Renal tubular acidosis classification: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Renal tubular acidosis}} | {{Renal tubular acidosis}} | ||
{{CMG}} ; {{AE}} {{ADG}} | {{CMG}} ; {{AE}} {{ADG}} {{SAH}} {{JSS}} | ||
==Overview== | ==Overview== | ||
Based on underlying defect in concentration of urine process in [[renal tubule]], renal tubular acidosis can be classified into type 1 ([[Anatomical terms of location|distal]]), type 2 ([[Proximal tubule|proximal]]), type 4 ([[hypoaldosteronism]]) and voltage-dependent RTA. | Based on underlying defect in concentration of urine process in [[renal tubule]], renal tubular acidosis can be classified into type 1 ([[Anatomical terms of location|distal]]), type 2 ([[Proximal tubule|proximal]]), type 4 ([[hypoaldosteronism]]) and voltage-dependent RTA. | ||
==Classification== | ==Classification== | ||
Renal tubular acidosis can be classified into 4 types. Renal tubular acidosis type 1( [[Distal convoluted tubule|distal]]), renal tubular acidosis type 2 ( [[Proximal Renal Tubular Acidosis|proximal]]), [[hypoaldosteronism]] (type 4) and voltage-dependent RTA. [[Potassium]] is the most common electrolyte abnormality associated renal tubular acidosis. Hypokalemia is seen in RTA type 1 and type 2 while type 4 and voltage-dependent RTA are hyperkalemic.<ref name="pmid24345454">{{cite journal |vauthors=Gil-Peña H, Mejía N, Santos F |title=Renal tubular acidosis |journal=J. Pediatr. |volume=164 |issue=4 |pages=691–698.e1 |date=April 2014 |pmid=24345454 |doi=10.1016/j.jpeds.2013.10.085 |url=}}</ref><ref name="pmid4894504">{{cite journal |vauthors=Rodriguez-Soriano J, Edelmann CM |title=Renal tubular acidosis |journal=Annu. Rev. Med. |volume=20 |issue= |pages=363–82 |date=1969 |pmid=4894504 |doi=10.1146/annurev.me.20.020169.002051 |url=}}</ref><ref name="pmid">{{cite journal |vauthors=Morris RC |title=Renal tubular acidosis. Mechanisms, classification and implications |journal=N. Engl. J. Med. |volume=281 |issue=25 |pages=1405–13 |date=December 1969 |pmid= |doi=10.1056/NEJM196912182812508 |url=}}</ref> | Renal tubular acidosis can be classified into 4 types. Renal tubular acidosis type 1( [[Distal convoluted tubule|distal]]), renal tubular acidosis type 2 ( [[Proximal Renal Tubular Acidosis|proximal]]), [[hypoaldosteronism]] (type 4) and voltage-dependent RTA. [[Potassium]] is the most common [[Electrolyte disturbance|electrolyte]] abnormality associated renal tubular acidosis. [[Hypokalemia]] is seen in RTA type 1 and type 2 while type 4 and voltage-dependent RTA are [[Hyperkalemia|hyperkalemic]].<ref name="pmid24345454">{{cite journal |vauthors=Gil-Peña H, Mejía N, Santos F |title=Renal tubular acidosis |journal=J. Pediatr. |volume=164 |issue=4 |pages=691–698.e1 |date=April 2014 |pmid=24345454 |doi=10.1016/j.jpeds.2013.10.085 |url=}}</ref><ref name="pmid4894504">{{cite journal |vauthors=Rodriguez-Soriano J, Edelmann CM |title=Renal tubular acidosis |journal=Annu. Rev. Med. |volume=20 |issue= |pages=363–82 |date=1969 |pmid=4894504 |doi=10.1146/annurev.me.20.020169.002051 |url=}}</ref><ref name="pmid">{{cite journal |vauthors=Morris RC |title=Renal tubular acidosis. Mechanisms, classification and implications |journal=N. Engl. J. Med. |volume=281 |issue=25 |pages=1405–13 |date=December 1969 |pmid= |doi=10.1056/NEJM196912182812508 |url=}}</ref> | ||
{| class="wikitable" | {| class="wikitable" | ||
!Type of RTA | !Type of RTA | ||
!'''Primary defect''' | !'''Primary defect''' | ||
!'''Plasma HCO<sub>3</sub> mEq/L''' | !'''[[Plasma]] HCO<sub>3</sub> mEq/L''' | ||
!'''Urine pH''' | !'''[[Urine pH]]''' | ||
!'''Plasma potassium''' | !'''[[Plasma potassium]]''' | ||
!'''Urine anion gap''' | !'''Urine anion gap''' | ||
!'''Urine calcium/creatinine ratio''' | !'''[[Urine calcium/creatinine ratio]]''' | ||
!'''Risk for nephrolithiasis''' | !'''Risk for nephrolithiasis''' | ||
|- | |- | ||
| Line 22: | Line 22: | ||
|< 10 | |< 10 | ||
|>5.3 | |>5.3 | ||
|Hypokalemic | |[[Hypokalemia|Hypokalemic]] | ||
|Positive | |Positive | ||
|↑ | |↑ | ||
| Line 31: | Line 31: | ||
|12 to 20 | |12 to 20 | ||
|<5.3 | |<5.3 | ||
|Hypokalemic | |[[Hypokalemic]] | ||
|Negative | |Negative | ||
|Normal | |Normal | ||
| Line 46: | Line 46: | ||
|- | |- | ||
|RTA type 4 | |RTA type 4 | ||
|Decreased aldosterone secretion | |Decreased [[aldosterone]] secretion | ||
Aldosterone resistance | [[Aldosterone]] resistance | ||
|>17 | |>17 | ||
|Variable | |Variable | ||
|Hyperkalemia | |[[Hyperkalemia]] | ||
|Positive | |Positive | ||
|Normal | |Normal | ||
| Line 56: | Line 56: | ||
|- | |- | ||
|Voltage-dependent RTA | |Voltage-dependent RTA | ||
|Reduced sodium reabsorption | |Reduced [[sodium]] reabsorption | ||
|>17 | |>17 | ||
|Variable | |Variable | ||
|Hyperkalemia | |[[Hyperkalemia]] | ||
|Positive | |Positive | ||
|Normal | |Normal | ||
Latest revision as of 20:56, 31 July 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2] Syed Ahsan Hussain, M.D.[3] Jogeet Singh Sekhon, M.D. [4]
Overview
Based on underlying defect in concentration of urine process in renal tubule, renal tubular acidosis can be classified into type 1 (distal), type 2 (proximal), type 4 (hypoaldosteronism) and voltage-dependent RTA.
Classification
Renal tubular acidosis can be classified into 4 types. Renal tubular acidosis type 1( distal), renal tubular acidosis type 2 ( proximal), hypoaldosteronism (type 4) and voltage-dependent RTA. Potassium is the most common electrolyte abnormality associated renal tubular acidosis. Hypokalemia is seen in RTA type 1 and type 2 while type 4 and voltage-dependent RTA are hyperkalemic.[1][2][3]
| Type of RTA | Primary defect | Plasma HCO3 mEq/L | Urine pH | Plasma potassium | Urine anion gap | Urine calcium/creatinine ratio | Risk for nephrolithiasis |
|---|---|---|---|---|---|---|---|
| RTA type 1 | Impaired distal acidification | < 10 | >5.3 | Hypokalemic | Positive | ↑ | ↑ |
| RTA type 2 | Reduced proximal HCO3 reabsorption. | 12 to 20 | <5.3 | Hypokalemic | Negative | Normal | - |
| RTA type 3 | Mixed (distal+ proximal RTA) | Variable | Variable | Variable | Variable | Variable | Variable |
| RTA type 4 | Decreased aldosterone secretion
Aldosterone resistance |
>17 | Variable | Hyperkalemia | Positive | Normal | - |
| Voltage-dependent RTA | Reduced sodium reabsorption | >17 | Variable | Hyperkalemia | Positive | Normal | - |
References
- ↑ Gil-Peña H, Mejía N, Santos F (April 2014). "Renal tubular acidosis". J. Pediatr. 164 (4): 691–698.e1. doi:10.1016/j.jpeds.2013.10.085. PMID 24345454.
- ↑ Rodriguez-Soriano J, Edelmann CM (1969). "Renal tubular acidosis". Annu. Rev. Med. 20: 363–82. doi:10.1146/annurev.me.20.020169.002051. PMID 4894504.
- ↑ Morris RC (December 1969). "Renal tubular acidosis. Mechanisms, classification and implications". N. Engl. J. Med. 281 (25): 1405–13. doi:10.1056/NEJM196912182812508.