What is the role of fludrocortisone in the treatment of type 4 renal tubular acidosis (RTA)?

Updated: Oct 10, 2018
  • Author: Christie P Thomas, MBBS, FRCP, FASN, FAHA; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

In resistant cases, fludrocortisone, a synthetic mineralocorticoid, can be used to increase K+ secretion, but this may increase Na+ retention. Alkali therapy is not usually required, because, in many patients, the mild degree of acidosis is corrected by achieving normokalemia. Hyperkalemia and acidosis worsen as renal function declines further; eventually, the patient develops a high-AG renal acidosis. Renal replacement therapy should be considered once the measures described fail to control hyperkalemia or acidosis.


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