Renal Tubular Acidosis Explained

Kidney Tubules AnatomyI hate really hate studying this material but once you understand it, it becomes very easy to memorize.

Remember in renal tubular acidosis (RTA) there is normal anion gap.  [Na – (Cl – HCO3)] = 6-12.
Proximal part is the upper part of the renal tubules, while the distal part is the end part of the tubules.
Type II (Proximal)

  1. Pathophysiology: Decreased ability of the proximal kidney tubules to reabsorb most of the filtered bicarbonate because normally bicarbonate is filtered at the proximal tube.
  2. Urine pH: Variable: Urine pH is basic until bicarbonate is depleted, the it is acidic (less than 5.5)
  3. Blood K+ level: Low
  4. Kidney Stones: No
  5. Associations
    • Diagnosis: Infuse bicarbonate and evaluate the urine pH
    • Treatment: Thiazide because it causes volume depletion, which will enhance bicarbonate reabsorption.

    Type I (Distal)

    1. Pathophysiology: Distal tubule is damaged so it is unable to generate bicarbonate. Without bicarbonate, H+ cannot be secreted in the tubule to the urine, raising urine pH.
    2. Urine pH: Urine pH more than 5.5.
    3. Blood K+ Level: Low
    4. Kidney Stones: Yes
    5. Associations
      • Amphotericin use
      • Lithium Use
      • Sickle Cell Disease
      • Autoimmune Diseases (SLE, Sjorgen Syndrome, Rheumatoid Arthritis, etc)
    6. Diagnosis: Infuse acid
    7. Treatment: Bicarbonate to be absorbed in the proximal tubule, because majority of the bicarbonate is absorbed there.

    Type IV (Distal)

    1. Pathophysiology: Decreased or diminished effect of aldosterone at the kidney tubule. Loss of sodium and retention of potassium and hydrogen ions.
    2. Urine pH: Less than 5.5
    3. Blood K+ level: High
    4. Kidney Stones: No
    5. Associations
      • Diabetes
      • Addison’s Disease
      • NSAIDs
    6. Diagnosis: Urine salt loss, despite sodium restricted diet
    7. Treatment: Fludrocortisone

    Microsoft OneNote for Medical Students

    Microsoft OneNote
    I haven’t posted in a while, and being in 4th year I am extremely busy trying to get things done.  I apologize greatly for those who emailed me with questions and I haven’t replied yet.  I strongly urge you to post your questions in the comments section so it’ll be easier to reply by not just me but by others who have experience to the subject matter.  I wanted to talk about Microsoft OneNote, as it may be useful for those who need organization.

    I cannot stress enough how well Microsoft OneNote has helped in my organization from studying to getting paper work done.  The best part of it is your data gets synced as you are working so if you are working on your laptop and you have to go somewhere, then you can grab your iPad and continue to work while you are on the go.  On top of that, you can sync your work in iPad, iPhone, Macbook, Windows OS, and Android devices.  The best part is Microsoft’s free version of Microsoft OneNote is incredibly useful with more than enough to do all your work as a medical student.  I think since the release of Windows 7, Microsoft finally got this one right since every other products after Windows 7 was a disaster for the company.  Keep one thing in mind, I’m not being paid to write this post, this post is strictly based on my positive experience from working with the software.

    I had my doubts about OneNote but after using it I was very impressed.  The feel and the ease of use speaks for itself. I have always put everything on it so I don’t have to open multiple programs like Excel or Word.  After I get my things organized I copy and paste the information to the proper program to send it off, like writing a report.  For example, when I have multiple presentations to do at once I create a tab for the respected rotation and work on them without switching to another program.  The only thing that is required extra, is the that you have to use your Outlook or Hotmail email account to get started. I highly recommend this program, especially for Macbook Pro users.  There is the Evernote program, but I’m not willing to pay for it.  So try it.