Type 4 renal tubular acidosis occurs in diseases and conditions associated with a failure of aldosterone action or hypoaldosteronism.
In this type of renal tubular acidosis, the acidosis is a result of loss of pH regulation secondary to hyperkalaemia.
The pH of the urine is usually below 5.4, and there is hyperkalaemia, secondary to hypoaldosteronism - mineralocorticoid deficiency causes a reduction in secretion of H+ in the distal nephron and a reduction in NH4+ sectretion. Other features include hyperchloraemic metabolic acidosis.
Treatment is with modest doses of bicarbonate and mineralocorticoid replacement.
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