Core Curriculum in Nephrology
Pathophysiology of Renal Tubular Acidosis: Core Curriculum 2016

https://doi.org/10.1053/j.ajkd.2016.03.422Get rights and content

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Total-Body Acid-Base Homeostasis

Metabolism of food particles generates both volatile carbonic acid, which is excreted by the lung, and fixed acid, which is generated primarily from metabolism of proteins. On a Western diet containing high levels of animal protein, an adult generates 15,000 mEq of volatile acid derived from fat and carbohydrate combustion and ∼1 mEq of fixed acid per kilogram of body weight from metabolism of proteins. This latter is initially neutralized by the body buffers, including HCO3-, and then excreted

Renal Tubular Acidosis

Based on clinical presentation and pathophysiologic mechanism, RTA is classified into proximal (pRTA or type II), distal (dRTA or type I), and hyperkalemic (or type IV) RTA (RTA type III [ie, combined pRTA and dRTA] is not detailed in this Curriculum because of its rarity).

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Support: None.

Financial Disclosure: The authors declare that they have no relevant financial interests.

Peer Review: Evaluated by 3 external reviewers, the Education Editor, and the Editor-in-Chief.

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