Kidneys secretory functions

Renal elimination of foreign compounds may change dramatically with increasing age by factors such as reduced renal blood flow, reduced glomerular filtration rate, reduced tubular secretory activity, and a reduction in the number of functional nephrons. It has been estimated that in humans, beginning at age 20 years, renal function declines by about 10% for each decade of life. This decline in renal excretion is particularly important for drugs such as penicillin and digoxin, which are eliminated primarily by the kidney. 

The thin (8 nm) outer cell membrane or "plasma-lemma" (Fig. 1-7) controls the flow of materials into and out of cells, conducts impulses in nerve cells and along muscle fibrils, and participates in chemical communication with other cells. Deep infoldings of the outer membrane sometimes nm into the cytoplasm. An example, is the "T system" of tubules which functions in excitation of muscle contraction (Figs. 19-7, 19-21). Surfaces of cells designated to secrete materials or to absorb substances from the surrounding fluid, such as the cells lining kidney tubules and pancreatic secretory cells, are often covered with very fine projections or microvilli which greatly increase the surface area. 

Excretion The primary route of excretion is through the organic acid (tubular) secretory system of the kidney (see p. 224), as well as by glomerular filtration. Patients with impaired renal function must have dosage regimens adjusted. Thus the Xyz of penicillin G can increase from a normal of 1/2 -1 hour to 10 hours in individuals with renal failure. Probenecid inhibits the secretion of penicillins. Nafcillin is primarily eliminated through the biliary route. [Note This is also the preferential route for the acylureido penicillins in cases of renal failure.]... 

Small molecule modulators of CFTR function may be useful in the treatment of cystic fibrosis, secretory diarrhea and polycystic kidney disease. The most common mutation in the CFTR gene, F508 deletion (AF508), causes retention of F508-CFTR in the endoplasmic reticulum and... 

Evaluation of secretory activity. The secretory activity of the renal tubules can be measured by determining the excretion of marker compounds (e.g., PAH) or dyes (e.g., Phenosulfophthalein). This approach is not often used in clinical evaluation of kidney function. 

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