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4 out of 6

Proximal & distal renal tubular acidosis is differentiated by all, except: (AIIMS May 10)

A Stones in kidney

B Hypokalemia

C Daily acid secretion

D Presence of Fanconi syndrome

Ans. B Hypokalemia

Type 2 (Proximal)

a. Type 2 (proximal) RTA is due to a 'bicarbonate leak': a defect in HCO3 reabsorption in the proximal tubule resulting in excess HCO3 in the urine.

b. Urine can acidify because distal tubule can secrete H ions so urine pH is <5.5 .

c. Hypokalemia is a feature.

d. Type 2 RTA is often associated with a more generalized tubular defect (Fanconi syndrome).

e. Hypocalcaemia is common due to the osmotic diuretic effect of HCO3 reabsorption.

f. Hypercalciuria occurs but urine citrate levels are normal or high, so renal stone formation is not feature.

g. Diagnosis: IV sodium bicarbonate load: there is high fractional excretion of HC03 (> 15%).

h. Treatment: High doses of bicarbonate (10mmol/kg/d) are required.