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Broadsheet number 40: The diagnosis of renal tubular acidosis

INTRODUCTION Renal tubular acidosis (RTA) refers to a condition in which there is metabolic acidosis due to impairment of renal tubular function, often unaccompanied by decreased glomerular filtration rate. It may occur as an isolated defect or as part of a clinical syndrome involving other disorders of renal function (eg; Fanconi syndrome) or extrarenal disease (eg; Sj6gren syndrome). RTA is usually first suspected by the discovery of metabolic acidosis (low plasma HCO3) accompanied by an absolute or relative hyperchloremia and a normal anion gap, 1 (ie; Na ÷ C1 HCO3 < 15). However, since hyperchtoremic acidosis may occur for other reasons, the definitive establishment of the existence of RTA in such a patient may be desirable.