Master the board step 3

Nephrology
If you cannot excrete acid from the kidney, the urine chloride goes down. This
gives a positive number (UAG). In RTA, you cannot excrete acid from the
kidney. The urine chloride will be low, and the UAG will be positive.
Metabolic Alkalosis
Volume Contraction
Volume contraction leads to metabolic alkalosis because there is a secondary
hyperaldosteronism, which causes increased urinary loss of acid.
Treat the underlying cause.
Conn Syndrome or Cushing Syndrome
Hyperaldosteronism resulting from primary hyperaldosteronism (Conn syndrome)
or Cushing syndrome causes urinary acid loss.
Surgically remove the adenoma. Also look for hypokalemia, which often
accompanies the increased urinary acid loss.
Hypokalemia
Hypokalemia causes metabolic alkalosis, because potassium ions shift out of
the cell to correct the hypokalemia. This shifts hydrogen ions into the cell in
exchange for the potassium ions leaving.
Milk-Alkali Syndrome
Metabolic alkalosis occurs from the administration of too much liquid antacid.
Vomiting
Vomiting causes a loss of acid from the stomach. In addition, the loss of fluids
leads to volume contraction and secondary hyperaldosteronism.
Cystic Disease
Cystic disease presents with recurrent hematuria, stones, and infections.
There are cysts throughout the body, such as in the liver, ovaries, and circle
of Willis; mitral valve prolapse; and diverticulosis. The most common site
of extrarenal cysts is the liver. The most common cause of death is end-stage
renal disease.
Subarachnoid hemorrhage
is not the most common
cause of death in cystic
disease.
There is no specific therapy.
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