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Renal - ABIM
Renal tubular acidosis
Question | Answer |
---|---|
What is the mnemonic to remember renal tubular acidosis? | Stones I, bones II, aldosterone IV |
What is the order of the renal tubular acidosis in the order that it shows up in the kidneys ? What does this order also denote? | 241–bones (proximal), aldosterone (distal), Stones (distal) bones (low K), aldosterone (high K), stones (low K) bones(high urine pH >5.5), aldosterone (low pH <5.5), stones (high pH>5.5) |
What is the tubular defect in RTA type II? | The body can't reabsorb bicarb HCO3- (like acetazolamide) |
What is the tubular defect in RTA type IV? | The body can't excrete H+ and K+ |
What is the tubular defect in RTA type I? | The body can't excrete H+ |
Which RTA has low bicarb, Low potassium, low phosphorus? | RTA type II |
Which RTA has high H and high K? | RTA type IV |
Which RTA has high H and low K? | RTA type I |
Which RTA has calcium phosphate stones? | RTA type I |
Which RTA is associated with autoimmune diseases such as Sjogren's and lupus? | RTA type I |
Which RTA is associated with renal obstruction? | RTA type I |
Which RTA is associated with hypo aldosterone? | RTA type IV |
Which RTA is associated with diabetes? | RTA type IV |
Which RTA is associated with osteomalacia? | RTA type II |
Which RTA is associated with multiple myeloma? | RTA type II |
Which RTA is associated with fanconi's syndrome? | RTA type II |
What drugs are associated with RTA type II? | topiramate, tanofovir, cycloPHOSphamide, iPHOSphamide (RTA II has low phos) |
What is the characteristic of urine pH in RTA type II? | Early pH > 5.5 because a lot bicarbonate in the urine. Late pH < 5.5 because the body compensates by excreting more H+ into the urine. |
What is the characteristic of urine pH in RTA type IV? | Urine pH less than 5.5 because there is increased chloride in the urine, which makes the urine acidic |
What is the characteristic of urine pH in RTA type I? | Urine pH is greater than 5.5 because there is no chloride in the urine. |
How do we assess the kidneys response to hypokalemia? | Urine potassium/ urine creatinine x 100. If the result is less than 15, then potassium loss is extra renal. If the result is greater than 20, then the kidney is wasting potassium. |
In a nonAG metabolic acidosis, how do we differentiate between a kidney problem versus a GI problem | Calculate urine anion gap: urine Na + urine K - urine Cl. neg means GI losses. pos means kidney losses. |
What are the three things you would see in Fanconi's syndrome? | Glucosuria with normoglycemia, proteinuria, hypophosphatemia |
Which RTA has calcium oxalate kidney stones? | RTA II when induced by drugs such as acetazolamide (Can't reabsorb HCO3â) or zonisamide |