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Renal Acidification Mechanisms

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Core Concepts in the Disorders of Fluid, Electrolytes and Acid-Base Balance

Abstract

Acid–base homeostasis is fundamental to normal health and development, and the renal contribution is central to this process. Acid–base homeostasis involves regulated reabsorption of filtered bicarbonate and generation of new bicarbonate. The latter process involves titratable acid excretion, organic anion excretion, and intrarenal ammoniagenesis and urinary ammonia excretion. Bicarbonate reabsorption predominantly occurs in the proximal tubule, with lesser rates in the thick ascending limb of the loop of Henle and the collecting duct, the regulation mechanisms of which differ in different nephron/collecting duct segments. Titratable acid excretion involves buffering of secreting H+ by intraluminal buffers, of which phosphate is the primary component. Renal urinary ammonia excretion involves regulated ammoniagenesis, primarily utilizing glutamine as a source molecule, and involves regulated transport in multiple renal epithelial cell sites. This chapter summarizes the fundamental mechanisms and regulation of these processes.

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Acknowledgments

The authors dedicate this chapter to the many talented investigators with whom we have been fortunate to work, the superb mentors who have supported, encouraged and, in many cases, enabled our scientific endeavors, and to our wonderful spouses and families who have supported all aspects of our lives. The preparation of this chapter was supported in part by funds from NIH R01-DK-45788, RO1-DK-49750, RO1-DK-82680 and Department of Veterans Affairs 1I01BX000818.

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Authors and Affiliations

  1. Department of Medicine, University of Florida College of Medicine and North Florida/South Georgia Veterans Health System, 1600 SW Archer Rd, Gainesville, FL, 32610, USA

    I. David Weiner M.D.

  2. Division of Nephrology, Hypertension and Transplantation, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA

    Jill W. Verlander D.V.M.

  3. Division of Nephrology, Department of Medicine, University of Florida, Gainesville, FL, USA

    Charles S. Wingo M.D.

  4. North Florida/South Georgia Vetrans Health System, Gainesville, FL, USA

    Charles S. Wingo M.D.

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  1. I. David Weiner M.D.
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  3. Charles S. Wingo M.D.
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Correspondence to I. David Weiner M.D. .

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Editors and Affiliations

  1. Brigham and Women's Hospital, Harvard Medical School, VA Boston Healthcare System, Blackfan Circle 4, Boston, 02115, Massachusetts, USA

    David B. Mount

  2. Harvard Medical School, Renal Division, Brigham and Women's Hospital, Francis Street 75, Boston, 02115, Massachusetts, USA

    Mohamed H. Sayegh

  3. Harvard Medical School, Renal Division, Brigham and Women's Hospital, Francis Street 75, Boston, 02115, Massachusetts, USA

    Ajay K. Singh

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Weiner, I.D., Verlander, J.W., Wingo, C.S. (2013). Renal Acidification Mechanisms. In: Mount, D., Sayegh, M., Singh, A. (eds) Core Concepts in the Disorders of Fluid, Electrolytes and Acid-Base Balance. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-3770-3_7

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