Hyperchloremic Metabolic Acidosis: Renal Tubular Acidosis

  • Alluru S. ReddiEmail author


Renal tubular acidoses (RTAs) are discrete renal tubular disorders that are characterized by the inability to excrete H+ in the urine, As a result, there is a positive H+ balance, causing metabolic acidosis. The net acid excretion is decreased, and some of the patients are unable to lower their urine pH < 5.5. Despite severe acidosis, the anion gap (AG) remains normal because the decrease in serum [HCO3 ] is compensated for by a proportionate increase in serum [Cl].

There are five types of RTAs: Distal RTA (classic or Type I RTA); Proximal RTA (Type II RTA); Incomplete RTA (Type III RTA); Hyperkalemic RTA associated with relative aldosterone deficiency or its resistance (Type IV RTA); and Hyperkalemic distal RTA associated with variable levels of aldosterone.


Renal tubular acidosis (RTA) Distal RTA Proximal RTA Incomplete RTA Hyperkalemic RTA Hyperkalemic distal RTA Type I RTA Type II RTA Type III RTA Type IV RTA 

Suggested Reading

  1. 1.
    Batlle D, Haque SK. Genetic causes and mechanisms of distal renal tubular acidosis. Nephrol Dial Transplant. 2012;27:3691–704.PubMedCrossRefGoogle Scholar
  2. 2.
    Golembiewska E, Ciechanowski K. Renal tubular acidosis-underrated problem? Acta Biochim Pol. 2012;59:213–7.PubMedGoogle Scholar
  3. 3.
    Haque SK, Ariceta G, Batlle D. Proximal renal tubular acidosis: a not so rare disorder of multiple etiologies. Nephrol Dial Transplant. 2012;27:4273–87.PubMedCrossRefGoogle Scholar
  4. 8.
    Izzedine H, Launay-Vacher V, Isnard-Bagnis C, et al. Drug-induced Fanconi syndrome. Am J Kidney Dis. 2003;41:292–309.PubMedCrossRefGoogle Scholar
  5. 4.
    Kraut JA, Madias NE. Treatment of acute metabolic acidosis: a pathophysiologic approach. Nat Rev Nephrol. 2012;8:589–601.PubMedCrossRefGoogle Scholar
  6. 6.
    Karet FE. Mechanisms in hyperkalemic renal tubular acidosis. J Am Soc Nephrol. 2009;20:251–4.PubMedCrossRefGoogle Scholar
  7. 7.
    Moorthi KMLST, Batlle D. Renal tubular acidosis. In: Gennari FJ, Adrogué HJ, Galla JH, Madias NE, editors. Acid-base disorders and their treatment. Boca Raton, Taylor & Francis; 2005. pp 417–67.Google Scholar
  8. 5.
    Reddy P. Clinical approach to renal tubular acidosis in adult patients. Int J Clin Pract. 2011;65:350–60.PubMedCrossRefGoogle Scholar
  9. 9.
    Rodriguez-Soriano J. Renal tubular acidosis: the clinical entity. J Am Soc Nephrol. 2002;13:2160–70.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of Medicine Division of Nephrology and HypertensionRutgers New Jersey Medical SchoolNewarkUSA

Personalised recommendations