1. Jonathan Pelletier, MD* 2. Rasheed Gbadegesin, MD, MBBS† 3. Betty Staples, MD* 1. *Department of Pediatrics and 2. †Department of Pediatric Nephrology, Duke Children's Hospital and Health Center, Durham, NC 1. 1. Reddy P Clinical Approach to Renal Tubular Acidosis in Adult Patients. Reddy P Int J Clin Pract. 2011;65(3):350–360 [OpenUrl][1][CrossRef][2][PubMed][3] 2. 1. Batlle D, 2. Haque SK Genetic Causes and Mechanisms of Distal Renal Tubular Acidosis. Batlle D, Haque SK. Nephrol Dial Transplant. 2012;27(10):3691–3704 [OpenUrl][4][CrossRef][5][PubMed][6][Web of Science][7] 3. 1. Karet FE Mechanisms in Hyperkalemic Renal Tubular Acidosis. Karet FE. J Am Soc Nephrol. 2009;20(2):251–254 [OpenUrl][8][Abstract/FREE Full Text][9] 4. 1. Haque SK, 2. Ariceta G, 3. Batlle D Proximal Renal Tubular Acidosis: A Not So Rare Disorder of Multiple Etiologies. Haque SK, Ariceta G, Batlle D Nephrol Dial Transplant. 2012;27(12):4273–4287 [OpenUrl][10][CrossRef][11][PubMed][12][Web of Science][13] 5. 1. Gbadegesin R, 2. Foreman W 1. Chand DH, 2. Valentini RP Renal Tubular Acidosis. Gbadegesin R, Foreman W In: Chand DH, Valentini RP, eds. Clinician's Manual of Pediatric Nephrology. 1st ed. Singapore: World Scientific Publishing Co; 2011 The body temporarily buffers hydrogen ions (H+) with plasma proteins, hemoglobin, and bicarbonate (HCO3−), but H+ must be excreted to prevent acidosis. The major functions of the kidneys in acid-base homeostasis are to excrete H+ and reabsorb HCO3−. Failure to perform these functions results in HCO3− wasting, leading to renal tubular acidosis (RTA), which is categorized into 3 major groups: distal (type I), proximal (type II), and hyperkalemic (type IV) RTA. Excretion of H+ to balance acid production is primarily the function of the distal convoluted tubule and collecting duct (DCT/CD), where α-intercalated cells actively transport H+ into the tubule. Secreted H+ combines with ammonia to form ammonium in the DCT/CD lumen. Because of its positive charge, ammonium cannot diffuse out of the tubular lumen, and it is passed in the urine. In distal RTA, α-intercalated cells cannot secrete sufficient H+ into the tubular lumen, resulting in decreased … [1]: {openurl}?query=rft.jtitle%253DInternational%2Bjournal%2Bof%2Bclinical%2Bpractice%26rft.stitle%253DInt%2BJ%2BClin%2BPract%26rft.aulast%253DReddy%26rft.auinit1%253DP.%26rft.volume%253D65%26rft.issue%253D3%26rft.spage%253D350%26rft.epage%253D360%26rft.atitle%253DClinical%2Bapproach%2Bto%2Brenal%2Btubular%2Bacidosis%2Bin%2Badult%2Bpatients.%26rft_id%253Dinfo%253Adoi%252F10.1111%252Fj.1742-1241.2009.02311.x%26rft_id%253Dinfo%253Apmid%252F21314872%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1111/j.1742-1241.2009.02311.x&link_type=DOI [3]: /lookup/external-ref?access_num=21314872&link_type=MED&atom=%2Fpedsinreview%2F38%2F11%2F537.atom [4]: {openurl}?query=rft.jtitle%253DNephrol%2BDial%2BTransplant%26rft_id%253Dinfo%253Adoi%252F10.1093%252Fndt%252Fgfs442%26rft_id%253Dinfo%253Apmid%252F23114896%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [5]: /lookup/external-ref?access_num=10.1093/ndt/gfs442&link_type=DOI [6]: /lookup/external-ref?access_num=23114896&link_type=MED&atom=%2Fpedsinreview%2F38%2F11%2F537.atom [7]: /lookup/external-ref?access_num=000310631500007&link_type=ISI [8]: {openurl}?query=rft.jtitle%253DJ%2BAm%2BSoc%2BNephrol%26rft_id%253Dinfo%253Adoi%252F10.1681%252FASN.2008020166%26rft_id%253Dinfo%253Apmid%252F19193780%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [9]: /lookup/ijlink?linkType=ABST&journalCode=jnephrol&resid=20/2/251&atom=%2Fpedsinreview%2F38%2F11%2F537.atom [10]: {openurl}?query=rft.jtitle%253DNephrol%2BDial%2BTransplant%26rft_id%253Dinfo%253Adoi%252F10.1093%252Fndt%252Fgfs493%26rft_id%253Dinfo%253Apmid%252F23235953%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [11]: /lookup/external-ref?access_num=10.1093/ndt/gfs493&link_type=DOI [12]: /lookup/external-ref?access_num=23235953&link_type=MED&atom=%2Fpedsinreview%2F38%2F11%2F537.atom [13]: /lookup/external-ref?access_num=000312645800008&link_type=ISI