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

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
Labs
1. Arterial Blood Gas (ABG)
  1. 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)
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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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.