Screenshot 2023-03-19 at 5.58.00 PM

GUEST EDITORIAL ACKD
Renal Tubular Acidosis and the Nephrology

Teaching Paradigm
T he renal tubular acidosis (RTA) syndromes, while

relatively rare, are of great interest among students
of pathophysiology because they offer a model of disease
team of experts who have covered the various types
of RTA and their complex and rich pathophysiology.
Ira Kurtz discusses the underlying tubular transport
in which the biochemical, physiologic, molecular, and, in abnormalities and extrarenal manifestations that can
some cases, genetic basis of its pathogenesis can be exam- be associated with proximal and distal RTA and offers
ined.1 Understanding the mechanisms causing RTA also his view as to how metabolic acidosis actually de-
offers a paradigm for nephrology teaching. Practicing velops. Finer and Landau discuss the syndrome of
physicians as well as adult and pediatric nephrologists proximal RTA as it occurs in children. Fuster and
in the academic setting who teach trainees at all levels Moe offer a provocative review of incomplete DRTA,
ought to have a solid understanding of the RTA syn- a controversial entity, and its association with risk of
dromes. Indeed, this complex tubular disease of the kid- kidney stones. Uduman and Yee provide an interesting
neys and the rich phenotype associated with it which discussion of conditions that may mimic DRTA, such as
spans from kidney stones to deafness to hyperkalemia chronic respiratory alkalosis. Valles and Batlle provide
or hypokalemia depending on the type of RTA is often a comprehensive review of classic or hypokalemic
a favorite topic to teach for the seasoned and novice DRTA and the possible mechanisms, yet unknown,
nephrologist. that are involved in the causation of hypokalemia
Finding young physicians interested in entering from urinary potassium wastage. Batlle and Arruda
nephrology is one of the main challenges that our spe- discuss the hyperkalemic forms of RTA associated
cialty faces. Parker and Glassock2 recently reminded us with aldosterone deficiency or resistance usually seen
that during the 1970s and 1980s, nephrology was flour- in the context of moderate CKD.
ishing as an intellectual pursuit and producing many We have encouraged the contributors to this issue of
meaningful contributions. To quote from their article Advances in CKD to provide color diagrams that illus-
“it was one of the most challenging and satisfying of all trate the normal and deranged physiology of the trans-
internal medicine specialties,” a premier, thinking per- porters involved in the RTA syndromes (our black
son’s profession. The curious physician vied for the board!). On this, chalk and nephrology teaching, we
much sought-after fellowship openings. The desire to know of someone who was very dear to the medical
understand basic physiology, pathophysiology, and world who would not have disagreed! (Picture). We
immunopathology was paramount. It was the best of hope aspiring nephrologists and fellows in training
times to be at the frontier of medicine.2 will find this issue devoted to RTA useful and that
Over the last decade or so, however, the interest of res- when they diagnose their first patient with RTA, they
idents to enter the specialty of nephrology has waned. will have a stimulating experience and will think that
The reasons are doubtless multifactorial, and in this their choice of Nephrology as their specialty was the
article, we will not speculate on all of them. Let us just right one.
mention two possible reasons. First, the teaching black
board once present at every hospital floor is gone with
the wind! How to teach the mechanisms of RTA without
one of those? It is hard to imagine the great nephrologists
of our time who have contributed to the understanding
of this disease, the likes of Seldin, Wrong, Steinmetz,
Al-Awqati, Halperin, Sebastian, Dubose, and Kurtzman,
explaining how the tubule gets rid of acid without a
black (or white) board. Second, equally, if not more
important, how can we inspire our trainees to enter
nephrology when the time on teaching rounds is limited
and their priority has become writing electronic notes
that fulfill the billing requirements? It seems as if bedside
teaching was taking too much time away from the
trainees’ busy day, usually culminated by the never-
ending note writing. Picture taken from the Southwestern University Medical
Center plaza in Dallas named after Donald Seldin, MD.
The knowledge acquired over the last 4 decades
Photo credit: UT Southwestern Medical Center.
about the physiology of renal acid-base transporters,
their deranged function, and the genetic aspects of
RTA has been phenomenal and worthy of a compre- Ó 2018 by the National Kidney Foundation, Inc. All rights reserved.
hensive review. In this issue of Advances in CKD 1548-5595/$36.00
devoted to the RTA syndromes, we have assembled a https://doi.org/10.1053/j.ackd.2018.05.002
Adv Chronic Kidney Dis. 2018;25(4):301-302 301

302 Batlle and Arruda
Daniel Batlle Financial Disclosure: The authors declare that they have no
Earle, del Greco Levin Professor of Nephrology/Hypertension relevant financial interests.
Professor of Medicine
Northwestern University Feinberg School of Medicine
Chicago, IL
REFERENCES
Jose Arruda 1. Batlle D, Kurtzman NA. Distal renal tubular acidosis: hypothesis on
the pathogenesis. In: Coe FL, ed. Hypercalciuric States, Chapter 9.
Chief Division of Nephrology
New York, NY: Grune & Stratton, Inc; 1984.
Professor of Medicine 2. Parker TF III, Glassock RJ. Lamentations and Provocations. Perspec-
University of Illinois at Chicago tives on the evolution of nephrology as a discipline. Nephrol News Is-
Chicago, IL sues. 2018;32(5).
Adv Chronic Kidney Dis. 2018;25(4):301-302

Screenshot 2023-03-19 at 5.58.00 PM

Uploaded by

Copyright:

Available Formats

Screenshot 2023-03-19 at 5.58.00 PM

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Screenshot 2023-03-19 at 5.58.00 PM

Uploaded by

Copyright:

Available Formats

GUEST EDITORIAL ACKD

Renal Tubular Acidosis and the Nephrology

T he renal tubular acidosis (RTA) syndromes, while

Adv Chronic Kidney Dis. 2018;25(4):301-302 301

Adv Chronic Kidney Dis. 2018;25(4):301-302

You might also like