A distal (type 1) renal tubular acidosis case that mimic coronary ischemia

Figures & data

Figure 1. Electrocardiography of the patient on admission.

Table 1. Characteristic of different types of renal tubular acidosis (RTA).

RTA	Type 1 (distal)	Type 2 (proximal)	Type 4
Basic defect	Decreased distal H^+ secretion	Diminished proximal HCO3 reabsorption	Aldosterone deficiency or resistance
Urine pH during academia	>5.3	<5.3 (>5.3 if above reabsorptive threshold	Usually <5.3
Urinary anion gap	Positive	Negative	Positive
excretion	Decreased	Normal	Decreased
Plasma [HCO3]	<10 mmol/L	Usually 14–20 mmol/L	Usually >15 mmol/L
Confirmation test	Response to NaHCO3 or NH4Cl	Response to NaHCO3	Measure plasma aldosterone concentration
Plasma [K^+]	Usually reduced	Normal or reduced	Elevated
Dose of to normalize  plasma [], meq/kg per day	1–2 in adults, 4–14 in children	10–15	1–3; may require no alkali if hyperkalemia corrected
Nonelectrolyte complications	Nephrocalcinosis and renal stones	Rickets or osteomalacia	None

What had been called type 3 RTA is actually a variant of type 1 RTA.

Adapted from Rose et al.1

Batlle D, Haque SK. Genetic causes and mechanisms of distal renal tubular acidosis. Nephrol Dial Transplant. 2012;27(10):3691–3704

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