7/19/2017 Characteristics of RTA - UpToDate

Official reprint from UpToDate®

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Characteristics of the different types of renal tubular acidosis

Hyperkalemic RTA –
Type 4 RTA
Type 1 RTA Type 2 RTA (hypoaldosteronism)
and distal tubule
voltage defects
Primary defect Impaired distal Reduced Decreased aldosterone
acidification proximal secretion or aldosterone
bicarbonate resistance. Reduced sodium
reabsorption reabsorption in the distal
tubule (voltage defect).

Plasma bicarbonate Variable, may Usually 12 to 20 Variable (greater than 17

be below 10 meq/L meq/L in
meq/L hypoaldosteronism)

Urine pH Greater than 5.3 Variable, greater Variable, greater than 5.3
than 5.3 if the with voltage defects, and
serum HCO3 usually less than 5.3 with
exceeds the hypoaldosteronism
tubule's
bicarbonate
reabsorptive
threshold. Less
than 5.3 when
the serum HCO3
is reduced to
levels that can be
largely
reabsorbed
despite defective
proximal tubule
reabsorptive
mechanisms.

Plasma potassium Usually reduced Reduced, made Increased; correcting the

but worse by hyperkalemia alone will
hyperkalemic bicarbonaturia improve the acidosis by
forms exist; induced by alkali increasing ammonium
hypokalemia therapy availability
largely corrects
with alkali
therapy

Urine anion gap Positive Negative Positive

Urine calcium/creatinine ratio Increased Normal Normal

Nephrolithiasis/nephrocalcinosis Yes No No

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7/19/2017 Characteristics of RTA - UpToDate

HCO3: bicarbonate; RTA: renal tubular acidosis.

Graphic 58428 Version 7.0

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