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混合型[[RTA]],是兼上述两型Ⅰ、Ⅱ型RTA的临床特征并存。有人将本型分为混合型和Ⅲ型RTA两种。认为混合型兼有Ⅰ、Ⅱ型RTA两者之临床特征，被称为Ⅱ型RTA的亚型。
==混合型肾小管性酸中毒的预防和治疗方法==
对Ⅲ型[[肾小管酸中毒]]，尚无有效预防措施。而[[继发性]][[疾病]]的预防应从治疗基础疾病入手，控制其发展致[[肾小管性酸中毒]]。
==混合型肾小管性酸中毒的病因==
(一)发病原因
<span> <span lang="EN-US">(5)</span>碱负荷试验：<span lang="EN-US"></span></span>
<span> <span lang="EN-US">①</span>口服碳酸氢钠法：从<span lang="EN-US">1mmol/(kg.d)</span>开始，逐天加量至<span lang="EN-US">10mmol/(kg.d)</span>，[[酸中毒]]被纠正后，测血、尿<span lang="EN-US">HCO<sub>3</sub><sup>-</sup></span>浓度与[[肾小球滤过率]]，计算尿<span lang="EN-US">HCO<sub>3</sub><sup>-</sup></span>的百分率：尿中<span lang="EN-US">HCO<sub>3</sub><sup>-</sup></span>量<span lang="EN-US">=</span>尿<span lang="EN-US">HCO<sub>3</sub><sup>-</sup> (mmol/L)×</span>[[尿量]]<span lang="EN-US">(ml/min)/</span>血浆<span lang="EN-US">HCO<sub>3</sub><sup>-</sup> (mmol/L)×GFR</span>。正常人尿<span lang="EN-US">HCO3-</span>为零<span lang="EN-US">;Ⅱ</span>型、混合型<span lang="EN-US">RTA>15%</span>，<span lang="EN-US">Ⅰ</span>型<span lang="EN-US">RTA<3%</span>～<span lang="EN-US">5%</span>。<br /><br /><span lang="EN-US"> ②</span>[[静脉滴入]]碳酸氢钠法：以<span lang="EN-US">4ml/min</span>的速度滴入<span lang="EN-US">5%NaHC03</span>，持续<span lang="EN-US">2h</span>。注入前测患者血<span lang="EN-US">pH</span>、<span lang="EN-US">PCO<sub>2</sub></span>、<span lang="EN-US">HCO<sub>3</sub><sup>-</sup></span>浓度和尿<span lang="EN-US">pH</span>、<span lang="EN-US">HCO<sub>3</sub><sup>-</sup></span>浓度<span lang="EN-US">;</span>以后分别在注入<span lang="EN-US">30</span>，<span lang="EN-US">90min</span>后测血<span lang="EN-US">pH</span>、<span lang="EN-US">PCO<sub>2</sub></span>、<span lang="EN-US">HCO<sub>3</sub><sup>-</sup>;60</span>，<span lang="EN-US">120min</span>测尿<span lang="EN-US">pH</span>和<span lang="EN-US">HCO<sub>3</sub><sup>-</sup></span>，在患者血<span lang="EN-US">HCO<sub>3</sub><sup>-</sup></span>恢复正常时，尿中<span lang="EN-US">HCO<sub>3</sub><sup>-</sup></span>排泄量<span lang="EN-US">></span>[[肾小球]]滤过量的<span lang="EN-US">15%</span>，提示近曲小管<span lang="EN-US">HCO<sub>3</sub><sup>-</sup></span>[[吸收障碍]]。尿<span lang="EN-US">HCO<sub>3</sub><sup>-</sup></span>排泄分数<span lang="EN-US">=(</span>尿<span lang="EN-US">HCO<sub>3</sub><sup>-</sup>/</span>血浆<span lang="EN-US">HCO<sub>3</sub><sup>-</sup>/(</span>尿[[肌酐]]<span lang="EN-US">/</span>血肌酐<span lang="EN-US">)</span>。血浆<span lang="EN-US">HCO<sub>3</sub><sup>-</sup></span>浓度正常时，<span lang="EN-US">Ⅱ</span>型<span lang="EN-US">RTA HCO<sub>3</sub><sup>-</sup></span>排泄分数<span lang="EN-US">>15%</span>，<span lang="EN-US">Ⅰ</span>型<span lang="EN-US">RTA<5%</span>。此法可鉴别<span lang="EN-US">Ⅰ</span>型、<span lang="EN-US">Ⅱ</span>型<span lang="EN-US">RTA</span>。<span lang="EN-US"></span></span>
<span> <span lang="EN-US">4.</span>[[影像学]]检查<span lang="EN-US"> KUB</span>平片或<span lang="EN-US">IVP</span>片中可发现鱼籽样[[肾结石]]。并可了解[[骨病]]情况。<span lang="EN-US"></span></span>
==混合型肾小管性酸中毒的并发症==
[[代谢性酸中毒]]、[[低钾血症]]、软骨病，[[生长发育]]迟缓，[[维生素D缺乏病]]或[[骨软化]]症，部分发生[[肾结石]]或[[肾钙化]]，晚期发展成[[尿毒症]]，少数有神经性[[耳聋]]等。
===混合型肾小管性酸中毒的西医治疗===
(一)治疗
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