can not get rid of enough acid, keep enough base or both.A renal tubular acidosis can be divided into different subtypes, each of which with its own characteristics.It is often detected by blood test, and early diagnosis can help health care providers prevent complications of long-term kidney dysfunction.
Science photo library / brand X images / getty images
RTA and kidney
The kidneys are crucial to maintain the equilibrium of acid and the base onThe body.
Under normal conditions, the body generates constantly acid, mainly through the breakdown of the proteins.
Normally, the kidneys Ela of the excess acid in the urine.The distribution of this process leads to the accumulation of acid in the blood known as metabolic acidosis.
To understand renal tubular acidosis, it is necessary to understand a little about the physiology of renal (kidney).In the current functional unit of the kidneys it is called nephrón , and each kidney consists of them a million.
Each nephron is A small and extremely thin tube. It is an extremely thin tube.However, the end of the slot is folded into the Cupplike structure, which surrounds the accumulation of small blood vessels, called glomerul. The blood is filtered, as it passes through the glomerulus and enters the nephron trench.
The pipes can be divided into two parts. The filtered blood (filtered) first enters the proximal tube, and then passes into the distal tube.Since it passes through the proximal and distal tubules, the kidneys assign some substances in it and repeatedly absorb other substances into the bloodstream. The confined product is the urine that is used in the kidney in the bladder.
In the proximal tube, the bicarbonate (base, the opposite of the acid) is reabsorbed from the filtering back to the bloodstream. In the distal tube, the acid is released from the blood directly to the filtrate and transferred. In the urine.If one of these processes breaks, metabolic acidosis is the result.
Types and reasons for renal tubular acidosis
Renal tubular acidosis is divided into three or four subtypes; Experts are distinguished by how to classify them.The general form of describing RTA is based on which part of the tube is defective:
type 1 (distal) RTA
type 2 (proximal) RTA Type 4 RTA (or Hypoalaldosteronism-ASTRESS RTA)
Type 3 RTA -This is a term that is now rarely used by health care providers. It combines the characteristics of types 1 and 2 and is associated with dysfunction or a deficit of an important enzyme called carbonic anhydrase.It was also used to describe the temporal rh, which can occur in young children whose nephron function is not completely mature. Type 1 (distal) RTA
As follows on the name,Type 1 or the distal RTA involves the problem in the distal wastewater system of nephrons and is characterized by the refusal of nephrons to assign sufficient acid in the urine.
Syndrome Marfan , the disease of Wilson’s disease and Ehlersfuerna syndrome of Danlos . Renal tissue dies, including also includes autoimmune diseases, such as lupus , rheumatoid arthritis and SOGREN SYNDROME Medulla , can also cause Type 1 RTA. NEFROL)
amphotericin B .
Type 1 RTA can also be See after renal transplant due to chronic deviation.
Type 2 (proximal) RTA
2 Type 2 RTA is characterized by the negative of the nephrons to restore a Sufficient amount of the base of the filtered blood.
The too large basis is lost in the urine, and the blood becomes too acidic (metabolic acidosis). Since this process is produced mainly in the proximal tube, type 2 is also called proximal RTA.
Type 2 RTA: The least common form of RTA, and, like Type 1 of RTA, usually does not occur in isolation, but is associated with another disorder. Once again, there is a long list of diseases that can cause type 2 type RTA.
Hereditary disorders that can cause RTA Type 2 include Fankoni’s syndrome, Wilson’s disease,
Tyrosinemia , fructose intolerance or
Acquired Conditions that can cause RTA Type 2,Includes heavy metal intoxication, the use of medications
acetazolamide / a> or some myeloma . Type 4 RTA (Hiral Steronism associated with RTA)
Type 4 RTA is characterized by The deficit of the hormone
aldosterone or the lack of renal cells to respond.
The aldosterone points out the kidneys to maintain sodium or get rid of potassium. If there is very little hormone, or if the cells of the kidneys usually do not respond, the kidney does not highlight enough potassium in the urine.This causes an increase in potassium levels in body conditions called Hyperqualemy
Metabolic acidosis is the result.Chronic kidney disease due to diabetes or other conditions may violate aldosterone levels and call Type 4 RTA.
Diseases that affect the function of the adrenal glands, they can also interfere with the extraction of aldosterone and the result in the RTA type 4.Rarely inherited conditions can lead to low levels of aldosterone or aldosterone resistance.
Many medications can cause a RTA 4 type through several mechanisms.These include ‘
anti-inflammatory drugs anti-inflammatory ‘ (NSAID), immunosuppressants (such as cyclosporine ), angiotensin inhibitors A> heparin , certain diuretics ( Like the spironolactone) and certain antibiotics (trimethopris and pentamidine).
Renal symptoms Tubular acidosis
Patients with RTA can reach medical care as babies, older children or adults.Since there are several types of RTA with several hered and unharmed (acquired) causes, symptoms of syndrome can be variable. In adults, RTA is usually the result of some other diseases, and symptomatology can be determined by the main disorder.
Children with types 1 and type 2 are often present with growth anomalies.
In Type 1 of RTA, the kidney stones They are a common problem, the image often prevails by this disease.
In general, health providers may suspect that they can have a renal tubular acidosis if it has recurrent kidney stones (especially if you have a long family history of stones).Your healthcare provider can also suspect that RTA if you or your child have certain inexplained bone disorders (
osteomagación or osteopertosses ), or if you have autoimmune diseases (for example, syndrome of SOZREN) metabolic acidosis. Patients with inexplicable metabolic acidosis can also be estimated for RTA.
Diagnostics RTA depends on the history of your illness and the results of simple blood and urine tests.Your health care provider can verify your blood for the level of electrolyte, especially
sodium , potassium , chlorine and bicarbonate.
Occasionally, an arterial blood sample may be required to confirm that it has metabolic acidosis. The health care provider can also verify its urine for acidity and ammonia levels and other electrolytes.If you suspect that type 4 RTA is suspected, you can verify the level of aldosterone of the blood and associated hormones.
Some patients with RTA may have relatively smooth blood and urine anomalies.You can perform ‘provocative’ tests to see if your kidneys generally excrete dispersed acids.
Historically, health care providers gave a slightly acidic oral solution (ammonium chloride) and then reviewed urine acid. .Some situations, your health care provider can control the bicarbonate IV and the urinary acidity of the probe. This can help distinguish type 1 and type 2 RTA.
The RTA treatment is based on the introduction of the base (bicarbonate or citrate, as a rule) neutralizes the excess blood flow or replace the loss of bicarbonate in the urine.If the bases introduced are not effective, tiazide diuretics (such as hydrochlorothiazide) may be required.
However, the deafness associated with certain hereditary conditions can be irreversible.
If the RTA is associated with another disease, such as lupus, treatment, the main disease can improve acidosis caused by medications, may require the termination of drug insults.
4 RTA 4 It may be necessary for treatment with steroid hormones (such as fluorphone or flowerf) acts instead of aldosterone deficiency.Potassium supplement for patients with associated low potassium may be required, while treatment of potassium decrease may be required in patients with high potassium.
Regardless of the treatment mode, the commitment of therapy is crucial to prevent complications of a long RTA.For example, the formation of a renal calculation, if uncontrolled, can ultimately lead to chronic kidney failure that requires dialysis.