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2 out of 6

Type I RTA is associated with all of the following, Except: (DNB Dec 10)

A Urinary PH > 5.5

B Normal Anion Gap Acidosis

C urinary calcium

D urinary citrate

Ans. D urinary citrate

1. Renal tubular acidosis (RTA) is a metabolic acidosis, due to impaired acid secretion by the kidney.

There is a hyperchloremic metabolic acidosis with normal anion gap.

Type 1 (distal)

a. RTA is due to an inability to excrete H+ and inability to generate acidic urine in the distal tubule, even in states of metabolic acidosis, and hypokalemia.

b. Features include rickets, or osteomalacia, due to buffering of H+ with calcium in bone.

c. Nephrocalcinosis with renal calculi is a feature. (AIPG 07)

d. Urine citrate is reduce.

e. Diagnosis: Acid load: oral ammonium chloride load is given-there is failure to lower urine pH <5.5.

f. Treatment: Oral sodium bicarbonate or citrate.

g. Complications (1) Renal calculi (2) End-stage renal failure may result from unrecognized obstruction.