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2. Which renal mechanism,s does the body use to cope with decreasing pH?
The internal pH of the body is maintained at 7.35 to 7.45. Above a pH of 8,
alkalosis is present, whilst below a pH of 6, acidosis is present.
The pH is tightly regulated mainly by buffers such as protein and hydrogen
carbonate (H2CO3).
Causes of acidosis include severe diarrhea, hypoventilation and increased
consumption of acids.
Signs of acidosis are coma and hyperventilation.
If a decrease in pH occurs (acidosis), after a few days, the kidneys respond
in a way as to increase the pH towards a normal value again.
The kidneys cope with decreasing pH by secretion of H+ ions.
This occurs by secondary active transport in the proximal tubule and thick
ascending limb of the loop of Henle, and by primary active transport in the
distal tubule.
In the proximal tubule, H+ is secreted via Na/H pumps which reabsorb one
sodium ion for each hydrogen ion secreted. The gradient for the sodium is
achieved via the Na/K ATPase. The H+ secreted combines with tubular HCO3to form H2CO3 (H+ + HCO3- -> H2CO3) which is in turn reabsorbed into the
cells. In the cells, through the use of carbonic anhydrase, the H2CO3
is reverted back into HCO3- and H+. The HCO3- moves into the blood to buffer
more H+ whilst the H+ is again moved through the Na/H pump back into the
tubular fluid. This also occurs in the thick ascending loop of Henle.
In the distal tubule, H+ is secreted into the tubular fluid by H+ ATPase.
These pumps are found on the a-intercalated cells of the distal tubules.
The same principle of combination with HCO3-, rebasorption, break down and
re-secretion still applies.
Depletion of HCO3- generation of new HCO3If stores of HCO3- are depleted, phosphate takes over the role of HCO3- in
the tubular fluid, combining with H+ which is excreted as Na2HPo4.
Whilst this is happening, carbon dioxide enters the cells and react with
H20. CO2 + H20 -> H2CO3 <-> H+ + HCo3-. The H+ is again secreted to combine
with Na2HPO4 whilst the HCO3- is moved into blood to act as a buffer.
In this way, new HCO3- is formed.
Ammonia buffer - chronic acidosis
In the case of chronic acidosis, glutamine metabolism is stimulated in the
proximal tubule.
The ammonia buffering system works in two ways:
1. To generate new HCo32. Excreting H+ as NH4+
The generation of new HCO3- in the proximal tubule is very similar to the
phosphate buffer system. Secreted H+ reacts with NH3 to form NH4+ which is
secreted, whilst CO2 and H2O react to form HCO3- and H+.