{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:25:24Z","timestamp":1787772324776,"version":"build-2784847793"},"reference-count":69,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Acid\u2013base homeostasis is maintained by renal and respiratory systems. The inability of the renal tubules to excrete acids or retain bicarbonate in adequate amounts leads to renal tubular acidosis (RTA). These disorders are characterised by the presence of normal anion gap metabolic acidosis with hyperchloremia. Both distal RTA (type 1) and proximal RTA (type 2) can occur due to a primary\/inherited defect in the renal tubule or may arise due to some secondary\/acquired causes. Urinary acidification defect defines type 1 RTA, while type 2 RTA is characterised by defective bicarbonate handling in the proximal tubule. Type 3 RTA includes features of both type 1 and type 2 RTA, whereas type 4 RTA is characterised by the presence of hyperkalaemia with normal anion gap metabolic acidosis. In this review article, we describe the various types of RTA and its pathophysiology along with a systematic and practical approach to a suspected case of RTA and its management.<\/jats:p>","DOI":"10.4103\/ijem.ijem_774_25","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T15:00:27Z","timestamp":1772204427000},"page":"26-36","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Approach to Renal Tubular Acidosis \u2013 A Review"],"prefix":"10.4103","volume":"30","author":[{"given":"Sambit","family":"Das","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishal","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas V.","family":"Paul","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kripa E.","family":"Cherian","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"R1-20260302","doi-asserted-by":"crossref","first-page":"2232","DOI":"10.2215\/CJN.07400715","article-title":"Acid-base homeostasis","volume":"10","author":"Hamm","year":"2015","journal-title":"Clin J Am Soc Nephrol"},{"key":"R2-20260302","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.kint.2016.09.012","article-title":"Chronic renal insufficiency cohort study investigators higher net acid excretion is associated with a lower risk of kidney disease progression in patients with diabetes","volume":"91","author":"Scialla","year":"2017","journal-title":"Kidney Int"},{"key":"R3-20260302","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1186\/s12882-020-01959-7","article-title":"A case series of distal renal tubular acidosis, Southeast Asian ovalocytosis and metabolic bone disease","volume":"21","author":"Gunaratne","year":"2020","journal-title":"BMC Nephrol"},{"key":"R5-20260302","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1053\/j.ajkd.2016.03.422","article-title":"Pathophysiology of renal tubular acidosis: Core curriculum 2016","volume":"68","author":"Soleimani","year":"2016","journal-title":"Am J Kidney Dis"},{"key":"R6-20260302","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1016\/0002-9343(60)90090-5","article-title":"The renal excretion of hydrogen ion in renal tubular acidosis. 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