Renal Tubular Acidosis In

Childhood
Akbarbudhi antono
0961050157
FK UKI
Renal tubular acidosis
HCO3-
reabsorpti
on failure

Normal hyperchlo
GFR remic

RTA

Metabolic Normal
acidosis anion gap
 Acid base balance
Lung and kidney have a role in maintainig acid
base balance
CO2

NH4

HCO3
 Physiology of nephron

filtration

glucose
HCO3-

reabsorption
Amino acids
electrolytes

secretion

H+ electrolytes

NH4+
http://www.buzzle.com/articles/labeled-diagram-of-nephron.html
Proximal tubule

Arizpe RM, Escobar L, Medeiros M. Renal tubular acidosis in children: state of the
art, diagnosis and treatment. Bol Med Hosp Infant Mex 2013;70(3): p 178-193.
Distal tubule

Arizpe RM, Escobar L, Medeiros M. Renal tubular acidosis in children: state of the
art, diagnosis and treatment. Bol Med Hosp Infant Mex 2013;70(3): p 178-193.
 H+

NH4+

H+

HCO3- Aldosterone

RTA pathophysiology
Figure above demonstrate the location of RTA type. The proximal
tubule(green) is the main location for bicarbonate reabsorption and it is
impaired in type 2 RTA causing bicarbonate loss. The distal tubule (purple)
has small role in bicarbonate reabsorption and mainly excrete acid. It is
impaired in type 1 RTA. The distal tubule and collecting duct (yellow) are
the places where aldosterone, the main problem of type 4 RTA, work.
Unable to excrete K+, amoniogenesis disturbed and H+ and NH4+ http://biologymayhem.blogspot.com/2
excretion also decreased. 011/01/on-kidneys_03.html
 Types of Renal Tubular Acidosis
Type 1 : distal tubule
Type 2 : proximal tubule
Type 3 : combination of type 1 & 2
Type 4 : hypoaldosteronism

Common among all:

Metabolic acidosis
Normal anion gap
Elevated urine anion gap
(UNa + UK)- UCl >0
 Symptoms of RTA
Growth
retardation

Weakness RTA Osteomalacia

paralysis symptoms rickets

Polyuria
Polydipsia
 RTA type 1
Causes Characteristic

autoimmune Hypokalemia

Amphotericine Nephrolithiasis
B

Serum HCO3 <

Sarcoidosis
10 mg/dL

Wilson disease Urine pH >5.5

Hyperchloremic
metabolic
acidosis
 RTA type 2
Causes Characteristic
Fanconi Hypokalemia
syndrome

Serum HCO3
Acetazolamide
14-20 mg/dL

Glycogen Urine pH >7

storage disease

Hyperchloremic
Amyloidosis metabolic
acidosis
 RTA type 4
Causes Characteristic
hypoladosteronism Hyperkalemic

primary adrenal Low renin &

insufficiency aldosterone

Serum HCO3 >

Spironolactone
17mg/dL

ACE Inhibitor Urine pH < 5.5

Mild metabolic
acidosis
 Metabolic
acidosis
pH, HCO3, BE

Anion gap

High
Normal (>16mEq/L)
(8-16 mEq/L) Unmeasured
anion
Ketoacidosis
Calycilate
GI tract RTA
poisoning
disorder:
Diarrhea
ileostomy
Urine anion
gap

Positive
Negative
Cl < (Na+K)
Cl > (Na+K)

pRTA K+ serum
pH <5.5
FE HCO3- >
10-15%
Low K+ Hi K+
serum serum
Albar H. Asidosis Tubular Ginjal Pada Anak.
pH > 5.5 pH <5.5
Maj Kedokt Indon. 2005; 55 : p 67-78

dRTA Hyperkalemi
RTA
Type Type 1 Type 2 Type 4
location Distal tubule Proximal tubule adrenal
acidosis Yes (severe) Yes Yes (mild)
potassium hypokalemia hypokalemia hyperkalemia
pathophysiology Failure of H+ Failed HCO3 Deficiency of
secretion by the reabsorption from aldosterone, or a
intercalated cells the urine by the resistance to its
and reclaim K proximal tubular effects,
cells (hypoaldosteronism
or
pseudohypoaldoste
ronism)

therapy bicarbonate Bicarbonate, Low K diet, loop

diuretics diuretics,
fludrocotisone
 Conclusion
The pathology of RTA is failure of tubules to
acidify urine. The problem may be proximal,
distal, or aldosterone.
The loss of bicarbonate and retention of H+
cause metabolic acidosis, the main
characteristic of RTA.
 REFERENCES
1. Albar H. Asidosis Tubular Ginjal Pada Anak. Maj Kedokt Indon. 2005; 55 : p 67-78
2. Arizpe RM, Escobar L, Medeiros M. Renal tubular acidosis in children: state of the art, diagnosis
and treatment. Bol Med Hosp Infant Mex 2013;70(3): p 178-193.
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