Renal Tubular Acidosis - USMLE STep 2 Review

Рет қаралды 71,016

Күн бұрын

This is a review of the pathophysiology, diagnosis and treatment of Renal Tubular Acidosis intended for 3rd and 4th year medical students and others learning clinical medicine.

Пікірлер: 35

@quantumchang4410 9 жыл бұрын

Beautifully lectured. Thank you.

@vangelis9911 9 жыл бұрын

how awesome are you? :) you proud of us for sitting our asses through ,good for you man, n btw, nice vid everything is so simple and the make it into a whole lot of complex concepts its like people who write these books we read havent really gotten the concepts themselves anyways...ty ;)

@MissSovietBones 11 жыл бұрын

I couldn't find a clear explanation anywhere, thank you!

@MegaEddog 9 жыл бұрын

wow thank you. great video.

@sarap7879 6 жыл бұрын

thank you! great vid!

@altafalinaushad6368 9 жыл бұрын

you get a lower urinary pH later in pRTA because all the bicarbonate in the body will get depleted later on in the course of the disease. The body keeps loosing the bicarbonate through glomerular filtration but its not reabsorbed.

@hiahmad 12 жыл бұрын

Type IV RTA, also known as hyporeninemia, hypoaldosteronism, occurs most often in diabetes. Finally, treatment of the different RTA makes sense if you keep the following in mind: dRTA type I, replacing bicarbonate is main tx as it will be absorbed in the PT, correcting the acidosis. pRTA type II, bicarb is not absorbed well, so high dose of bicarb is necessary and Thiazide diuretics can be used as the volume depletion it induces enhances bicarb reabsorption.

@Cp-rk2mz 2 жыл бұрын

Well explained! thank you

@terquisefog4264 7 жыл бұрын

Thank you so much doctor

@rahulshangrila 9 жыл бұрын

Thank you.!

@dick5174 8 жыл бұрын

Very clear and easy to understand

@hamo0dful 11 жыл бұрын

Awesome ... thanx

@hiahmad 12 жыл бұрын

Nice video, breaks down this complex issue well. First, the reason urine pH is low in pRTA II is because bicarb is lost in the urine until body is so depleted of bicarb that the DT can absorb the rest, which means urine pH will become low (below 5.3). In terms of basic assessment, know the fact that normal anion gap metabolic acidosis occurs due to either RTA or Diarrhea. The way to distinguish b/w the two causes is via urine anion gap (sodium minus chloride). RTA has +UAG, diarrhea has -UAG.

@ruchikamallick9285 6 жыл бұрын

hiahmad can you please explain why do we get positive UAG in proximal RTA? I mean in proximal rta the distal tubule is capable of acidyfying the urine.. So chloride should also come wd that.. Which should lead to negative UAG..??

@dtanoli 11 жыл бұрын

best video of RTA

@spring2869 11 жыл бұрын

thank u its v helpful

@drjohnvinodkumar 7 жыл бұрын

thank u

@abiaarisha8051 3 жыл бұрын

Thanks,my question is,in rta2 we should use the medicine lifelong?

@hiahmad 12 жыл бұрын

Potassium citrate is used to prevent stones from forming. In dRTA type 1 there is increased formation of kidney stones from calcium oxalate due to the alkaline urine, which is what KCitrate prevents.

@MedicinePearl Жыл бұрын

Nice❤

@vwziful 10 жыл бұрын

how come there is acidosis yet hypokalemia?

@tgrlil88 10 жыл бұрын

you mean at 0:52 that the pH is going DOWN [in the blood] because you're not getting rid of H+, right?

@wusongg 8 жыл бұрын

dude thanks so much but the part why ph in urine has any abswer now?

@heclas 7 жыл бұрын

Usually about 90% of the filtered HCO3- is absorbed by the proximal tubule, the rest is absorbed by the distal nephrons. In the setting of proximal impairment of HCO3- , the distal nephrons become overwhelmed by an increase in HCO3- delivery and cannot compensate for the loss in proximal function. However as urinary HCO3- loss progresses, plasma HCO3- drops to 15-18 meq/L. This causes the level of filtered HCO3- to fall and thus there is reduced delivery of HCO3- ions to the distal nephrons. At that point, the distal nephrons are no longer overwhelmed and can regain function, leading to a reduction in bicarbonaturia and a urine which can now be acidic. This is in contrast to type 1 RTA, where urine acidification is limited to a minimum urinary pH of 5.5.