Floyd C. Rector

The mechanisms of sodium absorption in the human small intestine

The present studies were designed to characterize sodium transport in the jejunum and ileum of humans with respect to the effects of water flow, sodium concentration, addition of glucose and galactose, and variations in aniomic composition of luminal fluid. In the ileum, sodium absorption occurred against very steep electrochemical gradients (110 mEq/liter, 5-15 mv), was unaffected by the rate or direction of water flow, and was not stimulated by addition of glucose, galactose, or bicarbonate. These findings led to the conclusion that there is an efficiently active sodium transport across a membrane that is relatively impermeable to sodium. In contrast, jejunal sodium (chloride) absorption can take place against only the modest concentration gradient of 13 mEq/liter, was dramatically influenced by water movement, and was stimulated by addition of glucose, galactose, and bicarbonate. The stimulatory effect of glucose and galactose was evident even when net water movement was inhibited to zero by mannitol. These observations led to the conclusion that a small fraction of jejunal sodium absorption was mediated by active transport coupled either to active absorption of bicarbonate or active secretion of hydrogen ions. The major part of sodium absorption, i.e. sodium chloride absorption, appeared to be mediated by a process of bulk flow of solution along osmotic pressure gradients. The stimulatory effect of glucose and galactose, even at zero water flow, was explained by a model in which the active transport of monosaccharide generates a local osmotic force for the absorption of solution (NaCl and water) from the jejunal lumen, which, in the presence of mannitol, is counterbalanced by a reverse flow of pure solvent (H(2)O) through a parallel set of channels which are impermeable to sodium. Support for the model was obtained by the demonstration that glucose and bicarbonate stimulated the absorption of the nonactively transported solute urea even when net water flow was maintained at zero by addition of mannitol to luminal contents.

The Mechanism of Bicarbonate Reabsorption in the Proximal and Distal Tubules of the Kidney

The mechanism of HCO3- reabsorption in proximal and distal tubules was examined in rats undergoing NaHCO3 diuresis. The steady-state intratubular pH was measured with pH-sensitive glass microelectrodes and compared with the equilibrium pH calculated from the HCO3- concentration of the tubular fluid (measured with quinhydrone electrodes) and plasma Pco2. In the proximal tubule the intratubular pH and the equilibrium pH were identical, indicating no accumulation of excess H2CO3. After inhibition of carbonic anhydrase, however, intratubular pH was significantly lower (0.85 pH U) than the equilibrium pH. It was concluded that HCO3- reabsorption in the proximal tubule was mediated by H+ secretion, but that carbonic anhydrase located in the luminal membrane of the cell prevented H2CO3 from accumulating in the tubular fluid. In the distal tubule the intratubular pH was 0.85 U lower than the equilibrium pH. This difference could be obliterated by an intravenous injection of carbonic anhydrase. It was concluded that HCO3- reabsorption in this segment was also accomplished by H+ secretion. The accumulation of excess H2CO3 in the tubular fluid indicated that, in contrast to the proximal tubule, carbonic anhydrase was not located in the luminal membrane of distal tubular cells.

The Site of Action of Furosemide and Other Sulfonamide Diuretics in the Dog

The discovery of the countercurrent multiplier system as the mechanism responsible for the concentration and dilution of the urine has provided a framework for the identification of the site of action of diuretic drugs. Agents that act at a single anatomic site in the nephron can be expected to alter the pattern of urine flow in a predictable way. A drug that acts solely in the proximal convoluted tubule, by causing the delivery of increased amounts of filtrate to the loop of Henle and the distal convolution, would augment the clearance of solute-free water (CH2o) during water diuresis and the reabsorption of solute-free water (TCHO) during water restriction. In contrast, drugs that inhibit sodium reabsorption in Henles loop would impair both CHSo and TCHO. Finally, drugs that act only in the distal tubule would reduce CHSo but not TcH2o (1). It is possible, however, that a diuretic drug might inhibit sodium reabsorption at multiple sites. Under such circumstances, localization of the areas of the nephron where the drug acts is far more difficult, since the effects of action in one segment might alter or obscure the effects on another. A new sulfonamide diuretic, furosemide, 4-chloro-N-(2-furylmethyl)-5-sulfonylanthranilic acid (2), offers several advantages in the study of localization of action: a) it is extremely potent, and therefore produces large effects; and b) its duration of action is brief, thereby facilitating multiple studies during a single experiment. A study * of furosemide was, therefore, undertaken to ex plore its effects on water excretion during hy-dration and hydropenia, and on potassium excre-tion during potassium loading. In addition, the diuretic effect of furosemide was compared to three other sulfonamide diuretics: chlorothiazide, chlor-thalidone, and benzhydroflumethiazide. The conventional sulfonamide diuretics resulted in the excretion of about 10% of filtered sodium and inhibited CQ2o without decreasing TCH2O. In contrast, as much as 38% of filtered sodium was excreted during furosemide diuresis, and both CH20 and TCHSo were inhibited. None of the diu-retics had an inhibitory effect on potassium secretion. The effects of the conventional sulfonamide diuretics can be explained by a single site of action distal to the loop of Henle. In contrast, furose-mide clearly has a potent effect in the ascending limb of Henles loop and probably in the proximal convoluted tubule as well. Methods A total of 50 experiments was performed on 40 dogs. All dogs were fasted overnight before each study. Mild pentothal anesthesia was induced …

Mechanism of bicarbonate absorption and its relationship to sodium transport in the human jejunum

Using a constant perfusion technique, sodium and bicarbonate absorption was studied in human subjects. The following observations were made on sodium absorption from saline solution: (a) the rate of sodium absorption is markedly influenced by bulk water flow, (b) when net water flow is zero, sodium absorption is zero if there are no concentration gradients between plasma and lumen that favor net NaCl diffusion; and (c) the PD between abraded skin and jejunal lumen is near zero when saline is perfused and does not change with partial substitution of sulfate or bicarbonate for chloride. Based on these observations, we conclude that sodium absorption from saline is entirely passive in the human jejunum. On the other hand, in the presence of bicarbonate sodium is absorbed actively against electrochemical gradients. The mechanism of the link between bicarbonate and sodium absorption was studied in normal subjects and in 11 patients with pernicious anemia; the latter were chosen because they do not secrete gastric acid which can react with bicarbonate in the jejunal lumen. We observed that bicarbonate absorption (a) occurs against steep electrochemical gradients, (b) does not generate a potential difference between abraded skin and jejunal lumen, (c) is inhibited by acetazolamide, and (d) generates a high CO2 tension in jejunal fluid. These observations suggest that bicarbonate absorption is mediated by active hydrogen secretion, rather than by bicarbonate ion transport per se, and that the link between sodium and bicarbonate transport is best explained by a sodium-hydrogen exchange process.

Angiotensin II in arterial and renal venous plasma and renal lymph in the dog.

Angiotensin II was determined by radioimmunoassay in systemic arterial, pulmonary arterial, and renal venous plasma and in renal hilar lymph in dogs. Levels of the peptide were determined prior to and during progressive graded hemorrhage or reduction in renal perfusion pressure. Levels of angiotensin II in plasma consistently rose during transit through the lung indicating pulmonary conversion of angiotensin I to angiotensin II. On the other hand, angiotensin II in the renal vein plasma was less than that in arterial plasma indicating renal extraction of the peptide from plasma. When renal hilar lymph was sampled under similar conditions, angiotensin II in lymph was consistently higher than that in arterial or renal venous plasma. Furthermore, in some experiments angiotensin II in lymph increased at a time when the concentration in plasma was undetectable. No evidence was found to indicate that angiotensin II in plasma entered renal lymph. It was concluded that angiotensin II levels in lymph reflected the concentration of angiotensin II in renal tissue. The data further suggested that angiotensin II is partially removed from arterial plasma by hydrolysis during transit through the kidney.

Influence of Expansion of Extracellular Volume on Tubular Reabsorption of Sodium Independent of Changes in Glomerular Filtration Rate and Aldosterone Activity

The excretion of sodium by the kidney is influenced by changes in glomerular filtration rate (GFR), serum sodium concentration, adrenocortical activity, the quantity of nonreabsorbable solutes in the glomerular filtrate, and the volume of extracellular fluid (ECF) (1-4). Some of these factors alter sodium excretion by affecting the amount of sodium filtered; others modulate the tubular reabsorption of sodium. The mechanism whereby acute changes in the volume of ECF influence sodium excretion is not entirely clear. At least two factors, however, have been identified. Both the secretory rate of aldosterone and the GFR are influenced by alteration in the volume of ECF and may play important roles in the regulation of sodium excretion by volume. Alteration of sodium excretion by patients with Addisons disease in a parallel fashion with sodium intake and without detectable changes in GFR (5, 6) suggests that a third factor may be operative. Furthermore, a number of investigators (7-9) have shown that, under conditions where the volume of ECF was acutely altered in the face of fixed adrenocortical activity, sodium excretion varied independently of GFR, suggesting that changes in volume were in some manner influencing the tubular reabsorption of sodium independent of adrenocortical hormones.

The Mechanism of Suppression of Proximal Tubular Reabsorption by Saline Infusions

The mechanism by which expansion of extracellular fluid volume with isotonic saline suppresses reabsorption in the proximal tubule was studied in rats by examining the relations among glomerular filtration rate (GFR), absolute and fractional reabsorption of filtrate, intrinsic reabsorptive capacity (rate of reabsorption per unit tubular volume), transit time, and tubular volume. Saline infusions reduced the per cent of the glomerular filtrate reabsorbed in the proximal tubule from 50% during antidiuresis to 25% during saline diuresis. The suppression of proximal reabsorption was the result of two factors: 1) a 30% reduction of intrinsic reabsorptive capacity, and 2) a 26% reduction of tubular volume per unit GFR.GFR invariably rose during saline diuresis. However, prevention of the rise in GFR by aortic clamping had no effect on either the inhibition of intrinsic reabsorptive capacity or the reduction in tubular volume per unit GFR produced by saline infusions. Expansion of extracellular fluid volume with isotonic saline, therefore, depressed intrinsic reabsorptive capacity and tubular volume per unit GFR by some mechanism completely independent of GFR. The effects of furosemide administration were contrasted with those of saline infusions. Furosemide inhibited intrinsic reabsorptive capacity by 40% but had no significant effect on proximal fractional reabsorption. The failure to suppress fractional reabsorption was the consequence of a disproportionate rise in tubular volume (relative to GFR) that was sufficient to completely overcome the inhibition of intrinsic reabsorptive capacity. Inhibition of intrinsic reabsorptive capacity alone, therefore, will not result in a net suppression of reabsorption of filtrate in the proximal tubule. We concluded that, although intrinsic reabsorptive capacity was inhibited during saline diuresis, the critical factor responsible for translating this inhibition into effective net suppression of proximal reabsorption was the observed reduction in tubular volume per unit GFR.

Measurement of Intracellular pH of Skeletal Muscle with pH-sensitive Glass Microelectrodes*

We used three methods to examine the relationship among intracellular pH, transmembrane potential, and extracellular pH. Single-barreled electrodes permitted the determination of resting potential and intracellular pH with a minimum of cellular injury. Double-barreled electrodes, which incorporated a reference as well as a pH-sensitive electrode in a single tip, facilitated the direct measurement of intracellular pH without the interposition of the transmembrane potential. Triple-barreled electrodes permitted measurement of intracellular pH during the controlled hyperpolarization or depolarization of the cell membrane. The results of all three methods were in close agreement and disclosed that the H(+) activity of intracellular and extracellular fluid is in electrochemical equilibrium at any given transmembrane potential. This implies that the determinants of intracellular pH are the transmembrane potential and the blood pH. The actual pH of the normal resting muscle cell is 5.99, as estimated from the normal transmembrane potential and blood pH, or as determined by direct measurements of intracellular pH.

Functional Characteristics of the Diluting Segment of the Dog Nephron and the Effect of Extracellular Volume Expansion on its Reabsorptive Capacity

The functional characteristics of the ascending limb of Henles loop were examined during hypotonic saline infusion by measuring solutefree water clearance (C(H2O)) at varying rates of solute delivery. The influence of expansion of extracellular volume was studied by comparing C(H2O) during hypotonic saline diuresis in normal dogs with dogs whose extracellular volume had been expanded acutely by saline infusions or chronically by the administration of deoxycorticosterone acetate and salt. In normal animals hypotonic saline infusions greatly increased urine flow (V) and C(H2O) without appreciably augmenting osmolar clearance (C(osm)). C(H2O) was, therefore, analyzed as a function of V, rather than C(osm), since V was the best estimate of delivery of filtrate to the diluting segment. C(H2O) increased as a linear function of V without any evidence of saturation.The validity of interpreting increases in C(H2O) and V as indications of increased sodium reabsorption and delivery was reinforced by tissue studies that disclosed a rise in papillary osmolality with rising urine flows. The observed increase in C(H2O) and V could not, therefore, be due to a decrease in back diffusion of solute-free water as a result of a diminished osmotic driving force, but probably represented increased formation consequent to augmented delivery as a result of decreased fractional reabsorption in the proximal tubule. In animals whose extracellular volume was acutely or chronically overexpanded before the infusion of hypotonic saline, sodium excretion was greater, and C(H2O) less, at any given V. Although the curve relating C(H2O) to V was flatter than in the control group, no tubular maximum was observed. The diminished C(H2O) in this group was interpreted to mean that massive expansion of extracellular volume inhibits sodium reabsorption in the ascending limb of Henles loop.

Demonstration of a hormonal inhibitor of proximal tubular reabsorption during expansion of extracellular volume with isotonic saline

Evidence for the elaboration of a hormonal inhibitor of renal tubular reabsorption in response to expansion of extracellular fluid volume was obtained by examining the effects of plasma from rats and dogs undergoing saline diuresis on the rate of proximal tubular reabsorption measured both directly by micropuncture techniques and indirectly by clearance techniques. Intravenous infusion of plasma from salineloaded rats and dogs, but not plasma from control animals, inhibited the intrinsic reabsorptive capacity of the proximal tubule (as estimated from the shrinking-drop technique) by 35%, and reduced fractional reabsorption (as estimated from the tubular fluid-to-plasma ratio) by 20%. In addition the natriuretic plasma increased urine flow, solute-free water clearance, and potassium excretion in rats with hereditary diabetes insipidus, indicating an increase in the delivery of filtrate out of the proximal tubule to the more distal diluting segments of the nephron. The hormonal inhibition of proximal tubular reabsorption had an extremely rapid onset of action (within seconds after instillation into the tubular lumen) and a short duration of action (less than 30 min after cessation of an intravenous infusion). Inhibitory activity was lost from natriuretic plasma upon dialysis and could be recovered in the dialysate. Dialysates of natriuretic plasma, when injected directly into the tubular lumen, also inhibited proximal reabsorption, indicating an action on the luminal side of the cell.