distal renal tubular acidosis with grade 4 vesicoureteral reflux in a child with single kidney

introduction renal tubular acidosis (rta) is a non-uremic defects of urinary acidification. it is characterized by a normal anion gap hyperchloremic  metabolic acidosis; plasma potassium may be normal, low or high-depending on the type of rta. these syndromes differ from uremic acidosis which is associated with a high anion gap, decreased glomerular filtration with enhanced proton secretion by the remaining   nephrons. case report we presented a 2 year-old male child with features of acute kidney injury with growth retardation. on evaluation the child was diagnosed to have distal renal tubular acidosis with grade 4 vesicoureteral reflux with right sided single kidney. conclusion the child had congenital malformation of renal system which was not evaluated previously and remains untreated for long duration which leads to growth retardation and presented in a serious condition in our case.