2014-18 dRTA-diagnosis drTa NH4CI Irosemide mineralocorticoid Hyperchloremic acidosis (fludrocortisone) Kidney stone Hypokalemia Sjogren syndrome Type 4 RTA Metabolic alkalosis Renal function compromised An elevated arterial pH Hyporeninemic hypoaldosteronism An increase in the serum [HCO3-] and a ncrease in Pco2 Urinary ammonium excretion depressed Often accompanied by hypochloremia and Pathogenesis Differential diagnosis Generative stage: loss of acid Maintenance stage: volume contraction, a low Bartter s or Gitelman s GFR or depletion of Cl or K2014-1-8 7 dRTA-diagnosis • NH4Cl • Furosemide + mineralocorticoid (fludrocortisone) dRTA • Hyperchloremic acidosis • Kidney stone • Hypokalemia • Sjogren syndrome Type 4 RTA • Renal function compromised • Hyporeninemic hypoaldosteronism • Hyperkalemia • Urinary ammonium excretion depressed Metabolic Alkalosis • An elevated arterial pH • An increase in the serum [HCO3-] and a increase in PCO2 • Often accompanied by hypochloremia and hypokalemia Pathogenesis • Generative stage: loss of acid • Maintenance stage: volume contraction, a low GFR or depletion of Cl or K Differential diagnosis • Mineralocorticoid excess • Bartter’s or Gitelman’s • Diuretics