Renal tubular acidosis: Pathology review

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Questions

USMLE® Step 1 style questions USMLE

of complete

A 76-year-old woman presents to the emergency department with fatigue, decreased appetite, and muscle weakness. Past medical history includes chronic migraines, hypertension, gastroesophageal reflux, and a recent episode of podagra. Current medications include topiramate, lisinopril, acetazolamide, omeprazole, and probenecid. Temperature is 37.0°C (98.6°F), pulse is 104/min, respirations are 24/min, and blood pressure is 96/66 mmHg. Arterial blood gas and laboratory testing are obtained, and the results are shown below.



Which of the following medications most likely contributed to this patient’s disease?

Summary

Renal tubular acidosis is a medical condition in which the kidney is unable to secrete acids or reabsorb bicarbonate from the body. When blood is filtered by the kidney, the filtrate passes through the tubules of the nephron, allowing for the exchange of salts, acid equivalents, and other solutes before it drains into the bladder as urine. The metabolic acidosis that results from renal tubular acidosis may be caused either by failure to recover sufficient bicarbonate ions from the filtrate in the proximal tubule or by insufficient secretion of hydrogen ions into the distal tubule. If left untreated, acidemia can cause peripheral vasodilation and shock. Treatment may include alkali supplements like potassium citrate or sodium bicarbonate to neutralize the acid in the blood.

Sources

  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "First Aid for the USMLE Step 1 2018, 28th Edition" McGraw-Hill Education / Medical (2017)
  4. "Nephrolithiasis in Renal Tubular Acidosis" Journal of Urology (1989)
  5. "Pathophysiology of Renal Tubular Acidosis: Core Curriculum 2016" American Journal of Kidney Diseases (2016)
  6. "Nephrolithiasis related to inborn metabolic diseases" Pediatric Nephrology (2009)
  7. "Renal Tubular Acidosis" Pediatric Clinics of North America (2019)
  8. "On the mechanism of renal potassium wasting in renal tubular acidosis associated with the Fanconi syndrome (type 2 RTA)" Journal of Clinical Investigation (1971)
Elsevier

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