Renal Tubular Acidosis

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USMLE related info for RTAs

Proximal Renal Tubular Acidosis

Renal tubular acidosis - proximal; Type II RTA; RTA - proximal; Renal tubular acidosis type II Proximal renal tubular acidosis is a disease that occurs when the kidneys don't properly remove acids from the blood into the urine. As a result, too much acid remains in the blood (called acidosis ). The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and the stimulation of red blood cell production. This is the typical appearance of the blood vessels (vasculature) and urine flow pattern in the kidney. The blood vessels are shown in red and the urine flow pattern in yellow. When the body performs its normal functions, it produces acid. If this acid is not removed or neutralized, the blood will become too acidic. This can lead to electrolyte imbalances in the blood. It can also cause problems with normal function of some cells. The kidneys help control the body's acid level by removing acid from the blood and excreting it into the urine. Acidic substances in the body are neutralized by alkaline substances, mainly bicarbonate. Proximal renal tubular acidosis (Type II RTA) occurs when bicarbonate is not properly reabsorbed by th Continue reading >>

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  1. Liam Gorman

    I agree with Anderson. It is a sad fact, however it is a harsh reality and we should accept violence can often only be the only answer to resolving an issue.
    Many would combat this point by saying peace is the way forward and a peaceful resolution is the best answer- it can often be this way, sadly it isn't always.
    If Anders Behring Breivik had been met with gunfire as he arrived on Utøya island lots of lives would have been saved that day.
    I know, for a certainty, that this is my view on the matter however I guess there would be many so opposed to murder, however justifiable, that they'd sooner stand up to talk them down and be shot trying.
    I think this question could be answered by posing a question along the lines of "If an armed madman broke into your child's school whilst you where there, and you had a gun at your disposal, what would you do?" I think that's a scenario which brings reason to my answer.
    So yes. I think that violence can sometimes only be resolved by violence. Obviously the less violent caused is best, but the world can be cruel that way, sometimes there can be no better way to put a cease to a horribly violent occurrence than by stamping it away with violence in return.
    Some may see it as unreasonable, but I think when it's the only possible way to end a situation like those mentioned above, with an unreasonable force, then yes, it's reasonable and justified.

  2. Ranjan Prithvi

    Absolutely. Violence is and should be the only answer to violence.
    But the important question is towards whom?
    Atleast where I live, Many people interpret this as retaliation towards the community of the people who initiated the attack, even if they had nothing to do with it. This is a very wrong interpretation of revenge directed at innocent people in the search for an immediate solace. A heat of the moment act committed and fuelled by a section of the society who perpetuate hatred in the name of revenge and protecting the interests of the community, as finding the actual culprits would be time and resource consuming

  3. Sam Morningstar

    Is there a supposition that humans, as a species, are not inherently violent?
    I don't think it is possible to exclude from this debate the causes of violence and how it manifests in our species. This is the primary flaw in pacifist arguments.
    One human inflicting violence on another will normally be for a specific purpose. Whether the intent is to kill, hurt or intimidate, it usually represent eliminating threats, gaining positions of power or asserting dominance (which might manifest as simply enjoying the power and thrill associated with the act of killing).
    In some cases, it represents an animal (yes, a human animal) that has some mental or psychological defect that causes erratic and dangerous behavior. In these instances, a violent outburts cannot be "resovled" in a way that is acceptable to any rational human being. And even in the case where there is no aberrational issues invovled, and we are talking about NORMAL violent human behavior, you will have one group of people or certain individuals that can and will resort to violence for a variety of reasons. If you set up the environment in a certain way, it is an inevitability. This is the pathology of our species.
    If thy reason for the violence is to intimidate and control, then sure...some people might be okay with being in a subservient or inferior role, being dominated by others. This might be seen as an acceptible compromise or "resolution" to avoid any further violence. However, there is a cost benefit analysis that has to be done. Once a violent act is being engaged in, the person being attacked has to understand the underlying causes and recognize what the possible outcomes will be.
    Of course there are violent situations that will have unacceptable outcomes ...that any moral, ethical, and rational person will not be able to tolerate (mainly, death of your loved ones or the utter destruction of your nation). In these cases, the laws of inertia apply. An opposing force must be applied.
    By the way, I do not consider theoretical or religious pacifism to be rational.Theoretical pacifists do not apply the laws of nature and have usually never seen violence actually threaten them personally. These folks would change their tune quickly if they were facing a real violent threat. And religious pacifists are not rational because they believe there is something beyond this mortal existence on planet earth. So, they ignore reality altogether and choose a fantastic degree of nihilism.

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This is a short video on the different types of renal tubule/tubular acidosis, or disorders in which the body cannot acidify urine. I created this presentation with Google Slides. Image were created or taken from Wikimedia Commons I created this video with the YouTube Video Editor. ADDITIONAL TAGS: Renal Tubule Acidosis Acidification of the body due to inability of the kidneys to acidify urine Type 1 Distal Type 2 Proximal Type 3 Combined Type 4 Hyperkalemic Type 1: Distal Type 4: Hyperkalemic Type 2: Proximal Type 1: Distal tubule RTA Failure of the alpha-intercalated cells in distal convoluted tubule to secrete acid (H+) Cannot acidify urine urine pH 6ish Decreased H+ in tubule lumen draws out K+ causing hypokalemia Associated with Sjgren Sjogren syndrome (autoAb against CAII, which generates H+ in DCT) Calcium phosphate kidney stones Caused by decreased citrate excretion and hypercalciuria Salts more likely to precipitate at higher pH Type 1 Distal Type 2 Proximal Type 3 Combined Type 4 Hyperkalemic Type 2: Proximal tubule RTA Failure of the proximal tubule to reabsorb filtered bicarbonate Initial insult: Excess bicarb excretion; urine pH is 6.5 After insult: Bicarb serum levels


This article discusses the pathophysiology, causes, diagnosis, treatment, and prognosis of renal tubular acidosis (RTA) in veterinary patients. RTA is classified as a non-anion-gap metabolic acidosis in the presence of a normal glomerular filtration rate. Proximal RTA occurs because of a deficiency in bicarbonate resorption in the proximal tubule, whereas distal RTA occurs because of decreased production of bicarbonate in the distal tubule. RTA can be transient or permanent and can occur secondary to other diseases. Therapy includes bicarbonate supplementation with careful acid-base and electrolyte monitoring and treatment of underlying causes. There are few published discussions of renal tubular acidosis (RTA) in the veterinary literature despite the abundance of reports of such disorders in humans. Although it is possible that the incidence of such conditions in small animals is less than that in humans, it is also plausible that tubular disorders are overlooked in veterinary patients (Table 1). RTA typically causes metabolic acidosis with both a normal anion gap and normal glomerular filtration rate (GFR). In contrast, renal failure is often associated with an increased anion g Continue reading >>

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  1. yogipete

    I've wanted a ketonix for a while but am not going to fork over hundreds of dollars. So I followed some advice and got myself a cheap breathalyzer on ebay. Apparently they don't distinguish between alcohol and acetone.
    Now I can measure easily whether or not I am in ketosis anytime I suspect I may have dropped out. The ketostix stopped working for me a long time ago as my body is very well adapted and I don't excrete a lot of measurable ketones.The breathalyzer is not much good for finding your millimoler value of ketones, but then again, by all accounts neither is a ketonix itself. The breathalyzer cost me $12 and you can get them cheaper. In fact, it's only the cheaper ones that work. You can get these breathalyzers as cheap as a few dollars.
    Here's the one I used below

    That reading above is while fully sober... * I swear * Only trouble is it beeps like crazy when it detects 0.05% or over (the legal alcohol driving limit in australia). I'm sure other models wouldn't beep.

    1 Reply

    Ketone meter
    Breath Meter
    Not seeing many results after ~1-2 month
    Keto Strips - No Ketones!
    Testing ketones

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  2. BillJay

    Thanks @yogipete ! This is both interesting and worrisome at the same time!

    I may get a cheap one myself, but in the meantime I'd love to see if others can replicate your results.

  3. yogipete

    My pleasure.

    I might also add that the reading is consistent regardless of my method of blowing etc... which is a problem that haunts the ketonix. I've done a few baseline tests on my partnerr who always blows 0 (she's currently non-keto) while I generally blow between .04 and .05 (but in any one moment of the day the reading is always identical regardless of my personal clumsiness in using the meter). I'm looking forward to testing some more non-keto friends.

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Renal Tubular Acidosis Key Highlights - Epocrates Online

Patients with renal tubular acidosis (RTA) are often asymptomatic but may present with complaints of muscular weakness related to associated hypokalemia. Patients with severe acidemia can show hyperventilation or Kussmaul breathing due to respiratory compensation. Patients with RTA have a low arterial pH and serum bicarbonate with hyperchloremia and a normal serum anion gap. The urine pH exceeds 5.5 in classic distal RTA, but is lower than 5.0 in patients with untreated proximal RTA and is low also in hyperkalemic distal RTA. Alkali therapy is the mainstay of treatment. Potassium supplementation may be required for hypokalemia, and low-potassium diets are used if hyperkalemia is present. If hyperkalemic distal RTA is due to mineralocorticoid deficiency, fludrocortisone can be given unless it is contraindicated due to the presence of fluid overload or uncontrolled hypertension. Proximal RTA occurs most often as a component of Fanconi syndrome, which is characterized by generalized dysfunction of the proximal tubule, with the resultant urinary loss of bicarbonate, calcium, phosphate, urate, amino acids, glucose, and other organic acids and bases. In children, Fanconi syndrome causes Continue reading >>

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  1. MariaMia816

    Can anyone tell me what an average weight loss per week or month is for 20 carbs a day? Im loosing soooooo slow.

  2. GSD_Mama

    I guess it will be different for everyone. My first two weeks I've lost about 10, of which water was probably 5-7lb. I'm going on my third month now and losing slow, sometimes I gain sometimes I lose, no rhyme or reason.

  3. stevieedge2015

    10lbs in a month. I'm trying to keep my calories to under 1500. I smoke like a chimney though so...aiming to get to 130 so I can quit and not worry about gaining 10lbs

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