TOC |  Kidney Proximal RTA - Type II

a. Diagnosis:

• Dx is suggested by large bicarbonaturia, hypovolemia, hypokalemia, & Hyperchloremic metabolic acidosis. Urine pH may be 7.0 7.8 in pts with plasma HCO3 of 20-24 meq/l, but may be 5.4 if plasma HCO3 is 16 meq/l.

b. Causes:

• Primary sporadic or inherited
• Fanconi like syndromes
• Multiple myeloma
• Amyloidosis
• Nephrotic syndrome
• Medullary cystic disease
• Outdated tetracycline, Cadmium poisoning, Lead poisoning
• Renal transplantation early rejection

c. Treatment:

• Ideally is directed to the specific cause, but if needed, large amounts of alkali 10-25 mmoles/kg/d may be needed. K+ Rx prn.