Role of Extracellular Fluid Volume Expansion and Diuretics in Renal Handling of Phosphate

  • Manuel Martinez-Maldonado
  • Garabed Eknoyan
Chapter

Abstract

One of the more remarkable functions of the kidney is maintenance of the constancy of the composition and volume (ECV) of the extracellular fluid. The understanding of the mechanisms involved in ECV homeostasis has improved colossally over the past two decades. A number of important studies during this period of time have revealed that a major site of salt and water regulation in the nephron is the proximal convoluted tubule (Jacobson and Seldin, 1977). During ECV expansion (ECVE), sodium reabsorption in the proximal convoluted tubule is depressed, whereas reabsorption is enhanced when ECV is contracted. The major determinants of proximal tubular reabsorption, in addition to a component of active sodium transport, are intrarenal hemodynamics and peritubular Starling forces. Although specific transport systems may exist for each of the constituents of glomerular filtrate, under conditions of changing ECV, bulk movement of fluid from lumen to blood or backleak from blood to lumen may take place. Considerable evidence has been presented (Boulpaep and Sackin, 1977) indicating that during ECVE, fluid backleaks through the tight junction or zona occludens of proximal tubules (or through intracytoplasmic channels).

Keywords

Proximal Tubule Sodium Reabsorption Ethacrynic Acid Phosphate Excretion Phosphate Reabsorption 
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© Plenum Publishing Corporation 1980

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  • Manuel Martinez-Maldonado
  • Garabed Eknoyan

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