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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Abstract titles should be brief and reflect the content of the abstract.
Renal tubular acidosis (RTA) is a condition in which normal-anion gap (AG) metabolic acidosis occurs due to dysfunction of renal tubular dysfunction. It is classified mainly into distal RTA, which causes impaired urinary acidification due to impaired hydrogen ion excretion into the distal tubules, and proximal RTA, which causes impaired bicarbonate ion reabsorption in the proximal tubules. Proximal RTA is often recognized as a clinical manifestation of Fanconi syndrome, in which the reabsorption of various substances in addition to bicarbonate ions in the proximal tubules is impaired. Type 3 RTA is a condition in which distal and proximal RTA occur simultaneously and is considered rare. In recent years, cases of acute transient type 3 RTA associated with an acute disease have been reported.
Adenovirus causes respiratory tract infections, pharyngoconjunctival fever, epidemic keratoconjunctivitis, and gastroenteritis. It also causes hemorrhagic cystitis, mainly in patients who have undergone hematopoietic stem cell transplantation or organ transplantation. However, to the best of our knowledge, no cases of RTA have been reported so far.
Case presentation
A 4-year-old boy had a fever and vomiting several times two days before he was admitted. One day before his admission, he had pharyngeal erythema. He was admitted due to poor oral intake (Day 0). PCR testing of a pharyngeal swab was positive for adenovirus and rhinovirus, and stool adenovirus antigen testing was also positive. He had severe mixed metabolic acidosis consisting of both AG metabolic acidosis and normal-AG metabolic acidosis based on the negativity of his ΔAG-Δbicarbonate ion level. His renal ultrasound revealed no calcification or hydronephrosis.
He was diagnosed with adenovirus pharyngitis. Moreover, he was diagnosed with distal RTA, since the pH of urine pH was 6.5 despite metabolic acidosis, suggesting impaired urinary acidification. The patient was also diagnosed with Fanconi syndrome due to low tubular reabsorption of phosphorus rate (%TRP) with low serum phosphorus levels and high urinary β2-microglobulin (MG) levels, suggesting multiple proximal tubule dysfunction. Fluid infusions were administered. On day 3 of hospitalization, a venous blood gas analysis revealed a pH of 7.498 and bicarbonate ion level of 30.2 mmol/L. Urinary β2-MG level was 2174 μg/L; however, the %TRP had normalized to 97.2%. On day 8, urinary β2-MG level had normalized to 108 μg/L and he was discharged since his oral intake was restored.
Due to renal tubular dysfunction, he was diagnosed with acute transient type 3 RTA. Proximal RTA was indirectly diagnosed since impaired reabsorption of multiple substances in the proximal tubules implied a high probability of impaired bicarbonate ion reabsorption. Moreover, renal tubular dysfunction was transient with the patient’s acute disease.
Acute transient type 3 renal tubular acidosis may not be rare as the present case, and acute transient type 3 renal tubular acidosis should be considered when marked metabolic acidosis is observed.
