![]() ![]() Regardless of the cause, the manifestation of all RTAs is metabolic acidosis (defined by the decrease of serum pH). *Type 3 RTA is a combination of type 1 and type 2 (when they both occur together) WHY IS IT A PROBLEM? ![]() Proximal (type 2): deficiency of bicarbonate resorption ( Fanconi syndrome, carbonic anhydrase deficiency) (urine pH ?hyperkalemia? => decreased NH3 synthesis in PCT? => decreased NH4+ excretion (any cause of decreased aldosterone signaling: ACE inhibitors, adrenal insufficiency, K+ sparing diuretics/ENaC antagonist)(urine pH Distal (type 1): caused by defect of intercalated cells to secrete H+ (amphotericin B toxicity, analgesic nephropathy) *hypokalemia present (urine pH > 5.5).
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