Type 4 Renal Tubular Acidosis

Aka: Type 4 Renal Tubular Acidosis, Type IV Renal Tubular Acidosis, Type IV RTA, Hyperkalemic RTA, Hyperkalemic Renal Tubular Acidosis

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II. Causes

  1. Aldosterone deficiency
    1. Syndrome Hyporeninemic Hypoaldosteronism
    2. Addison's Disease
    3. Heparin
    4. Potassium sparing Diuretics (e.g. Spironolactone)
  2. Collecting duct dysfunction from Renal Insufficiency
    1. Diabetic Nephropathy
    2. Interstitial Nephritis
    3. Obstructive Uropathy
    4. Renal Transplantation

III. Labs

  1. Arterial Blood Gas (ABG)
    1. Non-Anion Gap Metabolic Acidosis
  2. Chemistry panel
    1. Hyperkalemia
  3. Urinalysis
    1. Urine pH <5.5 with severe Metabolic Acidosis
  4. Creatinine Clearance decreased (<45 ml/min)

IV. Management

  1. Cause: Aldosterone or Mineralocorticoid deficiency
    1. Fludrocortisone
  2. Cause: Chronic Renal Insufficiency
    1. Dietary Potassium restriction
    2. Loop Diuretics
    3. Low dose Oral Sodium Bicarbonate (1-2 meq/kg/day)

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