The pathophysiology of renal tubular acidosis (RTA) seems well worked out. Distal or type 1 renal tubular acidosis (dRTA)leads to positive proton balance,which results in decreased bone mineral density (BMD) and a urinary phenotype most consistent with calcium phosphate stone formation: hypocitraturia, hypercalciuria, and a high urine pH. Nephrocalcinosis and CKD are also seen. Proximal or type 2 RTA does not lead to positive proton balance, and therefore, in (nongrowing) adults, it does not lead to reduced BMD and is not associated with stones or nephrocalcinosis. However, the most confounding category in RTA might be incomplete distal renal tubular acidosis (idRTA).
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