Acidosis Tubular Renal

Descripción General

Definición

La acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal es un desequilibrio en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el pH pH The quantitative measurement of the acidity or basicity of a solution. Acid-Base Balance fisiológico causado por la incapacidad del riñón para acidificar la orina para mantener el pH pH The quantitative measurement of the acidity or basicity of a solution. Acid-Base Balance de la sangre en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niveles fisiológicos.

Clasificación

La acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal se puede clasificar según las características clínicas y el defecto fisiológico:

• Tipo 1: acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal distal
• Tipo 2: acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal proximal
• Tipo 3: acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal mixta (muy rara)
• Tipo 4: acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal hiperpotasémica

Comparación de los LOS Neisseria tipos de acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal, incluidas las características clínicas, los LOS Neisseria defectos fisiológicos y las posibles etiologías:

Epidemiología

• La acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal hiperpotasémica (tipo 4) es la más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria Estados Unidos.
  • Más comúnmente causada por nefropatía diabética
  • Conduce a hipoaldosteronismo hiporreninémico y obstrucción del tracto urinario
• La acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal proximal (tipo 2) y la acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal distal (tipo 1) son poco frecuentes.
• Mixta (tipo 3) es extremadamente rara
• La acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal asociada con el uso de medicamentos está aumentando en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum incidencia:
  • Medicamentos antivirales
  • Medicamentos para trasplantes (20% de incidencia de acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal hiperpotasémica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum trasplantes renales)

Etiología

Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal distal (tipo 1)

En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum adultos, las etiologías más comunes son:

• Enfermedad autoinmune:
  • Síndrome de Sjögren
  • Artritis reumatoide
  • Lupus eritematoso sistémico
• Hipercalciuria:
  • Intoxicación por vitamina D
  • Hiperparatiroidismo
  • Sarcoidosis Sarcoidosis Sarcoidosis is a multisystem inflammatory disease that causes noncaseating granulomas. The exact etiology is unknown. Sarcoidosis usually affects the lungs and thoracic lymph nodes, but it can also affect almost every system in the body, including the skin, heart, and eyes, most commonly. Sarcoidosis
  • Hipercalciuria idiopática (familiar)

En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria niños, la etiología más común es genética:

• Autosómico dominante o autosómico recesivo:
  • Mutaciones del intercambiador Cl^–/HCO₃^–
  • Mutaciones de la bomba H⁺–ATPasa
• Otras asociaciones genéticas:
  • Síndrome de Marfan
  • Síndrome de Ehlers-Danlos
  • Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types drepanocítica
  • Obstrucción congénita del tracto urinario

Otras etiologías:

• Medicamentos:
  • Litio
  • Anfotericina B
  • AINE
  • Ifosfamida (más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal tipo 3)
• Uropatía obstructiva
• Rechazo del trasplante de riñón
• Riñón en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum esponja medular
• Enfermedad de Wilson

Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal proximal (tipo 2)

En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum adultos, la etiología más común es la gammapatía monoclonal:

• Mieloma múltiple
• Amiloidosis

En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria niños, las etiologías más comunes son:

• Idiopática
• Ifosfamida
• Cistinosis

Otras etiologías:

• Causas autoinmunes (especialmente síndrome de Sjögren)
• Genéticas:
  • Autosómico dominante o autosómico recesivo
  • Antiportador apical Na⁺/H⁺ de las células tubulares proximales
  • Cotransportador basolateral Na⁺/HCO₃^– de las células tubulares proximales
• Medicamentos/metales tóxicos:
  • Metales pesados (plomo, mercurio)
  • Inhibidores de la anhidrasa carbónica (como acetazolamida, topiramato)
  • Aminoglucósidos
  • Antirretrovirales (específicamente, tenofovir Tenofovir An adenine analog reverse transcriptase inhibitor with antiviral activity against HIV-1 and hepatitis b. It is used to treat HIV infections and chronic hepatitis b, in combination with other antiviral agents, due to the emergence of antiviral drug resistance when it is used alone. Anti-HIV Drugs)
  • Ifosfamida
  • Cisplatino, oxaliplatino
  • Ácido valproico
• Misceláneas:
  • Nefritis intersticial
  • Deficiencia de vitamina D
  • Hiperparatiroidismo secundario
  • Trasplante renal
  • Otras enfermedades asociadas al AL Amyloidosis síndrome de Fanconi:
    • Tirosinemia
    • Cistinosis
    • Galactosemia Galactosemia Galactosemia is a disorder caused by defects in galactose metabolism. Galactosemia is an inherited, autosomal-recessive condition, which results in inadequate galactose processing and high blood levels of monosaccharide. The rare disorder often presents in infants with symptoms of lethargy, nausea, vomiting, diarrhea, and jaundice. Galactosemia
    • Intolerancia hereditaria a la fructosa
    • Enfermedad de von Gierke (enfermedad de almacenamiento de glucógeno tipo I)
    • Enfermedad de Wilson
    • Enfermedad de Lowe
    • Hemoglobinuria Hemoglobinuria The presence of free hemoglobin in the urine, indicating hemolysis of erythrocytes within the vascular system. After saturating the hemoglobin-binding proteins (haptoglobins), free hemoglobin begins to appear in the urine. Transfusion Reactions paroxística nocturna

Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal mixta (tipo 3)

• No se han registrado casos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum adultos.
• En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria niños, la causa más común es la deficiencia de anhidrasa carbónica II.

Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal hiperpotasémica (tipo 4)

En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum adultos, las etiologías más comunes son:

• Nefropatía diabética
• Nefritis intersticial
• ERC de leve a moderada

Otras etiologías:

• Genéticas:
  • Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types drepanocítica
  • Deficiencia de 21-hidroxilasa
  • Pseudohipoaldosteronismo
• Autoinmunes (particularmente lupus)
• Medicamentos:
  • Diuréticos ahorradores de potasio
  • AINE
  • Inhibidores de la calcineurina (ciclosporina, tacrolimus Tacrolimus A macrolide isolated from the culture broth of a strain of streptomyces tsukubaensis that has strong immunosuppressive activity in vivo and prevents the activation of T-lymphocytes in response to antigenic or mitogenic stimulation in vitro. Immunosuppressants)
  • Inhibidores de la enzima convertidora de angiotensina (IECA)
  • Antagonistas de los LOS Neisseria receptores de angiotensina (ARA)
  • Inhibidores de la renina
  • Heparina
  • Trimetoprim
  • Pentamidina
• Misceláneas:
  • Obstrucción crónica del tracto urinario
  • Insuficiencia suprarrenal primaria
  • Enfermedad crítica

Fisiopatología

Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal distal (tipo 1)

La fisiopatología de la acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal distal (tipo 1) es la alteración de la secreción de protones en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el conducto colector del túbulo distal.

Proceso normal de acidificación urinaria:

• Las células intercaladas participan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la excreción de ácido:
  • Situadas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el conducto colector del túbulo distal
  • Células intercaladas-alfa:
    • H⁺/K⁺–ATPasa apical (1 H⁺ fuera de la célula, 1 K⁺ dentro de la célula)
    • H⁺–ATPasa apical(1 H⁺ fuera de la célula)
    • Na⁺/K⁺–ATPasa basolateral
    • Intercambiador basolateral de Cl^–/HCO₃
  • Células intercaladas-beta:
    • Intercambiador apical de Cl^–/HCO₃ (1 HCO₃^– fuera de la célula, 1 Cl^– dentro de la célula)
    • H⁺/K⁺–ATPasa apical (1 H⁺ fuera de la célula, 1 K⁺ dentro de la célula)
    • Na⁺/K⁺–ATPasa basolateral
    • H⁺–ATPasa basolateral
• Efecto neto
  • Las células intercaladas secretan H⁺ en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la luz tubular
  • H⁺ se combina con NH₃⁺ (amoníaco) y otros compuestos (ácidos titulables)
  • Se excretan NH₄⁺ (amonio) y ácidos titulables.
  • Se mantiene la homeostasis Homeostasis The processes whereby the internal environment of an organism tends to remain balanced and stable. Cell Injury and Death ácido–base

Procesos anormales que conducen a acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal distal:

• ↓ Actividad de la H⁺/K⁺–ATPasa apical (↓ secreción de H⁺ en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la luz tubular)
• ↑ Permeabilidad del conducto colector a H⁺:
  • El conducto colector es normalmente impermeable a H⁺:
    • Previene el reflujo de H⁺ secretado recientemente
    • Permite la excreción de orina que es más ácida que el plasma Plasma The residual portion of blood that is left after removal of blood cells by centrifugation without prior blood coagulation. Transfusion Products
  • Ejemplo: toxicidad por anfotericina
• ↓ Reabsorción de Na⁺
• Alteración en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la actividad del intercambiador Cl^–/HCO₃^–:
  • ↑ Actividad del intercambiador apical Cl^–/HCO₃^–
    • ↑ HCO₃^– secreción → pérdida del HCO₃^– neto → acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica
    • Ocurre en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las células intercaladas-beta
  • ↓ Actividad del intercambiador basolateral Cl^–/HCO₃^–:
    • ↓ HCO₃^– secreción → acumulación de HCO₃^– intracelular → ↑ pH pH The quantitative measurement of the acidity or basicity of a solution. Acid-Base Balance intracelular
    • ↓ Secreción de H⁺ a través de ATPasas apicales para corregir el pH pH The quantitative measurement of the acidity or basicity of a solution. Acid-Base Balance intracelular
    • Ocurre en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las células intercaladas alfa

Complicaciones:

• La acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica grave puede ocurrir en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal distal (tipo 1):
  • HCO₃^– sérico < 10 mEq/L si no se trata
  • Ocurre en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la nefrona distal → no ocurren procesos autorregulatorios
• Hipopotasemia
• Hipocitraturia (predispone a nefrolitiasis)

Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal proximal (tipo 2)

La fisiopatología de la acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal proximal (tipo II) es una alteración en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la reabsorción de bicarbonato en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el túbulo proximal.

Proceso normal de reabsorción de HCO₃^– en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el túbulo proximal:

• En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum circunstancias normales, el 80% del HCO₃ filtrado se reabsorbe en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el túbulo proximal
• Requiere un mecanismo complejo porque el HCO₃^– no es libremente permeable (debido a la carga):
  • El intercambiador de iones de sodio-hidrógeno 3 absorbe Na⁺ y secreta H⁺.
  • El H⁺ secretado se combina con el HCO₃^– filtrado para formar H₂CO₃ en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la luz tubular.
  • El H₂CO₃ se convierte en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum H₂O y CO₂ mediante la anhidrasa carbónica apical IV.
  • El CO₂ se difunde libremente a través de la membrana apical de regreso a la célula.
  • La anhidrasa carbónica intracelular II convierte CO₂ + H₂O de nuevo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum H₂CO₃.
  • Entonces, el H₂CO₃ puede disociarse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum H⁺ y HCO₃^–:
    • El H⁺ se recicla a través del NHE3 NHE3 A sodium-hydrogen antiporter expressed primarily by epithelial cells in the kidneys, it localizes to the apical membrane of the proximal kidney tubule, where it functions in sodium and water reabsorption and possibly calcium homeostasis. It also is expressed in heart, brain, and lung tissues and is resistant to amiloride inhibition. Carbonic Anhydrase Inhibitors
    • El HCO₃^– se absorbe a través de la membrana basolateral mediante el cotransportador Na⁺–HCO₃^– y el intercambiador HCO₃^––Cl ^–.
• Efectos netos de todo el proceso:
  • Excreción de H⁺
  • Absorción de HCO₃^–

Procesos anormales que conducen a acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal proximal (tipo 2):

• Mieloma múltiple: las cadenas ligeras son directamente tóxicas para las células del túbulo proximal
• Medicamentos que causan toxicidad en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las células del túbulo proximal a través de múltiples mecanismos
• Mutaciones en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:
  • Intercambiador de iones de sodio-hidrógeno 3 apical
  • Cotransportador basolateral Na⁺/HCO₃^–

Complicaciones:

• Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica moderada
  • HCO₃^– sérico de 14–20 mEq/L, incluso si no se trata
  • La mayor parte del túbulo proximal mantiene su capacidad para reabsorber HCO₃^–:
    • Reducción del umbral de reabsorción para HCO₃^– en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el túbulo proximal
    • HCO₃^– sérico ↓ hasta que coincida con el nuevo umbral (estado estacionario)
    • La acidificación distal se mantiene → la carga ácida diaria se trata sin empeorar la acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis
• Hipopotasemia
• Síndrome de Fanconi

Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal mixta (tipo 3)

El defecto subyacente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal de tipo 3 consiste en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum anomalías tubulares renales tanto proximales como distales que dan lugar a una acidemia Acidemia Respiratory Acidosis sistémica grave.

• Mutación autosómica recesiva en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el gen CA2 en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cromosoma 8q22:
  • Deficiencia de la anhidrasa carbónica II:
    • Deterioro de la reabsorción proximal de bicarbonato
    • Incapacidad de acidificar la orina distalmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el conducto colector
  • Pérdida severa de bicarbonato:
    • Bicarbonato sérico peligrosamente bajo
    • Pérdida renal de potasio concomitante
  • Hipocalemia:
    • Debido a un fallo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la reabsorción de potasio dependiente de la anhidrasa carbónica
    • Se produce en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la nefrona distal → no hay procesos descendentes para compensar

Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal hiperpotasémica (tipo 4)

El mecanismo clásico para la mayoría de los LOS Neisseria pacientes con acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal hiperpotasémica (i.e., nefropatía diabética y ERC de leve a moderada) es hipoaldosteronismo hiporreninémico.

• Acciones normales de la aldosterona:
  • El efecto neto es:
    • Reabsorber Na⁺
    • Secretar K⁺
    • Secretar H⁺
  • Estimula el canal de Na epitelial ( ENaC ENaC Sodium channels found on salt-reabsorbing epithelial cells that line the distal nephron; the distal colon; salivary ducts; sweat glands; and the lung. They are amiloride-sensitive and play a critical role in the control of sodium balance, blood volume, and blood pressure. Liddle Syndrome) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la célula principal
    • ↑ Reabsorción de Na⁺ → ↑ gradiente eléctrico de secreción de K⁺
    • La secreción de K⁺ ocurre a través del canal de potasio de la médula externa renal en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la célula principal.
• La hiperpotasemia contribuye a la acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica:
  • ↑ K⁺ inhibe la amoniagénesis en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el túbulo proximal
  • ↓ Amonio urinario → ↓ excreción de ácido
• Todas las demás etiologías también implican alguna alteración en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el estado del SRAA → ↓ aldosterona, que puede ser absoluta o relativa (i.e., resistencia a la aldosterona).

Presentación Clínica

Las acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubulares renales a menudo no tienen una presentación clínica específica y solo se consideran una vez que se descubre la acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica. Aunque algunos pacientes son asintomáticos, muchos tienen síntomas significativos causados por la etiología subyacente de la acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal, en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum lugar de síntomas de la acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis misma.

Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal distal (tipo 1)

• Adultos:
  • Nefrolitiasis inexplicable
  • Síndrome de Sjögren con acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica inexplicable
• Niños:
  • Falta de crecimiento
  • Osteomalacia Osteomalacia Disorder caused by an interruption of the mineralization of organic bone matrix leading to bone softening, bone pain, and weakness. It is the adult form of rickets resulting from disruption of vitamin d; phosphorus; or calcium homeostasis. Osteomalacia and Rickets
  • Raquitismo

Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal proximal (tipo 2)

• Por lo general, ocurre como parte del síndrome de Fanconi, en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum lugar de una acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal aislada:
  • El síndrome de Fanconi se refiere a la disfunción general del túbulo proximal
  • Reabsorción anormal de fósforo, ácido úrico, aminoácidos y glucosa
  • Se produce la pérdida urinaria de todas estas sustancias
• Adultos:
  • Pacientes con mieloma múltiple y síndrome de Fanconi
  • Síndrome de Fanconi por medicamentos
• Niños:
  • Enfermedad genética que causa el síndrome de Fanconi (cistinosis, tirosinemia)
  • Síndrome de Fanconi por medicamentos

Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal mixta (tipo 3)

• Se observa sólo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum zonas donde la consanguinidad es frecuente:
  • Norte de África
  • Arabia Saudí
• Observada sólo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños:
  • Los LOS Neisseria defectos metabólicos suelen ser incompatibles con la supervivencia hasta la edad reproductiva
  • Los LOS Neisseria que sobreviven tienen pocas probabilidades de reproducirse.
• Se observa que los LOS Neisseria niños afectados tienen:
  • Baja estatura
  • Enfermedad cerebral marmórea → retraso mental
  • Calcificaciones cerebrales → sordera y ceguera por compresión nerviosa
  • Dismorfismo facial
  • Osteoporosis Osteoporosis Osteoporosis refers to a decrease in bone mass and density leading to an increased number of fractures. There are 2 forms of osteoporosis: primary, which is commonly postmenopausal or senile; and secondary, which is a manifestation of immobilization, underlying medical disorders, or long-term use of certain medications. Osteoporosis → fracturas óseas
  • Nefrolitiasis
  • Parálisis hipocalémica aguda (asociada a insuficiencia respiratoria diafragmática)
  • Coma Coma Coma is defined as a deep state of unarousable unresponsiveness, characterized by a score of 3 points on the GCS. A comatose state can be caused by a multitude of conditions, making the precise epidemiology and prognosis of coma difficult to determine. Coma
  • Shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock

Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal hiperpotasémica (tipo 4)

• En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum adultos, esto suele ser un hallazgo de laboratorio incidental relacionado con:
  • Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus
  • ERC de leve a moderada
  • Medicamentos (AINE, diuréticos ahorradores de K, IECA, ARA, heparina, trimetoprim)
• En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria niños, esto suele deberse a una enfermedad genética poco frecuente:
  • Pseudohipoaldosteronismo tipo 2 (síndrome de Gordon)
  • Hipoaldosteronismo congénito aislado

Diagnóstico

La acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal debe considerarse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el diagnóstico diferencial de la acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica sin desequilibrio aniónico

Paso 1

Una vez que se identifique la acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica sin desequilibrio aniónico, considerar el diagnóstico diferencial:

• Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal
• Diarrea
• Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis dilucional (i.e., exceso de solución salina normal intravenosa)
• ERC (gravedad leve a moderada)
• Desviación urinaria al AL Amyloidosis tracto gastrointestinal (i.e., fístula ureterosigmoidea)
• Toxicidad por tolueno (pegamento “resoplado”)

Paso 2

Comprobar la brecha osmolal en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum orina y/o la brecha aniónica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum orina.

• Diferencia la acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal de otra causas de acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica sin desequilibrio aniónico, ya que las fórmulas se aproximan a la excreción de amonio en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la orina:
  • Las acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubulares renales generalmente no tienen una mayor excreción de amonio.
  • Otras causas de acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica sin desequilibrio aniónico aumentan la excreción de amonio.
• La brecha osmolal en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum orina es más útil que la brecha aniónica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum orina:
  • La brecha aniónica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum orina es inexacta en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum muchas situaciones clínicas comunes:
    • Hipovolemia
    • Aniones urinarios no medidos (i.e., cetoacidosis)
    • Disfuncion renal
  • La brecha osmolal en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum orina explica esas ESAs Hematopoietic Growth Factors condiciones, pero es inexacta si:
    • Infección del tracto urinario ureasa positiva está presente
    • Envenenamiento por alcohol tóxico (e.g., metanol, etilenglicol)
• Brecha osmolal urinaria = osmolalidad urinaria medida – osmolalidad urinaria calculada
  • Osmolalidad urinaria = 2(Na⁺ + K⁺) + (Nitrogeno de urea Urea A compound formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. Urea Cycle(BUN, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)/2,8) + (glucosa/18)
  • Rangos de brecha osmolal en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum orina:
    • 10 a 100 = normales
    • < 150 = acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal
    • > 400 = acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica sin desequilibrio aniónicono no debida a acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal
• Brecha aniónica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum orina = orina (Na⁺ + K⁺ – Cl^–)
  • 0–20: normal o acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal
  • –20 a –50: acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica sin desequilibrio aniónico no debida a acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal (i.e., diarrea)

Paso 3

Para diferenciar entre los LOS Neisseria tipos de acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal, evaluar:

Nivel de bicarbonato sérico:

• Distal (tipo 1): < 10 mEq/L
• Proximal (tipo 2): 14–20 mEq/L
• Mixta (tipo 3): < 3 mEq/L
• Hiperpotasemia (tipo 4): >15 mEq/L

pH pH The quantitative measurement of the acidity or basicity of a solution. Acid-Base Balance de la orina:

• Distal (tipo 1): ≥ 5,5
• Proximal (tipo 2): variable Variable Variables represent information about something that can change. The design of the measurement scales, or of the methods for obtaining information, will determine the data gathered and the characteristics of that data. As a result, a variable can be qualitative or quantitative, and may be further classified into subgroups. Types of Variables
  • ≥ 5,5 si el HCO₃^– sérico es > umbral de reabsorción del túbulo proximal
    • Fase temprana en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el curso de la enfermedad → aún no se encuentra en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum estado estacionario
    • Durante el tratamiento con bicarbonato
  • < 5,5 si el HCO₃^– sérico es ≤ umbral de reabsorción del túbulo proximal
    • Sin tratamiento y en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum estado estacionario
    • No se está perdiendo HCO₃^– urinario
• Mixta (tipo 3): variable Variable Variables represent information about something that can change. The design of the measurement scales, or of the methods for obtaining information, will determine the data gathered and the characteristics of that data. As a result, a variable can be qualitative or quantitative, and may be further classified into subgroups. Types of Variables
• Hiperpotasemia (tipo 4): < 5,5

Potasio sérico:

• Distal (tipo 1): bajo
• Proximal (tipo 2): bajo
• Hiperpotasemia (tipo 4): alto

Paso 4

Si el diagnóstico aún no está claro, se puede realizar una prueba de infusión de bicarbonato:

• Ayuda a diferenciar del tipo distal (tipo 1) del proximal (tipo 2)
• Rara vez se realiza en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la práctica
• Se administra bicarbonato intrevenoso hasta que el HCO₃^– sérico = 18–20 mEq/L.
• Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal distal (tipo 1)
  • El pH pH The quantitative measurement of the acidity or basicity of a solution. Acid-Base Balance de la orina no cambia, a pesar del ↑ sérico de HCO₃^–
  • La excreción fraccional de HCO₃^– es < 3% (nivel normal)
• Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal distal proximal (tipo 2)
  • El pH pH The quantitative measurement of the acidity or basicity of a solution. Acid-Base Balance de la orina aumenta a medida que aumenta el HCO₃^– sérico.
  • La excreción fraccional de HCO₃^– es > 15% (↑ por pérdida de HCO₃^–).

Tratamiento

Principios generales para la acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal distal y proximal

• El objetivo de la terapia es normalizar el bicarbonato sérico.
• El pilar de la terapia es el reemplazo de álcali (i.e., bicarbonato).
• Se puede utilizar bicarbonato o citrato oral:
  • El citrato se convierte en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum bicarbonato en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el hígado.
  • Relación 1:1: 1 mEq de citrato se convierte en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum 1 mEq de bicarbonato.
  • El citrato es beneficioso para el tratamiento de la nefrolitiasis
• El potasio sérico debe ser considerado:
  • Se pueden preferir las preparaciones que contienen potasio si existe hipopotasemia.
  • Las preparaciones que contienen sodio se utilizan de otra manera
  • A menudo se necesita un reemplazo de potasio oral por separado
• La sobrecarga de pastillas es un gran problema:
  • La mayoría de las tabletas de bicarbonato y citrato tienen dosis relativamente bajas de bicarbonato
  • La dosificación es a menudo múltiples tabletas por dosis administradas varias veces al AL Amyloidosis día.
  • Predispone al AL Amyloidosis incumplimiento y mala calidad de vida.
• Opciones de medicamentos:
  • Bicarbonato de sodio de venta libre
    • 1 cucharadita = 54 mEq de bicarbonato de sodio
    • La opción más rentable
    • Útiles cuando se necesitan dosis altas para ayudar a reducir la cantidad de pastillas
  • Tabletas de bicarbonato de sodio
  • Tabletas de bicarbonato de potasio
  • Citrato de sodio líquido
  • Citrato de potasio en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum tabletas o líquido

Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal distal (tipo 1)

• Bicarbonato oral (o equivalente): 1–2 mEq/kg/día en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum dosis divididas
• Relativamente fácil de corregir, porque la reabsorción de HCO₃^– del túbulo proximal es normal
• También puede requerir suplementos de potasio

Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal proximal (tipo 2)

El tratamiento de la acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal proximal es más complicado que simplemente reemplazar el bicarbonato:

Razón fundamental:

• Un poco de bicarbonato suplementario siempre se perderá en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la orina:
  • Se necesitan dosis mucho más altas de bicarbonato
  • Frecuentemente no es posible normalizar el bicarbonato sérico independientemente del tratamiento
• La pérdida de bicarbonato da como resultado un empeoramiento de la hipopotasemia:
  • HCO₃^– viaja a través de la nefrona unido a Na⁺ (NaHCO₃)
  • ↑ NaHCO₃ → ↑ suministro distal de Na⁺ a las células principales del conducto colector
  • ↑ Reabsorción de Na+ por el canal de Na epitelial→ ↑ Secreción de K⁺ por el canal de potasio de la médula externa renal

El tratamiento implica un abordaje combinado:

• Si es posible, suspender cualquier sustancia/medicamento nocivo
• Tratar la afección subyacente, si es posible.
• Suplementación con bicarbonato:
  • Bicarbonato oral
  • La hidroclorotiazida se puede utilizar para mejorar la cantidad de píldoras:
    • Diuréticos → depleción ligera de volumen → estimula la reabsorción de Na⁺ y HCO₃^– en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria túbulos proximales
    • El efecto secundario es el empeoramiento de la hipopotasemia
• Suplementos de potasio:
  • Un problema mucho mayor que con la acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal distal (tipo 1)
    • Exacerbados por la bicarbonaturia
    • Exacerbados por el uso de tiazidas
  • Por lo general, requieren más K⁺ de lo que se incluye en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria suplementos de bicarbonato.
  • Los LOS Neisseria diuréticos ahorradores de K⁺ se pueden utilizar para ↓ la necesidad de suplementos de K⁺
• Es posible que se necesiten suplementos adicionales para el síndrome de Fanconi:
  • Fósforo
  • Vitamina D
• Laboratorios frecuentes para monitorear HCO₃^–, K⁺ y fosfato sérico

Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal mixta (tipo 3)

Debido a su rareza, no hay consenso sobre el tratamiento de la acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal tipo 3.

• NaHCO₃ para la acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis aguda
• Suplemento de potasio
• Suplemento de vitamina D
• Litotricia para los LOS Neisseria cálculos renales
• Fijación quirúrgica de las fracturas óseas
• Análisis frecuentes para monitorizar el HCO₃^– y el K⁺ en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum suero

Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal hiperpotasémica (tipo 4)

El tratamiento para la acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal hiperpotasémica difiere significativamente del de las otras formas de acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal, principalmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum que la terapia con bicarbonato oral no es el tratamiento de 1ra línea.

• Fludrocortisona:
  • Análogo oral de la aldosterona
  • El efecto secundario de la retención de Na⁺ puede limitar la utilidad
    • Empeora la hipertensión
    • Puede conducir a una sobrecarga de volumen ( edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema periférico y pulmonar)
• Dieta baja en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum K⁺
• Diuréticos de asa ASA Anterior Cord Syndrome o tiazídicos (particularmente si no se puede utilizar fludrocortisona)
• La terapia con bicarbonato oral generalmente no se utiliza.

Diagnóstico Diferencial

• Mieloma múltiple: discrasia de células plasmáticas malignas que conduce a niveles tóxicos de paraproteína sérica. La presentación clínica es con el síndrome CRAB ( en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés), incluye hyperCalcemia (hipercalcemia), Renal insufficiency (insuficiencia renal), Anemia ( anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types) y Bone (lesiones/ dolor Dolor Inflammation óseo). También puede haber acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal proximal (tipo 2). El diagnóstico se realiza con electroforesis de proteínas séricas con inmunofijación, que identifica la paraproteína anormal (conocida como pico M en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la electroforesis de proteínas séricas). Las pruebas adicionales incluyen electroforesis de proteínas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum orina y la proporción de cadenas ligeras libres en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum suero. El tratamiento consiste en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum quimioterapia y trasplante de células madre hematopoyéticas.
• Pseudohipoaldosteronismo tipo 1: trastorno poco frecuente que se presenta en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el período neonatal como hiponatremia, hiperpotasemia y acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica ( acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal hiperpotasémica tipo 4). El pseudohipoaldosteronismo tipo 1 se puede diagnosticar por una actividad elevada de renina plasmática y un nivel elevado de aldosterona. El tratamiento incluye suplementos de sodio y tratamiento agresivo de líquidos y electrólitos.
• Cistinosis: la enfermedad de almacenamiento lisosomal autosómica recesiva es la causa hereditaria más común del síndrome de Fanconi en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños y es causada por una mutación en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un gen que codifica la proteína transportadora cistinosina. La cistina intralisosomal se acumula en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum todo el cuerpo, incluso en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las células del túbulo proximal, durante el 1er año de vida (lo que da como resultado acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal proximal tipo 2 y síndrome de Fanconi). Se produce daño renal progresivo (incluido el glomérulo) y la enfermedad renal en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum etapa terminal ocurre durante la infancia. El tratamiento incluye cisteamina, un agente que reduce la cistina y terapia de reemplazo renal (incluido el trasplante renal).
• Síndrome de Sjögren: enfermedad autoinmune en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la que los LOS Neisseria tejidos glandulares, como las glándulas salivales y lagrimales, son infiltrados por linfocitos, provocando síntomas como ojos secos y xerostomía. Existe una amplia gama de manifestaciones extraglandulares del síndrome de Sjögren, que incluyen acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal distal (tipo 1), fenómeno de Raynaud, neuropatía y vasculitis Vasculitis Inflammation of any one of the blood vessels, including the arteries; veins; and rest of the vasculature system in the body. Systemic Lupus Erythematosus cutánea. El diagnóstico se valida mediante el examen clínico, los LOS Neisseria estudios serológicos y la biopsia de las glándulas salivales. Se necesita un enfoque multidisciplinario para tratar a los LOS Neisseria pacientes afectados y tratar el alivio de los LOS Neisseria síntomas.
• Lupus eritematoso sistémico (LES): enfermedad autoinmune crónica que causa el depósito de complejos inmunes en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria órganos, lo que resulta en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum una amplia gama de posibles manifestaciones sistémicas. Las posibles características clínicas notables incluyen erupción malar, artritis no destructiva, nefritis lúpica, serositis Serositis Inflammation of a serous membrane. Systemic Lupus Erythematosus, citopenias, enfermedad tromboembólica, convulsiones y/o psicosis. La acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal hiperpotasémica (tipo 4), también puede estar presente. El diagnóstico se realiza al AL Amyloidosis cumplir con los LOS Neisseria criterios clínicos, que incluyen anticuerpos antinucleares, anticuerpos específicos de LES y hallazgos clínicos específicos. Las opciones de tratamiento incluyen hidroxicloroquina y medicamentos inmunosupresores (e.g., prednisona, metotrexato, micofenolato mofetilo).
• Tirosinemia: trastorno genético autosómico recesivo causado por un defecto en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la descomposición del aminoácido tirosina, lo que provoca un retraso en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el crecimiento durante el primer mes de vida. Otras manifestaciones clínicas incluyen acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal proximal (tipo 2), síndrome de Fanconi, heces sanguinolentas, olor a repollo, ictericia, hepatomegalia y vómitos. Sin tratamiento, se desarrollarán cirrosis y carcinoma hepatocelular. El tratamiento incluye nitisinona y una dieta baja en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum tirosina (i.e., baja en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum proteínas).
• Enfermedad de Wilson: también conocida como degeneración hepatolenticular. La enfermedad de Wilson es un trastorno autosómico recesivo asociado con mutaciones en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el gen ATP7B, que dan como resultado la acumulación de cobre en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el hígado, el cerebro y la córnea. La presentación es con síntomas hepáticos, neurológicos y psiquiátricos. La acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis tubular renal distal (tipo 1), también puede estar presente. El diagnóstico se establece mediante la detección de depósitos corneales de cobre (anillos de Kayser-Fleischer), ceruloplasmina plasmática baja y/o niveles elevados de cobre en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la orina. El tratamiento es con el uso de agentes quelantes del cobre como la penicilamina.