The College of Medicine, the largest of six colleges at the University of Florida Academic Health Center, opened in 1956 with a mission to increase Florida's supply of highly qualified physicians, provide advanced health-care services to Florida residents and foster discovery in health research.įounded in 1956, the University of Florida College of Nursing is the premier educational institution for nursing in the state of Florida and is ranked in the top 10 percent of all nursing graduate programs nationwide. dental schools for the quality of its educational programs, oral health research enterprise and commitment to patient care and service. The UF College of Dentistry is the only public-funded dental school in Florida and is recognized as one of the top U.S.
The Licensed Content is the property of and copyrighted by DSM. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. “Clinical approach to renal tubular acidosis in adult patients”. “Renal tubular acidosis: The clinical entitiy”. “Renal tubular acidosis: Developments in our understanding of the molecular basis”. Laing, CM, Tove, AM, Capassa, G, Unwin, RJ. “Molecular basis of proximal renal tubular acidosis”. Potassium citrate can be used in hypokalemic forms of RTA but should not be used in type 4 RTA or in hyperkalemic distal (type 1) RTA. Treatment of proximal RTA can worsen hypokalemiaįollow-up of urine and serum studies, see key pointsįludrocortisone can cause volume overload (edema, hypertension) and hypokalemia Common Pitfalls and Side-Effects of Management of this Clinical Problem Manage hyperkalemia, including stopping potassium-sparing medicationsįludrocortisone for primary adrenal insufficiency and for hyporeninemic hypoaldosteronism (may require concurrent loop diuretic to avoid volume overload)ī. Withdraw causative or contributing medications The key principles are treatment of the acidosis with alkali therapy and management of potassium derangement: Proximal (type 2) renal tubular acidosisĪlkali replacement (Sodium bicarbonate + citrate)
Management while the Diagnostic Process is Proceeding A. Fludrocortisone can be effective in hyporeninemic hypoaldosteronism.Īssociated medical conditions: primary or acquired hypoaldosteronism, chronic interstitial nephropathies, K +-sparing diuretics.
Response to treatment: depends on the etiology. Urine anion gap in metabolic acidosis positive (impaired ammoniagenesis) It is important to note that distal urinary acidification is intact such that in proximal RTA in steady state, the urine pH is usually appropriately low (pH 17meq/L)
The urine pH is only transiently elevated during bicarbonaturia. Therefore the bicarbonaturia is self-limited and the serum bicarbonate concentration usually stabilizes between 14 and 20 meq/L. However, due to urinary loss, the subsequent serum and filtered bicarbonate concentrations decrease below the resorptive threshold such that filtered bicarbonate is then resorbed normally. During the development of proximal RTA, bicarbonate is excreted into the urine because the filtered concentration exceeds the resorptive threshold of the proximal tubule, raising the urine pH. A decrease in proximal tubular bicarbonate resorptive capacity results in proximal (type 2) RTA. The reclamation of bicarbonate is accompanied by excretion of a proton (H+) and occurs primarily in the proximal tubule (90% of filtered bicarbonate). Reclaiming filtered bicarbonate in the proximal tubule – proximal (type 2) renal tubular acidosis