Renal tubular acidosis pathophysiology: Difference between revisions
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==Overview== | ==Overview== | ||
==Pathophysiology== | ==Pathophysiology== | ||
===Normal Physiology of Acid-Base balance=== | |||
*Normally kidneys reabsorb the filtered bicarbonate and excrete acid to maintain acid-base balance. | |||
*HCO3 reabsorption is facilitated by Na-H and proton pumps. | |||
**Na-H reabsorbs about 80-90% of the filtered HCO3 at the proximal tubule. | |||
**The remaining 10 percent is reclaimed in the distal nephron via hydrogen secretion by proton pumps (H-ATPase and H-K ATPase). | |||
**Under normal condition, there is no bicarbonate in the final urine. | |||
*Collecting tubules serve the function of excretion of acid. | |||
**Hydrogen ions need a buffer to get excreted. | |||
**The principal buffers in the urine are ammonia and phosphate. | |||
**Ammonium excretion requires the renal synthesis of ammonia and the secretion of hydrogen ions into the tubular lumen where they are trapped as ammonium. | |||
**Ammonia diffuses freely across membranes, while ammonium does not. | |||
**The renal tubular production of ammonia is stimulated by intracellular acidosis. | |||
**When the systemic acid load is modestly increased, near-normal balance is maintained by increases in ammonium production and excretion. | |||
**Failure to excrete sufficient ammonium often leads to the net retention of hydrogen ions and the development of metabolic acidosis. | |||
[[Image:Renal_Diuretics.gif|thumb|center|400px|Source:By Haisook at English Wikipedia, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=2945979]] | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 14:24, 16 May 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Pathophysiology
Normal Physiology of Acid-Base balance
- Normally kidneys reabsorb the filtered bicarbonate and excrete acid to maintain acid-base balance.
- HCO3 reabsorption is facilitated by Na-H and proton pumps.
- Na-H reabsorbs about 80-90% of the filtered HCO3 at the proximal tubule.
- The remaining 10 percent is reclaimed in the distal nephron via hydrogen secretion by proton pumps (H-ATPase and H-K ATPase).
- Under normal condition, there is no bicarbonate in the final urine.
- Collecting tubules serve the function of excretion of acid.
- Hydrogen ions need a buffer to get excreted.
- The principal buffers in the urine are ammonia and phosphate.
- Ammonium excretion requires the renal synthesis of ammonia and the secretion of hydrogen ions into the tubular lumen where they are trapped as ammonium.
- Ammonia diffuses freely across membranes, while ammonium does not.
- The renal tubular production of ammonia is stimulated by intracellular acidosis.
- When the systemic acid load is modestly increased, near-normal balance is maintained by increases in ammonium production and excretion.
- Failure to excrete sufficient ammonium often leads to the net retention of hydrogen ions and the development of metabolic acidosis.
