• The kidneys play an important role in regulating the body's acid-base status

◦ HCO3− reabsorption
▪ this is the major extracellular buffer and is thus why it is importan
▪ ~99.9% of filtered HCO3− is reabsorbed
▪ the proximal convoluted tubule is the site where most o
▪ Na+H+ exchanger secretes H+ into the tubular lumen and combine
▪ H2CO3 is converted into CO2 and H2O with the aid of brush
▪ CO2 and H2O enters the proximal tubular cell to be con
▪ H2CO3 becomed HCO3− and H+
▪ H+ gets secreted by the Na+-H+ exchanger to
▪ there is no net secretion of H+ since it is
▪ angiotensin II stimulates the Na+-H+ exc
▪ this explains contraction alkalosis
▪ HCO3− gets transported into the blood via
▪ Na+-HCO3− cotransport
▪ Cl−-HCO3− exchanger
▪ excess of HCO3− exceeds HCO3− reabsorption capacity and
▪ arterial CO2 and renal compensation
▪ not completely understood
▪ respiratory acidosis
▪ increased CO2 exposed to renal cells generates m
▪ this increases HCO3− reabsorption
▪ respiratory alkalosis
▪ decreased CO2 exposed to renal cells decrease H
▪ this decreases HCO3− reabsorption
◦ H+ excretion
▪ H+ excretion is accompanied by new HCO3− synthesis and reabs
▪ there are two mechanisms involved
▪ excretion of titratable acid (e.g., urinary buffers such as inorg
▪ this is accomplished by H+ATPase (which can be stimu
distal convoluted tubule and collecting ducts
▪ H+ binds to HPO4-2 to form H2PO4− (the titratable
▪ every titratable acid that excreted results in th
▪ excretion of NH4+
▪ proximal convoluted tubule
▪ NH4+ is secreted via the Na+-H+ exchanger
▪ glutamine is metabolized into glutamate and
▪ NH3 is lipid soluble and diffuses from the tub
▪ Na+-H+ exchanger secretes H+ which wi
▪ this is diffusion trapping
▪ collecting duct
▪ H+-ATPase and H+-K+ ATPase on α-intercalated c
▪ this is diffusion trapping
Acid-Base Disorders
• Acidosis results in acidemia due to an increased serum H+ (decreased pH)
• Alkalosis results in alkalemia due to a decreased serum H+ (increased pH)
• These acid base disorders may be due to primary disturbances in HCO3− (m
◦ the Hendersen-Hasselbalch equation shows that changes in HCO3− or
▪ pH = pKa + log ([HCO3-]/(0.03 * PCO2)
• Metabolic acidosis
◦ due to a decrease in HCO3−
▪ either because of increased H+ or loss of HCO3−
• Metabolic alkalosis
◦ due to an increase in HCO3−
• Respiratory acidosis
◦ due to an increase in CO2
▪ secondary to hypoventilation (which retains CO2)
• Respiratory alkalosis
◦ due to a decrease in CO2
▪ secondary to hyperventilation
• Winter's formula
◦ determines expected respiratory compensation in response to metabo
◦ PCO2 = 1.5 (HCO3-) + 8 +/- 2
▪ if actual PCO2 is greater than expected PCO2 → also has a primar
▪ if actual PCO2 is less than expected PCO2 → also has a primary re