How are disorders of hyperchloremic acidosis categorized?

Updated: Sep 03, 2020
  • Author: Sai-Ching Jim Yeung, MD, PhD, FACP; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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The kidneys maintain acid-base balance by bicarbonate reclamation and acid excretion. Most conditions that affect the kidneys cause a proportionate simultaneous loss of glomerular and tubular function. Loss of glomerular function (associated with decreased glomerular filtration rate [GRF]) results in the retention of many end products of metabolism, including the anions of various organic and inorganic acids and urea. Loss of tubular function prevents the kidneys from excreting hydrogen cations (H+) and thereby causes metabolic acidosis. The development of azotemia, anion retention, and acidosis is defined as uremic acidosis, which is not hyperchloremic.

The term hyperchloremic acidosis (ie, RTA) refers to a diverse group of tubular disorders, uncoupled from glomerular damage, characterized by impairment of urinary acidification without urea and anion retention. Consequently, typically RTA is unaccompanied by significant decreases in GFR. These disorders can be divided into 2 general categories, proximal (type II)and distal (types I and IV).

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