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Renal Tubular Reabsorption
and Secretion
• Some substances are selectively reabsorbed from
the tubules back into the blood, whereas others are
secreted from the blood into the tubular lumen.
• For many substances, tubular reabsorption plays a
much more important role than secretion in
determining the final urinary excretion rate.
• However, tubular secretion: accounts for
significant amounts of potassium ions,
hydrogen ions, and a few other
substances that appear in the urine.
TUBULAR REABSORPTION IS
QUANTITATIVELY LARGE AND HIGHLY
SELECTIVE
• Unlike glomerular filtration, which is relatively
nonselective (essentially all solutes in the plasma
are filtered except the plasma proteins or
substances bound to them), tubular
reabsorption is highly selective.
TUBULAR REABSORPTION INCLUDES
PASSIVE AND ACTIVE MECHANISMS
• For a substance to
be reabsorbed, it
must first be
transported (1)
across the tubular
epithelial
membranes into the
renal interstitial fluid
and then (2) through
the peritubular
capillary membrane
back into the blood.
water and solutes can be transported through the cell
membranes (transcellular route) or through the spaces
between the cell junctions (paracellular route).
water and solutes are transported through the
peritubular capillary walls into the blood by
ultrafiltration (bulk flow) that is mediated by
hydrostatic and colloid osmotic forces
1
2
1- Primary Active Transport Through the Tubular
Membrane Is Linked to Hydrolysis of ATP:
a) Sodium-potassium ATPase.
b) Hydrogen ATPase.
c) Hydrogen-potassium
ATPase.
d) Calcium ATPase.
The primary active transporters in the kidneys that are known
include:
2- Secondary Active
Through the Tubular Membrane:
• Exampule: (Na-Glucose) symport.
• Sodium glucose co-transporters
(SGLT2{90% in early Proximal CT}
and SGLT1{10% in late Proximal
CT}) are located on the brush
border of proximal tubular cells.
Secondary Active
into the Tubules:
• Example: (sodium-hydrogen
exchanger) in the brush border
of the luminal membrane.
Pinocytosis—An Active Transport
Mechanism for Reabsorption of Proteins:
• Some parts of the tubule, especially the
proximal tubule, reabsorb large molecules
such as proteins by pinocytosis.
• Once inside the cell, the protein is digested
into its constituent amino acids, which are
reabsorbed through the basolateral
membrane into the interstitial fluid.
Transport Maximum for Substances
That Are Actively Reabsorbed:
• Transport Maximum: is a limit to the rate at
which the solute can be transported.
• For example:
• Measurable glucose does not appear in the
urine because essentially all the filtered
glucose is reabsorbed in the proximal tubule.
• When the filtered load exceeds the capability
of the tubules to reabsorb glucose, urinary
excretion of glucose does occur.
Transport Maximums for Substances
That Are Actively Reabsorped:
Transport Maximums for Substances
That Are Actively secreted:
Substances That Are Actively or
passively Transported but Do Not
Exhibit a Transport Maximum.
• These are called gradient-time transport.
• This determined by:
(1) The electrochemical gradient for diffusion of the substance
across the membrane.
(2) The permeability of the membrane for the substance.
(3) The time that the fluid containing the substance remains
within the tubule.
• An example of gradient-time transport is sodium reabsorption
in the proximal tubule.
• the greater the concentration of sodium in the proximal tubules,
the greater its reabsorption rate. Also, the slower the flow rate
of tubular fluid, the greater the percentage of sodium that can
be reabsorbed from the proximal tubules.
• Passive water reabsorption by osmosis is
coupled mainly to sodium reabsorption.
• Reabsorption of chloride, urea, and other
solutes by passive diffusion.
REABSORPTION AND
SECRETION ALONG
DIFFERENT PARTS
OF THE NEPHRON
• Substances Reabsorbed from Proximal Convoluted Tubule:
• glucose, amino acids, sodium, potassium, calcium, bicarbonates,
chlorides, phosphates, urea, uric acid and water.
• Substances secreted from Proximal Convoluted Tubule:
1. bile salts, oxalate, urate, and catecholamines, para-aminohippuric acid
(PAH).
2. Certain drugs and toxin.
1- Proximal convoluted Tube:
Reabsorption
Reabsorption
Secretion
Reabsorption
A value of 1.0 indicates that the
concentration of the substance
in the tubular fluid is the same
as the concentration in the
plasma.
Values below 1.0 indicate that
the substance is reabsorbed
more avidly than water, whereas
values above 1.0 indicate that
the substance is reabsorbed to a
lesser extent than water or is
secreted into the tubules.
2- Loop Of Henle:
• thin descending segment, the thin ascending
segment, and the thick ascending segment.
• Substances Reabsorbed from Loop of Henle:
• Sodium and chloride.
• Substances Secreted from Loop of Henle:
• Urea.
• Thin descending segment is:
1. Highly permeable to reabsorp water.
2. moderately permeable to most solutes, including
urea and sodium.
• The ascending thin and thick segments is
• virtually impermeable to water, a characteristic that
is important for concentrating the urine.
A) Substance reabsorbed in thin ascendig parts:
• lower reabsorptive capacity for H2O and solute.
B) Substance reabsorbed in thick ascendig parts:
• Active reabsorption of Na, Cl, K and also calcium,
bicarbonate, and magnesium
Thick ascending limb:
A_ Solute reabsorption in the thick ascending limb is the
sodium-potassium ATPase pump in the epithelial cell
basolateral membranes.
B_ In the thick ascending loop, movement of sodium across
the luminal membrane is mediated primarily by a 1-
sodium, 2-chloride, 1-potassium co-transporter.
• The thick ascending limb of the loop of Henle is the site of
action of the powerful “loop” diuretics furosemide,
ethacrynic acid, and bumetanide.
C_The thick ascending limb also has a sodium-hydrogen
counter-transport mechanism.
D_ There is also significant paracellular reabsorption of
cations, such as Mg++, Ca++, Na+, and K+
• The thick segment of
the ascending loop of
Henle is virtually
impermeable to water.
• Therefore, most of the
water delivered to this
segment remains in the
tubule despite
reabsorption of large
amounts of solute.
A
B
C
D
3- DISTAL TUBULE:
• Have 2 portions:
1. The first portion is macula densa.
2. The second part is higly convulated tube and is same
charecteristic to the thick asending Helne, so this part is called
“Diluting Segments”.
• The second part of convulated distal also devided into:
A. Early distal convulasted tube.
B. Late distal convulated tube.
• Charecteristc of early distal C T:
I. Approximately 5% of the filtered load of sodium chloride is
reabsorbed of this site.
II. Have sodium-chloride co-transporter.
• The thiazide diuretics, which are widely used to treat disorders
such as hypertension and heart failure, inhibit the sodium-
chloride co-transporter
4- Collecting Ducts:
• The collecting ducts is divide into 2 ducts:
1. Cortical collecting ducts.
2. Medullary collecting ducts.
• the distal tubule and the subsequent cortical
collecting tubule have similar functional
characteristics.
• Anatomically, they are composed of two distinct cell
types:
A. principal cells.
B. intercalated cells.
• The principal cells reabsorb
sodium and water from the
lumen and secrete potassium
ions into the lumen.
• The principal cells are the
primary sites of action of the
potassium-sparing diuretics,
including spironolactone,
eplerenone, amiloride, and
triamterene.
A.principal cells:
• Intercalated cells play a major role in acid-base regulation
• There are two types of intercalated cells, type A and type B.
1- Type A intercalated cells secrete hydrogen ions by a
hydrogen-ATPase transporter and by a hydrogen-
potassium-ATPase transporter.
• Type A intercalated cells are especially important in
eliminating hydrogen ions while reabsorbing bicarbonate
in acidosis.
2- Type B intercalated cells secrete bicarbonate into the
tubular lumen while reabsorbing hydrogen ions in
alkalosis.
• Type B intercalated cells have hydrogen and bicarbonate
transporters on opposite sides of the cell membrane
compared with type A cells.
A.intercalated cells:
The functional characteristics of the late distal tubule
and cortical collecting tubule can be summarized as
follows:
1. Impermeable to urea.
2. Reabsorb Na ions and secretes K ion by the
hormones aldosterone.
3. Acid-base regulation of the body fluids.
4. The permeability of water is controlled by the
concentration of Anti Diuretic Hormone (ADH),
which is also called vasopressin.
• With high levels of ADH, these tubular segments are
permeable to (reabsorp more) water, but in the
absence of ADH, they are virtually impermeable to
water.
MEDULLARY COLLECTING DUCT
A. Reabsorb less than 10% of the filtered water and
sodium.
B. The final site for processing the urine
C. Play an extremely important role in determining
the final urine output of water and solutes.
D. The epithelial cells of the collecting ducts are
nearly cuboidal in shape with smooth surfaces
and relatively few mitochondria.
Special characteristics of
this tubular segment are as follows:
1. The permeability of the medullary collecting
duct to water is controlled by the level of ADH.
2. The medullary collecting duct is permeable to
urea.
3. The medullary collecting duct is capable of
secreting hydrogen ions against a large
concentration gradient.
PERITUBULAR CAPILLARY AND RENAL
INTERSTITIAL FLUID PHYSICAL FORCES
REGULATION OF
TUBULAR REABSORPTION:
1- GLOMERULOTUBULAR BALANCE:
• if the GFR increases from 125 ml/min to 150 ml/min,
the absolute rate of proximal tubular reabsorption
also increases from about 81 ml/min to about 97.5
ml/min.
2- HORMONAL CONTROL OF TUBULAR
REABSORPTION:

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Urophysiology 3

  • 2. • Some substances are selectively reabsorbed from the tubules back into the blood, whereas others are secreted from the blood into the tubular lumen. • For many substances, tubular reabsorption plays a much more important role than secretion in determining the final urinary excretion rate. • However, tubular secretion: accounts for significant amounts of potassium ions, hydrogen ions, and a few other substances that appear in the urine.
  • 3. TUBULAR REABSORPTION IS QUANTITATIVELY LARGE AND HIGHLY SELECTIVE • Unlike glomerular filtration, which is relatively nonselective (essentially all solutes in the plasma are filtered except the plasma proteins or substances bound to them), tubular reabsorption is highly selective.
  • 4. TUBULAR REABSORPTION INCLUDES PASSIVE AND ACTIVE MECHANISMS • For a substance to be reabsorbed, it must first be transported (1) across the tubular epithelial membranes into the renal interstitial fluid and then (2) through the peritubular capillary membrane back into the blood. water and solutes can be transported through the cell membranes (transcellular route) or through the spaces between the cell junctions (paracellular route). water and solutes are transported through the peritubular capillary walls into the blood by ultrafiltration (bulk flow) that is mediated by hydrostatic and colloid osmotic forces 1 2
  • 5.
  • 6. 1- Primary Active Transport Through the Tubular Membrane Is Linked to Hydrolysis of ATP: a) Sodium-potassium ATPase. b) Hydrogen ATPase. c) Hydrogen-potassium ATPase. d) Calcium ATPase. The primary active transporters in the kidneys that are known include:
  • 7. 2- Secondary Active Through the Tubular Membrane: • Exampule: (Na-Glucose) symport. • Sodium glucose co-transporters (SGLT2{90% in early Proximal CT} and SGLT1{10% in late Proximal CT}) are located on the brush border of proximal tubular cells. Secondary Active into the Tubules: • Example: (sodium-hydrogen exchanger) in the brush border of the luminal membrane.
  • 8. Pinocytosis—An Active Transport Mechanism for Reabsorption of Proteins: • Some parts of the tubule, especially the proximal tubule, reabsorb large molecules such as proteins by pinocytosis. • Once inside the cell, the protein is digested into its constituent amino acids, which are reabsorbed through the basolateral membrane into the interstitial fluid.
  • 9. Transport Maximum for Substances That Are Actively Reabsorbed: • Transport Maximum: is a limit to the rate at which the solute can be transported. • For example: • Measurable glucose does not appear in the urine because essentially all the filtered glucose is reabsorbed in the proximal tubule. • When the filtered load exceeds the capability of the tubules to reabsorb glucose, urinary excretion of glucose does occur.
  • 10. Transport Maximums for Substances That Are Actively Reabsorped: Transport Maximums for Substances That Are Actively secreted:
  • 11. Substances That Are Actively or passively Transported but Do Not Exhibit a Transport Maximum. • These are called gradient-time transport. • This determined by: (1) The electrochemical gradient for diffusion of the substance across the membrane. (2) The permeability of the membrane for the substance. (3) The time that the fluid containing the substance remains within the tubule. • An example of gradient-time transport is sodium reabsorption in the proximal tubule. • the greater the concentration of sodium in the proximal tubules, the greater its reabsorption rate. Also, the slower the flow rate of tubular fluid, the greater the percentage of sodium that can be reabsorbed from the proximal tubules.
  • 12. • Passive water reabsorption by osmosis is coupled mainly to sodium reabsorption. • Reabsorption of chloride, urea, and other solutes by passive diffusion.
  • 14. • Substances Reabsorbed from Proximal Convoluted Tubule: • glucose, amino acids, sodium, potassium, calcium, bicarbonates, chlorides, phosphates, urea, uric acid and water. • Substances secreted from Proximal Convoluted Tubule: 1. bile salts, oxalate, urate, and catecholamines, para-aminohippuric acid (PAH). 2. Certain drugs and toxin. 1- Proximal convoluted Tube:
  • 15. Reabsorption Reabsorption Secretion Reabsorption A value of 1.0 indicates that the concentration of the substance in the tubular fluid is the same as the concentration in the plasma. Values below 1.0 indicate that the substance is reabsorbed more avidly than water, whereas values above 1.0 indicate that the substance is reabsorbed to a lesser extent than water or is secreted into the tubules.
  • 16.
  • 17. 2- Loop Of Henle: • thin descending segment, the thin ascending segment, and the thick ascending segment. • Substances Reabsorbed from Loop of Henle: • Sodium and chloride. • Substances Secreted from Loop of Henle: • Urea.
  • 18. • Thin descending segment is: 1. Highly permeable to reabsorp water. 2. moderately permeable to most solutes, including urea and sodium. • The ascending thin and thick segments is • virtually impermeable to water, a characteristic that is important for concentrating the urine. A) Substance reabsorbed in thin ascendig parts: • lower reabsorptive capacity for H2O and solute. B) Substance reabsorbed in thick ascendig parts: • Active reabsorption of Na, Cl, K and also calcium, bicarbonate, and magnesium
  • 19.
  • 20. Thick ascending limb: A_ Solute reabsorption in the thick ascending limb is the sodium-potassium ATPase pump in the epithelial cell basolateral membranes. B_ In the thick ascending loop, movement of sodium across the luminal membrane is mediated primarily by a 1- sodium, 2-chloride, 1-potassium co-transporter. • The thick ascending limb of the loop of Henle is the site of action of the powerful “loop” diuretics furosemide, ethacrynic acid, and bumetanide. C_The thick ascending limb also has a sodium-hydrogen counter-transport mechanism. D_ There is also significant paracellular reabsorption of cations, such as Mg++, Ca++, Na+, and K+
  • 21. • The thick segment of the ascending loop of Henle is virtually impermeable to water. • Therefore, most of the water delivered to this segment remains in the tubule despite reabsorption of large amounts of solute. A B C D
  • 22. 3- DISTAL TUBULE: • Have 2 portions: 1. The first portion is macula densa. 2. The second part is higly convulated tube and is same charecteristic to the thick asending Helne, so this part is called “Diluting Segments”. • The second part of convulated distal also devided into: A. Early distal convulasted tube. B. Late distal convulated tube. • Charecteristc of early distal C T: I. Approximately 5% of the filtered load of sodium chloride is reabsorbed of this site. II. Have sodium-chloride co-transporter. • The thiazide diuretics, which are widely used to treat disorders such as hypertension and heart failure, inhibit the sodium- chloride co-transporter
  • 23.
  • 24. 4- Collecting Ducts: • The collecting ducts is divide into 2 ducts: 1. Cortical collecting ducts. 2. Medullary collecting ducts. • the distal tubule and the subsequent cortical collecting tubule have similar functional characteristics. • Anatomically, they are composed of two distinct cell types: A. principal cells. B. intercalated cells.
  • 25. • The principal cells reabsorb sodium and water from the lumen and secrete potassium ions into the lumen. • The principal cells are the primary sites of action of the potassium-sparing diuretics, including spironolactone, eplerenone, amiloride, and triamterene. A.principal cells:
  • 26. • Intercalated cells play a major role in acid-base regulation • There are two types of intercalated cells, type A and type B. 1- Type A intercalated cells secrete hydrogen ions by a hydrogen-ATPase transporter and by a hydrogen- potassium-ATPase transporter. • Type A intercalated cells are especially important in eliminating hydrogen ions while reabsorbing bicarbonate in acidosis. 2- Type B intercalated cells secrete bicarbonate into the tubular lumen while reabsorbing hydrogen ions in alkalosis. • Type B intercalated cells have hydrogen and bicarbonate transporters on opposite sides of the cell membrane compared with type A cells. A.intercalated cells:
  • 27.
  • 28. The functional characteristics of the late distal tubule and cortical collecting tubule can be summarized as follows: 1. Impermeable to urea. 2. Reabsorb Na ions and secretes K ion by the hormones aldosterone. 3. Acid-base regulation of the body fluids. 4. The permeability of water is controlled by the concentration of Anti Diuretic Hormone (ADH), which is also called vasopressin. • With high levels of ADH, these tubular segments are permeable to (reabsorp more) water, but in the absence of ADH, they are virtually impermeable to water.
  • 29. MEDULLARY COLLECTING DUCT A. Reabsorb less than 10% of the filtered water and sodium. B. The final site for processing the urine C. Play an extremely important role in determining the final urine output of water and solutes. D. The epithelial cells of the collecting ducts are nearly cuboidal in shape with smooth surfaces and relatively few mitochondria.
  • 30. Special characteristics of this tubular segment are as follows: 1. The permeability of the medullary collecting duct to water is controlled by the level of ADH. 2. The medullary collecting duct is permeable to urea. 3. The medullary collecting duct is capable of secreting hydrogen ions against a large concentration gradient.
  • 31.
  • 32. PERITUBULAR CAPILLARY AND RENAL INTERSTITIAL FLUID PHYSICAL FORCES
  • 33. REGULATION OF TUBULAR REABSORPTION: 1- GLOMERULOTUBULAR BALANCE: • if the GFR increases from 125 ml/min to 150 ml/min, the absolute rate of proximal tubular reabsorption also increases from about 81 ml/min to about 97.5 ml/min. 2- HORMONAL CONTROL OF TUBULAR REABSORPTION: