The Excretion of Acid in Unilateral Renal Disease in Man*

Steinmetz, Philip R.; Eisinger, Robert P.; Lowenstein, Jerome

doi:10.1172/jci105171

Cited by 22 publications

(5 citation statements)

References 21 publications

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“…Since this study only included subjects with normal glomerular filtration rates, the effect of marked changes of this rate on acid excretion could not be adequately assessed. Others have shown that significant decrease of glomerular filtration rate is associated with diminution in the amount of net acid excreted in response to an acid load (Wrong & Davies, 1959;Gonick et al, 1969;VanSlyke et al, 1926;Steinmetz et al, 1965). This finding must be considered in the interpretation of acidification tests when the glomerular filtration rate is abnormal.…”

Section: Discussionmentioning

confidence: 99%

“…A variety of factors have been shown to affect one or both of these parameters. These include rate of urine flow (Woeber, Reid, Kiem & Hills, 1963;Tannen, 1969), status of body potassium stores (Tannen, 1970;Clarke, Evans, MacIntyre & Milne, 1955), posture (Steinmetz & Bank, 1963), age of subjects (Adler et al, 1968), glomerular filtration rate (Wrong & Davies, 1959;Gonick et al, 1969;VanSlyke, Linder, Hiller, Leiter & McIntosh, 1926;Steinmetz, Eisinger & Lowenstein, 1965), the quantity of acid ingested (Edelmann et al, 1967), and urine infection with urea-splitting bacteria (Mookerjee, Allen & Dossetor, 1968). Other factors that might influence the results of acidification tests are the preceding diet, the ingestion of food during the procedure, the size of the patient, the rate of buffer excretion, the time of day and the presence of systemic acidbase disturbances.…”

Section: Discussionmentioning

confidence: 99%

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The Response of Normal Subjects to the Short Ammonium Chloride Test: The Modifying Influence of Renal Ammonia Production

Tannen

1971

Clinical Science

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I. The response to the short ammonium chloride acidification procedure in seventeen normal young men was carefully defined by performing this test with rigid control.2. Wide variation in the response was observed, emphasizing the difficulty of interpretation of small changes when using this procedure.3. After ingestion of ammonium chloride, urine pH correlated positively with both net acid and ammonium excretion contrary to present concepts. It is suggested that the renal capacity to produce ammonia dictates the relation of urine pH to net acid and ammonium excretion, respectively. done under highly controlled conditions. Considering the variety of factors that might influence urine acidification, such information should be of value.During a series of studies designed to investigate some of the factors affecting urine acidification, I day ammonium chloride tests were performed on a number of normal men under rigidly controlled conditions. The normal response to the test was carefully defined and an unexpected relationship between urine pH, net acid and ammonium excretion was observed.A modified short ammonium chloride test was performed on eighteen occasions in seventeen men aged 19-31 years with normal renal function. All subjects were volunteers who gave informed consent. Six had malaria with apparent cure 1-2 months before the study. Two of them had a transient increase in blood urea nitrogen to approx. 35 mg/lOO ml with mild proteinuria during the acute malaria. One subject had idiopathic hypercalciuria without evidence of renal calculi. None of the remaining subjects had any significant illnesses. At the time of study every subject had a normal blood pressure, urinalysis and creatinine clearance and a negative urine culture.For 3 days before the test all subjects ingested a formula diet (Meade Johnson Low Electrolyte Food Powder 700(1) supplemented with sodium chloride and potassium chloride solutions which provided daily: 35 cal, 30 ml of water, 2 mmo1 of sodium and 0·75 mmol of potassium/kg body wt. This diet is deficient in magnesium and although a significant amount of magnesium depletion would not be expected in 3 days (Dunn & Walser, 1966;Fitzgerald & Fourman, 1956), mean serum magnesium concentration measured in eight subjects decreased from 0·75 to 0·66 mmol/l after 3 days of diet. In four studies the diet was supplemented with magnesium chloride (4 mmol/day). These subjects responded in the same way as those who did not receive a magnesium supplement. Therefore it is unlikely that the small change in magnesium influenced the study significantly.On the day of the test the subjects were awakened at 6.30 a.m. and from that time to the completion of the test they remained in the upright position and fasted except for the ingestion of water. A water load of 300-400 ml was ingested from 6.30 to 7.30 a.m. and approx. 100 mljh thereafter, in an attempt to maintain a urine flow rate between 1 and 3 ml/min, After the collection of two control hourly urine samples, NH 4Cl in gelatin capsules (2 mmol/kg) was sw...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Response of Normal Subjects to the Short Ammonium Chloride Test: The Modifying Influence of Renal Ammonia Production

Tannen

1971

Clinical Science

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“…The bladder was than short-circuited and a control rate of H+ secretion was determined with either K+ or Cae+ absent from the mucosal medium. (11)(12)(13)(14)(15). Although the cellular mechanisms of urinary acidification may well be different in the turtle bladder and the mammalian renal tubule, there are important similarities in the orientation of H+ and Na+ transport and in the maximal transcellular gradient of pH that can be reached in the two epithelia.…”

Section: Methodsmentioning

confidence: 99%

Independence of Hydrogen Ion Secretion and Transport of Other Electrolytes in Turtle Bladder*

Steinmetz¹,

Omachi²,

Frazier³

1967

J. Clin. Invest.

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Abstract. The relationship between hydrogen ion secretion and the transport of other electrloytes was examined in the isolated urinary bladder of the water turtle. Symmetrical solutions which were free from exogenous carbon dioxide and bicarbonate bathed the two surfaces of the preparation, and the spontaneous electrical potential of the bladder was nullified by a voltage clamp. Active transport of sodium from mucosal to serosal medium was confirmed by simultaneous bidirectional flux measurements and found to be slightly, but not significantly, greater than the short-circuit current. In the absence of sodium in the bathing solutions, the normal potential difference across the bladder reversed and the current required to nullify this reversed potential difference had the same magnitude as the simultaneously measured rate of hydrogen ion secretion. The results indicate that, under these experimental conditions, the bladder transports sodium and hydrogen ion actively, but that chloride movement does not contribute to the short-circuit current.The rate of secretion of hydrogen ion was not affected by replacement of the sodium in the bathing media by cesium, or by inhibition of sodium transport by dinitrophenol. Acidification continued when chloride in the solutions was replaced by sulfate, or when potassium or calcium was removed from the solution bathing the mucosal surface. Secretion of hydrogen ion by the turtle bladder is not dependent on the simultaneous transport of other electrolytes across the bladder.

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“…in the proximal tubule and the loop of Henle. A well-preserved function of the distal tubule is also compatible with the fact that the excretion of acid and the ability to establish an H+-gradient between the tubular cells and the tubular lumen is usually normal (17,46) in diseased nephrons, although there are exceptions (53). The finding of a lower potassium concentration in the urine after the injection of furosemide, however, suggests some functional derangement also in the distal portion of the nephron in the diseased kidneys.…”

Section: Discussionmentioning

confidence: 86%

The Effect of Furosemide on the Function of Normal and Diseased Kidneys in Patients With Unilateral Pyelonephritis

Ofstad

1971

Journal of Internal Medicine

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Abstract. In nine patients with unilateral pyelonephritis the renal function has been measured by the split function technique before and after the i.v. injection of furosemide. Before the injection the excretion fraction of sodium and chloride as well as the diuresis, the osmotic clearance and the free water clearance per unit of glomerular filtrate were greatest, and the urinary concentration of inulin was least, in the pyelonephritic kidneys. After the injection of furosemide these differences were no longer significant. When related to the osmotic clearance, the free water clearance was reduced in all kidneys after the injection. The findings are compatible with the presence of a functioning loop of Henle in most nephrons of the pyelonephritic kidneys.

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The Excretion of Acid in Unilateral Renal Disease in Man*

Cited by 22 publications

References 21 publications

The Response of Normal Subjects to the Short Ammonium Chloride Test: The Modifying Influence of Renal Ammonia Production

The Response of Normal Subjects to the Short Ammonium Chloride Test: The Modifying Influence of Renal Ammonia Production

Independence of Hydrogen Ion Secretion and Transport of Other Electrolytes in Turtle Bladder*

The Effect of Furosemide on the Function of Normal and Diseased Kidneys in Patients With Unilateral Pyelonephritis

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