Jan 1, 1976

Nephrology rounds, University of Iowa Hospitals: renal tubular acidosis

The American Journal of the Medical Sciences
P R SteinmetzW J Lawton

Abstract

We have discussed two patients who had renal tubular acidosis complicated by hypokalemia. The first patient had a distal acidifying defect. Circumstantial evidence has been presented suggesting that exposure to toluene-diisocyanate or toluene-diamine played a role in the pathogenesis. The acidosis and the hypokalemia of this patient were easily corrected by the administration of small amounts of sodium bicarbonate without potassium supplementation. The second patient had an interstitial nephritis of unknown etiology and presented with moderate renal insufficiency, renal tubular acidosis, and proximal as well as distal acidifying defects. The proximal tubular dysfunction was associated with general aminoaciduria and glucosuria. This patient required large quantities of both alkali and potassium to correct the electrolyte abnormalities. The mechanisms of potassium wasting in proximal and distal renal tubular acidosis are reviewed. A classification is presented of cellular defects that may underlie the different renal acidifying defects. Attempts to distinguish between pump and permeability defects from urinary pCO2 levels must take into account the simultaneous HCO-3 concentration, since large pCO2 elevations require the presence...Continue Reading

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Mentioned in this Paper

Wasting
Pathogenic Aspects
Urine
Electrolytes
Pathogenesis
Entire Lumen of Body System
Nephritis
Kidney Failure
Hypoaldosteronism
Resting Potentials

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