title: Clinical and laboratory approaches in the diagnosis of renal tubular acidosis.
abstract: In the absence of a gastrointestinal origin, a maintained hyperchloremic metabolic acidosis must raise the diagnostic suspicion of renal tubular acidosis (RTA). Unlike adults, in whom RTA is usually secondary to acquired causes, children most often have primary forms of RTA resulting from an inherited genetic defect in the tubular proteins involved in the renal regulation of acid-base homeostasis. According to their pathophysiological basis, four types of RTA are distinguished. Distal type 1 RTA, proximal type 2 RTA, mixed-type 3 RTA, and type 4 RTA can be differentiated based on the family history, the presenting manifestations, the biochemical profile, and the radiological findings. Functional tests to explore the proximal wasting of bicarbonate and the urinary acidification capacity are also useful diagnostic tools. Although currently the molecular basis of the disease can frequently be discovered by gene analysis, patients with RTA must undergo a detailed clinical study and laboratory work-up in order to understand the pathophysiology of the disease and to warrant a correct and accurate diagnosis.
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Asturias, Spain. fsantos@uniovi.es.|Facultad de Medicina, Área de Pediatría, c/ Julián Clavería 6, 33006, Oviedo, Spain. fsantos@uniovi.es.
authors.forename: Fernando
authors.initials: F
authors.lastname: Santos
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Asturias, Spain.
authors.forename: Flor A
authors.initials: FA
authors.lastname: Ordóñez
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Asturias, Spain.
authors.forename: Débora
authors.initials: D
authors.lastname: Claramunt-Taberner
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Asturias, Spain.
authors.forename: Helena
authors.initials: H
authors.lastname: Gil-Peña
mesh_terms: D000141:Acidosis, Renal Tubular / Q000175:diagnosis* / Q000235:genetics / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007668:Kidney / Q000503:physiopathology*
keywords: Diagnosis; Functional tests; Inherited diseases; Metabolic acidosis; Renal tubular acidosis
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