Acid base

kidney
regulation
SUBTITLE
PRIMARY SYSTEM REGULATE ACID-BASE IN
EXTRACELLULAR FLUID’

1. Acid-Base buffer system

2. Respiration center
3. Renal
RENAL CONTROL OF ACID-BASE BALANCE

1. The basic mechanism is to excrete HCO3- (filtered to the tubules)

to the urine to make extracelluler fluid more acid or to excrete
H+ (from epitelial cell) to make extracellular fluid more base
2. If HCO3- is excreted more then H+  the body will loss base.
(same in H+)
RENAL CONTROL OF ACID-BASE BALANCE

▪ In body, produce nonvolatile acid, from

protein metabolism  cant be remove by
the lung  the primary mechanism to
remove is renal excretion
▪ The kidney prevent the loss of bicarbonate
in the urine.
▪ Each day body produce  4320 mEq of
HCO3-  almost all this is reabsorbed from
the tubules.
▪ The total of H+ secreted in tubular fluid is
 4400 mEq each day (4320 for
reabsorbed HCO3- and 80 mEq for remove
the nonvolatile acids produce each day)
RENAL CONTROL OF ACID-BASE BALANCE

▪ Alkalosis in extracelular fluid  the kidney secret less H+

and fail to reabsorb HCO3- (because it can buffer the H+
in extracellular fluid)
▪ Acidosis in extracellular fluid  kidney secrete additional
H+ and do not excrete HCO3- but reabsorb all HCO3-
SECRETION OF H+ AND REABSORPTION OF HCO3-
BY THE RENAL TUBULES

▪ Occurs in all parts of the tubules except the

descending and ascending thin limbs of the
loop of henle.
▪ Different tubular segment accomplish this
task differently.
▪ Proximal tubule : 80 – 90% of the HCO3-
reabsorption (and H+ secretion occurs in
the proximal tubule.
▪ The rest of HCO3- is reabsorbed in thick
ascending 10 %. And distal tubules and
collecting duct too.
I. SECONDARY ACTIVE TRANSPORT IN THE EARLY
TUBULAR SEGMENT
▪ The proximal tubule, thick
segment of the ascending
limb loop of henle, and the
early distal tubule secrete
H+, by sodium-hydrogen
counter-transport.
▪ The energy for H+ secretion
against concentration
gradient is derived from
sodium gradient favoring
NA+ movement into the cell.
HCO3- REABSORPTION ACROSS THE
BASOLATERAL MEMBRAN

▪ The transport of HCO3- in

basolateral membrane fascilitated
by two mechanism :
1. NA+ HCO3- co transport 
proximal tubules
2. CL- HCO3- co transport  late
segment of the proximal tubule,
the thick ascending loop of
henle and the collecting tubules
and ducts.
HCO3- is titrated againts H+ in the tubules

▪ HCO3- and H+ normally titrate against each other in the tubules 

quantities of the two ions entering the tubulus are almost equal H+ =
4400 mEq, and HCO3- = 4320 mEq
▪ Excess Of HCO3- over H+ in the urine, occurs in metabolic alkalosis, the
excess HCO3- cannot be reabsorbed, which correct the metabolic
alkalosis
▪ Excess H+ relative to HCO3- causing complete reabsorption of the HCO3-;
the excess H+ passes into the urine in combination with urinary buffers,
especially phospate and ammonia.
▪ “the basic mechanism by which the kidney correct either acidosis or
alkalosis is incomplete titration of H+ against HCO3- , leaving on or the
other to pass into the urine and be removed from extracellular fluid.
II. PRIMARY ACTIVE SECRETION OF H+ IN INTERCALATED
CELLS OF LATE DISTAL AND COLLECTING TUBULES.
▪ In the late distal tubule and the remainder
tubular system  tubular epithelium
secretes H+ by primary active transport
▪ H+ transported directly by spesific protein,
a hydrogen-pottasium ATPase transporter
▪ Occurs in special type of cells, “A
intercalated celss of the late distal tubules
and in the collecting duct”
▪ Its same with the process in proximal
tubules, the main difference is H+ move
across its luminal membrane by an active
H+ pump instead of by counter-transport,
early part of the nephron.
▪ In the collecting tubules, H+ concentration
can increas 900 fold  important to
forming maximally acidic urine.
PHOSPATE AND AMONIA

▪ Some H+ secreted into tubular fluid of collecting duct are buffered,

but not by HCO3- (most of it has been filtered and reabsorbed)
▪ The other buffer is :
1. HPO4- (monohydrogen phosphate ion)
Combine with H+  H2PO4- (dihydrogen phospate ion)
2. NH3 (ammonia)
Combine with H+  NH4+ (ammonium ion)
• Those ion can’t diffuse back into tubule cells, they are excreted in
the urine.