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    discussion 37

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    Ro and La positive pt, how about his HCO3- and K+?

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    ans

    hi mimi, what are "Ro and La "?

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    guest

    Chronic renal failure leading to metabolic acidosis (low HCO3 ) and Hyperkalemia

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    re

    Ro--- anti-SS-A
    La--- anti-SS-B

    try again......

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    my input

    Excellent correlation with yesterdays AG discussion Mimi!
    This question tests your knowledge of a couple of different areas and your ability to correlate them to get your answer.

    First you need to realize that "Ro" and "La" are discriptions of anti-SS-A and B respectively, which are both markers for Sjogren's syndrome. Then you need to remember that this syndrome causes distal renal tubualr acidosis. And finally, you need to know that distal type I renal tubular necrosis is one of the main causes of normal AG metabolic acidosis.

    From yesterdays discussions, you'll remember that the AG is normal because the lost HCO3- is replaced by Cl-. So as guest said, the HCO3 will be low and the Cl- will be high. This will give a normal hyperchloremic AG met acidosis.

    AG = Na - (Cl + HCO3)


    ref: kaplan notes by goljan sec 1 pgs 82-84, sec 2 pg 221

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    re

    Great step 1, you are on the right track to the answer:

    HCO3- is low, as you said, which is correct. (metabolic acidosis from type I RTA in sjogren syndrome.)

    As it is type I RTA in SS, please read RTA in renal chapter, you will find serum K+......


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    oops

    Rushing through questions and missing important information is my downfall I overlooked K+ in your question

    In renal tubular acidosis, all will have dec K+ except type 4. Since this is type 1, it will have dec K+. Dysfunctional aldosterone mediated H+/K+ ATPase pump in the collecting ducts.

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    re

    yeal, you got it !!!

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