Pathogenesis of distal renal tubular acidosis

Abstract

Most of the experimental observations in patients with distal RTA can be explained in terms of either the 'failure to secrete' or the 'back-diffusion' of hydrogen ions and carbonic acid hypotheses. Because distal RTA can result from a variety of causes, it is possible that either mechanism might be operative in certain instances, or even that both mechanisms could play a role in the same patient. Further elucidation of which of these pathophysiologic mechanisms is more important in any particular type of distal RTA must await more sophisticated methodology for the detection of distal hydrogen ion secretion in vivo.