Madin-Darby canine kidney cells resemble the intercalated cells of the renal collecting duct. In these cultured epithelial cells, aldosterone activates apical Na+/H+ exchange, initiating a cascade of intracellular events like cell growth, epithelial cell polarity and stimulation of transepithelial ion transport. H+ secretion is driven by secondary active Na+/H+exchange and the primary active H+/K+ pump, both located in the apical cell membrane and stimulated by aldosterone. Steroid-dependent HCO–3 secretion is mediated by secondary active Cl-/HCO-3 exchange and selective HCO-3 channels. Transepithelial K+ secretion is triggered by the insertion of new ion channels and the activation of previously quiescent channels with increasing cytoplasmic pH. The driving force for transepithelial Na+ reabsorption and K+ secretion is derived from the primary active basolateral Na+/K+ pump activated by intracellular alkalinization and high intracellular Na+ concentration. Aldosterone supplies its target cell with a variety of specific ion transporters necessary for adequate function of the renal collecting duct when the organism is metabolically challenged.