Renal Tubular Acidosis

Metabolic Acidosis in a Young Woman

“…Several mechanisms may be responsi ble for the potassium-conserving response including a decrease in aldosterone secretion, diminished delivery of sodium and fluid to distal nephron sites, an increase in renal ammonia production and excretion, and a fall in the Proximal RTA is characterized by an abnormality in bicarbonate reabsorption by the proximal nephron, while H+ transport by the distal nephron is normal. Serum potassium levels may be normal or slightly reduced in untreated cases [7], However, marked renal potassium wasting commonly occurs during treatment with NaHCOi [8]. Alkali therapy increases plasma bicarbon ate concentration and thereby results in an increased fil tered load of bicarbonate.…”

“…Either a specific defect in the transport capacity of the proton pump or a reduction in the permeability barrier to H+ resulting in increased backfiux of H+ across the tubular epithelium can account for the abnormalities found in distal RTA [7], Unlike proximal RTA, severe K+ deple tion occurs commonly in untreated patients. Several fac tors appear to account for renal K+ wasting.…”

Renal Tubular Acidosis in Recurrent Renal Stone Formers

“…However, several lines of evidence indicate that impaired urinary acidification precedes the development of stone disease rather than being its result. The observations that therapy with bicarbonate [38], thiazides [39] and/or potassium citrate [29] reduces the stone frequency and at the same time normalizes the excretion of calcium and citrate, favor the view that RTA, whether or not the result of another metabolic abnormality, is an important contributor to stone for mation.…”

Renal Tubular Acidosis

“…Since that time, type III RTA has been essentially dropped from the classification scheme of RTA. It is interesting to note that the review by Genarri and Cohen did not mention type III RTA (19).…”