Distal Renal Tubular Acidosis
Distal RTA is the true Nephrogenic RTA and can be truly divided into two variants- the hypokalemic and the hyperkalemic types.
Type A intercalated cells - A Low K problem
• H secretion defect
- Mutations in the luminal H ATPase
- AEI mutations (basolateral side)
- Carbonic anhydrase II defects
- Autoimmune diseases(Sjogren's Syndrome)
- Analgesic Nephropathy
- Sickle cell disease
- Nephrocalcinosis
- Drugs( Ifosfamide, topiramate, CA inhibitors)
• H gradient defect - Back leak via luminal side via holes (amphotericin B induced)
Generalized distal RTA - A high K problem
• Voltage defect
- ENaC mutation
- SCNN mutation
- Familial Hypokalemic HTN (WNKI and 4 mutations)
- CNI agents
- Amiloride and Triamterene use
- Pentamidine, Trimethoprim
• Low Mineralocorticoid State
- Hyporenin Hypoaldosteronism (classic Type IV)
- NH3 secretion defects
- Drugs (heparin)
- DMII
- Obstructive Uropathy
- ACEI/ARB
Dr. Kenar Jhaveri @kdjhaveri
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