tubule, while much less occurs in the distal. y is the acidosis not severe, but moderate in this case?
bcoz the distal part can compensate for the proximal changes ( refer pharma on diuretics. i m using that logic)
in summary
RTA question.
1. check serum K
if hyperkalemia--type 4 (hypoal4steronism) RTA.
2.if K= low, its the other two.
d1stal= type 1 ( defective H= secretion, hence urine ph has to be alkaline), acidosis is severe
type 2 is proximal. we know hypokalemia is present ( coz hyper is only in type 4)
acidosis is moderate ( coz distal can compensate)
urinary pH is acidic ( the alkaline ph was type 1)
this wud be due to a depletion of body HCO3 stores, i think.
if an HCO3 load is given, URINE Ph WILL rise in.. type 2 rta
urinary anion gap and Fe Hco3 are also useful for rtas..but i think that wud be an overload.
saadtazjam, do u find rtas difficult or electrolytes in general?
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| saadtazjam
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Thanks!That Was elpful and I will never Miss it now!Electrolytes too particularly MEtabolic Acidosi/Alkalosis/Mixed Acid base disorders?Any help is appreciated.I know what it invoves but it is too difficult to interpret in a question.
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| study_ing
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post a q u found difficult...
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