Acidosis! Hyperchloremia!
Renal tubular acidosis type I = Distal RTA = Decreased distal acidification. Urine pH > 5.3. Low to normal k. Nephrocalcinosis and renal stones due to hypercalciuria. Sjögren's syndrome, amphotericin. Give bicarbonate.
Type II = Proximal RTA = Decreased proximal bicarbonate absorption. Urine pH variable. Low to normal k. Rickets, osteomalacia, fanconi's syndrome = hypophosphatemia, hyperuricosuria, glycosuria. Multiple myeloma, acetazolamide, heavy metal poisoning. Treat cause, restrict sodium.
Type III = mixed type I and II
Type IV = Aldosterone deficiency or resistance. Urine pH < 5.3. Hyperkalemia. Diabetes, primary adrenal insufficiency, spironolactone, amiloride, triamterine, tmp, pentamidine. Sodium restriction, frusemide.
Alkalosis! Hypokalemia!
Bartter syndrome = hypokalemia, high urine calcium, act like loop diuretic (impaired sodium, k chloride reabsorption in TAL) Replace potassium, give amiloride, indomethacin.
Gittelman syndrome = hypokalemia, low urine calcium, acts like thiazides diuretic (sodium chloride cotransporter). Hypomagnesemia ? Mechanism. Replace potassium, magnesium. K sparing diuretic.
Liddle syndrome = hypokalemia , metabolic alkalosis, hypertension. Hypoaldosteronism secondary to constitutive activation of sodium channel. Triamterine , amiloride .
