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Renal Tubular Acidosis
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Type 1 Renal Tubular Acidosis (Distal)
Pathophysiology: Impaired hydrogen ion secretion in the distal nephron. Clinical features: Hypokalemia, nephrolithiasis, and urinary alkalization. Treatment: Oral bicarbonate or citrate to correct acidosis, and potassium supplements.
Type 2 Renal Tubular Acidosis (Proximal)
Pathophysiology: Defective bicarbonate reabsorption in the proximal tubule. Clinical features: Polyuria, dehydration, and growth retardation in children. Treatment: Bicarbonate supplements in large amounts can be required, along with thiazide diuretics.
Type 3 Renal Tubular Acidosis (Combined Distal and Proximal)
Pathophysiology: This is primarily a historical subtype that involves both Type 1 and Type 2 RTA features. It is rare and not often discussed separately in the literature. Clinical features and treatment would mirror a combination of Type 1 and Type 2 renal tubular acidosis. Often it is genetically inherited as part of a syndrome.
Type 4 Renal Tubular Acidosis (Hyperkalemic)
Pathophysiology: Decreased aldosterone production or action leading to impaired ammonium and hydrogen secretion. Clinical features: Hyperkalemia, mild acidosis, and possibly renal insufficiency. Treatment: Fludrocortisone for aldosterone deficiency, dietary potassium restriction, and loop diuretics.
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