RENAL TUBULAR ACIDOSIS | USMLE STEP 1
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- Опубліковано 30 бер 2017
- * At 6:58 I said hpo3-. Please correct it to hpo4 3-.
* At 6:23 I said calcium oxalate stones, it should be calcium phosphate stones. please correct that.
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I didn't find any clearly understandable video about RTA on internet until I found this one.. You really crack this complexity..You saved me dude! Hats off 🙏
My med school needs to refund me and I'll pay you everything. You are an amazing instructor. GOAT
I’m give up every time when I start to study but I am so glad found your channel you make everything easy to understand
Thank you
YOU ARE SIMPLY THE BEST HONESTLY!!!!!!!!!
Just Wow and no other word for your explanation!
thank you so much this has to be the most clear and logical explanation ever
Thank you so much .. It clarified many points .. but a little note that aldosterone doesn't act on H+/K+ exchanger but on H+ ATPase that's why the hyperkalemic effect of aldosterone in RTA type4 is not offsetted by this ATPase
your explanation is always easy to understand ,make sense and memory-philic . thank you so much
wish i came across this channel while preparing for step-1. amazing work. i always struggled in this topic.
Ek dum majbut bhai 🙏
The best video fr concepts....Thank u
Thankyou so much. I am so regretful that i didnt find this video last year and had to just memorize the concept. Now i know how easy it was. Thanks alot. Really cleared the concept,
Thank you very much, simply the best video !. We wish you can make more videos.
best explanation ever!!! cheerz buddy
This is an amazing video and you are amazing teacher, thank you.
Your explanation is very very clear and easy to understand!
Great explanation sir..couldn't find anywhere else
Thankyou
You really saved me ❤ thank you so much
Thanks for the video sir.. This is the best
Salam brother!! calcium oxalate stones are form in acidic medium, while calcium phosphate stone are form in alkaline urine...👍👍💪
Still the medium for calcium oxalate is ph= 6 that is even though acidic still is basic than normal urine ph=5.5
Thanks alot meet....i always follow your video..
Hhahah happy to see ring in ur finger in this video...
Congratulations brother...stay blessed .... :)
Youre the best.. Thankss
Thank you sooo much God bless you!!
Thank you very much....u have made it so easy
ur videos are awesome! thank u so much!!
Excellent
God level!
simply superb.
Shankar Bhat thank you :))
well explained, thank you ....
Thank you so much for this!
It would be great if u make a video on Neuromuscular blocking drugs. It has a lot of important concepts Especially Phase 1, Phase 2 block, Effect of AchE inhibitor on each phase, Effect of these drugs in Myasthenia gravis, effect of these drugs in K+ levels! Just a suggestion:)
great explanation!!!
god bless You🥺🥳
thanks a lot .u made it really easy to understand..
Thank you :))
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Thank you.
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excellent
NICEEEEEEE :)GOOD JOB
thank you :))
GREAT WORK.
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Just a little correction i want to make that oxalate stones are not precipitatedd at high ph.[at 6.20 in video]
struvite stones are ppted.
shubham biyani.. Hi.. Calcium phoshate stones formed at high ph.. and calcium oxalate stones formed at acidic ph.
This wat have been looking for thnx. May do or have u tutorial for all other condition.
Thank you
u made it simple....
Dr sultan saudagar thank you doctor :)
THANK YOU
Thank you!!!!
Leidy buitrago welcome !! :)
Tq
in type 4
the reaction in PCT is that: in acidosis glutamine in PCT will give NH3 and alpha-ketoglutarate (which will go to Krebs cycle and make co2 & H20) and NH3 will combine with H+ and go into lumen thereby balancing acidosis so what you said make sense in alkalosis in PCT cells NH3 is formed less but is the reaction correct?
your prep is like 270 not 260 bro.Wonderful
Dr Nasser haha thank you...may god bless you with that score
thank you so much
Thanks a lot,would you please explain why in renal tubular acidosis we have normal anion gap acidosis (hyperchloremic acidosis) and why does the chloride osmolarity go up in plasma?what's the mechanism? RTA type 1 and 2 and 4 each one separately
excellent lecture, i have one question, why did you take urine ph 5.5??
That last one concept is part of what type of acidosis
Type 2 is in proximal where neither bicarbonates are resorbing nor hydrogen is excreting then how there is hydrogen potassium exchange and acidic urine ....is there too a hydrogen potassium in pct??
This is a great video,But had an NBME with option Distal RTA but the Q had pH < 5.5(which u said is a late finding).I solely put that option after remembering this.I ended up being wrong,the right answer was different one and if I'm not wrong Q had patient taking Ibuprofen(which is a cause of distal RTA).I'm saying this coz Distal RTA with pH 5.5) on which Qs are tested.So its better to stick to pH>5.5 for Distal RTA-1
You're confusing Type 1 RTA with Type 2 RTA
How rt4 causes acidosis bcz in this tubules have alkaline pH?
reclemation and regeneration was new to me... thnx
Hassan Naeem welcome :)
Bro: a little update for viewers, 1) Glutamine ----- by Glutaminase ----> Glutamate ----by Glutamate DH -----> alpha- ketoglutarate and ammonia. 2) The steroid hormone Aldosterone (DNA --> mRNA---> Protein) increases the # working ATPase pumps on the Basement membrance side. It creates a high K+ inside the intercalated cell, and the K+ gets out into the lumen by high K+ conc. gradient inside the cell. Then the lumen K+ leaks back into the cell on the brushborder side and balanced by the H+ exchange for the + electrical charge balance across the membrance. 3) When Aldosterone action decreased, then it presents the picture of less Na retention, less K+ excretion, and less H+ excretion and less bicarb reabsorption. Acidoses thus comes about. Please comment.
@Meet patel. i loved ur explaination but the equation that u gave for the type 4 RTA is wrong. NH3 shud b on the left side of equation and "gluatamate" not glutamine on the right side. please correct it. Thank You.
An exception in DENT's disease which is a genetic cause of RTA type 2 in which renal stones are present
I have a question please!
Sir you showed in RTA4 sodium potassium pump through potassium out of the cell....it's impossible
I thought compensation is by regeneration of bicarbonate in distal tubule but not proximal tubules REGAINING the capacity to re-absorb bicarbonate.
Sir, I would request you to verify the reaction regarding alphaketoglutarate and glutamate. I think it is alphaketoglutarate plus ammomia forms glutamate and not vice versa
Glutamate dehydrogenase (GLDH, GDH) is an enzyme, present in most microbes and the mitochondria of eukaryotes, as are some of the other enzymes required for urea synthesis, that converts glutamate to α-ketoglutarate, and vice versa.
Amit Kapuria sir. Okay. Thank you
meet Bhai plz teach confidence interval...
hey Smit....i will try my best to make a video on that but CK prep is taking a lot of time.
Type 1 in dct not collecting duct which is type 4
hi.i am reading anesthetics in pharmacology.i am unable to understand the relation between cardiac output and induction of anesthesia.could you please please upload a video on that?
Srishti Basu can you tell me the page no. in FA? i am unable to manage time bcz of ck preparation so i usually make videos on whatever topic i am prepared with
Actually I have not yet studied FA.i was studying from Lippincotts Illustrated Review of Pharmacology.Maybe I can send you the picture of that page on your mail or something?if it's ohkay...
email me on my email id fastaidstep1@gmail.com
hi.emailed
Srishti Basu replied 👍
where is ph 5.5 came from. aren't we have of ph is 7.35 - 7.45.. please explain?
ali shah Its about urine ph not plasma ph..Normal urine ph is 5.5
you have such nice cursive wow
isn't it like this...that in type2 rta because theirs a problem in absorbing bicarbs and bicarbs are getting excreted, urine is basic initially till all bicarbs are excreted and then urine gets acidic.because person wont be normal in type 2 rta and start reabsorbing bicarbs?(ref: kaplan)
Shubham Khajanchi i think thats what is said. ..urine is basic initially and then becomes acidic....'all bicarbs are excreted' i didnt get this sentence...can you elaborate so i can understand and answer properly
Hi...see you said that in type2 rta initially urine is basic then later on gets acidic because when bicarbs level fall down to 18 absorption takes place as per you said. But what i am saying is that peson is not normal then how he can absorb bicarbs but bicarbs are continuously getting excreted and after somtime urine becomes acidic when no bicarbs are left
Shubham Khajanchi its absolutely not possible that no bicarb is left otherwise person would surely die...its not that bicarbs are excreted limitless...its just that they are excreted much more than normal people (untill level falls 18)
then why urine becomes acidic later ?
and i meant that bicarbs go really low and relatively acidic urine occurs not that body is out of bicarbs completely
thank you so much! what's your source btw?
apaar dadlani you are welcome brother :)) I got 249
Meet patel that's nice! btw I asked about the source, not score
apaar dadlani LOL this is from goljan pathology
Golgan pathology
i think glutamine >>> glutamate +ammonia
glutamate>> alpha ketgluturate +ammonia
Abdelrahman Alwan actually the reaction given in uworld is different. ...i agree you are right...but i got this info from goljan and it was simple reaction so i included without changes...the main thing to consider for RTA is inhibition of ammonia due to intracellular alkalosis.