Normal acid–base homeostasis is maintained by the kidneys and respiratory system

Renal tubular acidosis (RTA) occurs when the kidneys are unable to adequately reclaim filtered bicarbonate or excrete sufficient hydrogen ions because of defects in tubular transport

Three main types of RTA are common in clinical practice: distal (type 1), proximal (type 2), and hyperkalemic (type 4) RTA

Differential diagnosis of RTA should consider presenting signs and symptoms, the anion gap, serum biochemistry, and urine pH

Treatment options depend on the type of RTA diagnosed; alkali therapy may be used in patients with type 1 or 2 RTA, and newer potassium binders may be beneficial for patients with type 4 RTA