Merck Manual

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Some Types of Renal Tubular Acidosis

Some Types of Renal Tubular Acidosis



Underlying Abnormality

Resulting Symptoms and Metabolic Abnormalities


May be hereditary or may be triggered by an autoimmune disorder or certain drugs

Cause usually not known, especially in women

Inability to excrete acid into the urine

High blood acidity

Mild dehydration

Low potassium levels in the blood, leading to muscle weakness and paralysis

Fragile bones

Bone pain

Calcium deposits, leading to kidney stones


Usually caused by a hereditary disease such as Fanconi syndrome, hereditary fructose intolerance, Wilson disease, or oculocerebrorenal syndrome (Lowe syndrome)

May also be caused by multiple myeloma, heavy metal poisoning, or certain drugs

Inability to reabsorb bicarbonate from the urine, so too much bicarbonate is excreted

High blood acidity

Fragile bones

Bone pain

Mild dehydration

Low potassium levels in the blood

Decreased production of the active form of vitamin D


Not hereditary

Caused by diabetes, an autoimmune disorder, chronic kidney disease, or an obstruction in the urinary tract

Worsened by certain drugs, including potassium-sparing diuretics, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers

Deficiency of or inability to respond to aldosterone, a hormone that helps regulate potassium and sodium excretion by the kidneys

Mildly increased blood acidity and high potassium levels in the blood that rarely cause symptoms, unless the potassium level is unusually high (in that case, irregular heartbeats and muscle paralysis develop)

Note: Type 3 is a mixture of Types 1 and 2 and is extremely rare.