Type 1 (distal)
RTA
Common
It result in many
diseases that mainly involve medullary part of the kidneys.
Causes
include:
·
Primary Type 1 RTA : genetic or
idiopathic
·
Tubulointerstitial disease: chronic
interstitial nephritis
·
, chronic pyelonephritis, ,
obstructive uropathy, or renal transplant rejection
·
Nephrocalcinosis: chronic
hypercalcaemia or, medullary sponge kidney
·
Autoimmune disease: systemic
lupus erythematosus (SLE), chronic active hepatitis, Sjögren syndrome
·
Drugs and toxins: amphotericin
, lithium
Type 2 (proximal) RTA
Uncommon
Causes
include:
·
Primary: idiopathic
·
Tubulointerstitial disease:
interstitial nephritis, amyloidosis , or
multiple myeloma
·
In association with other
diseases : Wilson's disease, Sjögren syndrome, and fructose intolerance
·
Drugs and toxins: heavy
metals (lead and mercury, acetazolamide, and sulfonamides
Consequences
of RTA Type 1 and Type 2
Nephrocalcinosis
and renal calculi
due
increased urinary calcium excretion. This is more common in Type II because
severe acidosis is more frequent.
Hypokalaemia (in Type 1 RTA)
Oteomalacia/rickets
(in Type 2 RTA)
Treatment of RTA:
Oral potassium
and bicarbonate replacement.
Treatment of underlying
or associated disease.
Type 3 RTA : Both Type 1 and Type 2 combined
Type 4
RTA
Metabolic acidosis plus hyperkalaemia in Chronic Kidney
Disease
Cause : commonly caused
by mineralocorticoid deficiency
Less
commonly
due to abnormal collecting
duct function
or treatment with
spironolactone or amiloride
In the common cases with mineralocorticoid
deficiency it could be either:
1- Hyporeninaemic
hypoaldosteronism:
Secondary to diabetes
mellitus
or treatment with NSAIDs
Characterized by Low
renin, low aldosterone
OR
2- Hyperreninaemic
hypoaldosteronism
Secondary to adrenal disease
, congenital enzyme deficiencies , or treatment with ACE inhibitors
Characterized by High
renin, low aldosterone
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