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Issue: March 1, 2007
Case: Acid-Base Disorders
Taken from
Med-Challenger FM Career
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Question:
Which of the following best describes the acid-base disorder
seen in all forms of renal tubular acidosis (RTA)?
- Normal anion gap (hyperchloremic) metabolic acidosis
- Wide anion gap metabolic acidosis
- Compensated metabolic acidosis
Answer:
A
Remediation:
RTA develops as a result of the inability of renal tubules to resorb filtered bicarbonate and excrete hydrogen
when necessary. There are three major subgroups of RTA, and they
each have
different clinical characteristics. They are:
- Distal, or type 1 RTA
- Proximal, or type 2 RTA
- Hypoaldosteronism, or type 4 RTA
Although initially used to describe a transiently severe form
of type 1 RTA in infants, the term type 3 RTA is now most
often applied to a rare autosomal recessive syndrome (resulting
from carbonic anhydrase II deficiency) with features of both
type 1 and type 2 RTA. In addition to RTA, affected patients
suffer from osteopetrosis, cerebral calcification, and mental
retardation.
About the Image(s):
Image 1:
Nephrocalcinosis due to Renal Tubular Acidosis
These calcifications are typical of nephrocalcinosis in the
medullary portion of the kidney. The location of the
calcifications distinguishes this condition from nephrolithiasis, although
the latter may be associated. This patient had renal tubular
acidosis. Other etiologies include medullary sponge kidney,
hyperparathyroidism, sarcoid, and various disorders with
hypercalcemia. The pattern is characteristic.
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