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LECTURE 6
As glucose is further increased, more glucose appears in the urine. At very high filtered glucose, reabsorption remains constant, this is called tubular transport maximum for glucose (TmG)
At this maximum transport, all the glucose carriers are saturated and no more glucose can be transported
Glucose reabsorption
Mechanism of glucose reabsorption Secondary active transport Luminal membrane
Cotransport with Na
Basolateral membrane
GLUT2
LUMEN
BLOOD
Steps involved in reabsorbing glucose from tubular fluid into peritubular capillary blood
1) Glucose move from tubular fluid cell by binding with Na+ to the cotransport protein (GLUT1) which rotates in the membrane Na+ and glucose released to ICF. Glucose is transported against an electrochemical gradient. 2) Na+ gradient is maintained by the Na-K ATPase in the peritubular membrane. Because ATP is used directly to energize the Na-K ATPase and indirectly to maintain the Na gradient, Na+-glucose cotransport called secondary active transport. 3) Glucose transported from cell peritubular capillary blood by facilitated diffusion (GLUT2). Glucose move down electrochemical gradient, no energy required.
Glucose Reabsorption
INTERSTITIAL FLUID K+ Na+ GLUT 2 SGLT 2 Early proximal tubule cell TUBULAR LUMEN
Glucose
Inulin
UV
Glucose
P
TmG
Splay
Ideal Actual
Renal threshold = 300 mg/dl 375 mg/min (TmG) divided by 125 ml/min (GFR)
Renal threshold
Plasma glucose level at which glucose first appear in urine 200mg/dl in arterial; 180 mg/dl in venous
Glucose absorption is inhibited by Phlorhizin competes for binding to the carrier blood glucose level ( renal threshold) exceed Tm glucose in urine glucosuria Diabetes Mellitus
800
Filtered GFR x PG Excreted UG x V
600
TmG (375) Reabsorbed
400
200
Splay
Threshold (200)
Basolateral membrane
diffusion
Bicarbonate reabsorption
90% of filtered is reabsorbed in PCT Filtered HCO3 + H2O H2CO3 H2CO3 H2O + CO2 in the presence of carbonic anhydrase CO2 diffuses into the cell + H2OH2CO3 H2CO3 CA H + HCO3 HCO3 is reabsorped H+ is secreted in exchange for Na +
Bicarbonate reabsorption
Lumen
Filtrate Na+ HCO3 + H+ H2CO3 H2O + CO2
cont.
Tubular cell
Blood
H+
Tight junction
Brush border
Phosphate reabsorption
Bones, teeth & skeleton (80%) Intracellular P (20%) Plasma P 1mmol/l freely filtered 1/3 of filtered is excreted in urine Cotransported with Na Rate of absorption is under the control of PTH & VD (rate of absorption) Compete with glucose: blocking glucose P reabsorption
Urea reabsorption
Plasma urea concentraion 15-40mg/100ml End product of protein metabolism 40-50% of filtered urea reabsorbed
Passive diffusion Reabsorbed in consequent of Na reabsorption
50-60% excreted
GFR Concentration in blood
2.6 2.4
2.2
2.0 1.8 1.6 Cl K+ Na+ osm 0.8 0.6 0.4 0.2 HCO3 Amino acids Glucose Inulin
1.4
1.2
TF P
1.0
25
30
75
100
Tubular secretion
From peritubular blood interstitium tubular cell tubular lumen Secretion:
Passive NH3, salicylic acid Active
Tm: creatinine; PAH No Tm: K; H
Hydrogen
Excretion is inversely proportional to K