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

    How Much Money Does a Nephrologist Make

    What is Nephrology?
    It is the study of the renal system, as in the kidneys and all that it does. Nephrology spans from the biochemistry of the kidney’s function to the pathology of the kidneys.
    What does a Nephrologist do?
    Nephrologists consult with their patients to determine the appropriate course of treatment; they suggest and orders tests to determine extent of illness or aid in diagnosis. Nephrologists diagnose and treats kidney disorders and everything related to it.  They treat electrolyte disorders, acid-base disorders, kidney stones, high blood pressure, and end-stage renal disease.  It also goes further in treating vascular disorders that tie in with the renal vasculature and nutritional metabolism.
    How to Become a Nephrologist?
    Nephrology is under the subspecialty of internal medicine so that means you have to do 3 years of internal medicine residency.  And after residency you have the option of doing 2-4 years of nephrology fellowship.  A nephrologist must be approved by the board in order to be fully licensed.
    How Much Does a Nephrologist Make?
    The median salary for a nephrologist is $210,355, which is not bad even in a bad economy; yes that’s enough to buy your sexy black BMW 645Ci.  Basically, you get $17,529 every month excluding the income taxes and insurance.  The lowest recorded salary is $163,830 and the highest salary recorded is a whopping $274,045.