Nephrology: distal RTA: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Nephrology: distal RTA

Sample item

A child with failure to thrive has normal anion gap metabolic acidosis, hypokalaemia, urine pH of 6.5 and nephrocalcinosis. Which condition is likely?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Distal (type 1) renal tubular acidosis

Type 1 RTA is an inability to acidify urine, so the urine pH is above 5.5 despite systemic acidosis, with hypokalaemia, hypercalciuria and nephrocalcinosis. Treatment is alkali such as bicarbonate or citrate. Proximal RTA has bicarbonate wasting and Fanconi features and no nephrocalcinosis.

Option by option

  • A. Type 4 RTA

    Type 4 RTA presents with hyperkalaemia.

  • B. Distal (type 1) renal tubular acidosis (correct)

    Correct. This is distal RTA.

  • C. Bartter syndrome

    Bartter syndrome has alkalosis.

  • D. Proximal (type 2) RTA

    Proximal RTA does not produce nephrocalcinosis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is B, Distal (type 1) renal tubular acidosis. Type 1 RTA is an inability to acidify urine, so the urine pH is above 5.

Why is "Type 4 RTA" not the answer?

Type 4 RTA presents with hyperkalaemia.

Why is "Bartter syndrome" not the answer?

Bartter syndrome has alkalosis.

Why is "Proximal (type 2) RTA" not the answer?

Proximal RTA does not produce nephrocalcinosis.

What concept does this question test?

It tests Nephrology: distal RTA in Pediatrics. 5 despite systemic acidosis, with hypokalaemia, hypercalciuria and nephrocalcinosis. Treatment is alkali such as bicarbonate or citrate. Proximal RTA has bicarbonate wasting and Fanconi features and no nephrocalcinosis.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Nephrology: distal RTA?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.