Renal Tubular Acidosis: Core Curriculum 2025

Renal tubular acidoses (RTAs) are a subset of non-anion gap metabolic acidoses that result from complex disturbances in renal acid excretion. Net acid excretion is primarily accomplished through the reclamation of sodium bicarbonate and the buffering of secreted protons with ammonia or dibasic phosphate, all of which require a series of highly complex and coordinated processes along the renal tubule. Flaws in any of these components lead to the development of metabolic acidosis and/or a failure to compensate fully for other systemic acidoses. Identification and diagnosis of RTA can be challenging, and the consequences of untreated RTA can be life-threatening. The use of serum and urinary indices can help elucidate the kidney’s capacity to respond to acidemia, characterize these disturbances further, and guide treatment.