Tubular secretion

Tubular secretion is the transfer of substances from the peritubular capillaries into the renal tubule for excretion in urine. This process is particularly important for the regulation of potassium and hydrogen ions in the body it is also responsible for removal of many organic compounds from the body. These may include metabolic wastes as well as foreign compounds, including drugs such as penicillin. Most substances are secreted by secondary active transport. 

Potassium ion secretion. Potassium ions are secreted in the distal tubule and the collecting duct. These ions diffuse down their concentration gradient from the peritubular capillaries into the interstitial fluid. They are then actively transported up their concentration gradient into the tubular epithelial cells by way of the Na+, K+ pump in the basolateral membrane. Finally, potassium ions exit the epithelial cells by passive diffusion through K+ channels in the luminal membrane and enter tubular fluid to be excreted in the urine. 

Potassium secretion is enhanced by aldosterone. As the concentration of K+ ions in the extracellular fluid increases, the secretion of aldosterone from the adrenal cortex also increases. The mechanism of action of aldosterone involves an increase in the activity of the Na+, K+ pump in the basolateral membrane. Furthermore, aldosterone enhances formation of K+ channels in the luminal membrane. 

Hydrogen ion secretion. Hydrogen ions are secreted in the proximal tubule, distal tubule, and collecting duct. The secretion of hydrogen ions is an important mechanism in acid-base balance. The normal pH of the arterial blood is 7.4. When the plasma becomes acidic, H+ ion secretion increases and when it becomes alkalotic, H+-ion secretion is reduced. 

The question of whether polymers pass between the cells of the epithelia or only through them by vesicle transport is also relevant in the discussion of polymer passage into the intestine lumen and into the bile. Both routes are often assumed in the literature as ways in which polymers can leave the body. 

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The process of reabsorption depends on the HpophiHc—hydrophiHc balance of the molecule. Charged and ioni2ed molecules are reabsorbed slowly or not at all. Reabsorption of acidic and basic metaboHtes is pH-dependent, an important property in detoxification processes in dmg poisoning. Both passive and active carrier-mediated mechanisms contribute to tubular dmg reabsorption. The process of active tubular secretion handles a number of organic anions and cations, including uric acid, histamine, and choline. Dmg metaboHtes such as glucuronides and organic acids such as penicillin are handled by this process. 

In subsequent studies attempting to find a correlation of physicochemical properties and antimicrobial activity, other parameters have been employed, such as Hammett O values, electronic distribution calculated by molecular orbital methods, spectral characteristics, and hydrophobicity constants. No new insight on the role of physiochemical properties of the sulfonamides has resulted. Acid dissociation appears to play a predominant role, since it affects aqueous solubiUty, partition coefficient and transport across membranes, protein binding, tubular secretion, and reabsorption in the kidneys. An exhaustive discussion of these studies has been provided (10). 

Several hydrophilic, anionic technetium complexes can be used to perform imaging studies of the kidneys. Tc-Mertiatide (Fig. 5a) is rapidly excreted by active tubular secretion, the rate of which is a measure of kidney function. Tc-succimer (Fig. 5b), on the other hand, accumulates in kidney tissue thus providing an image of kidney morphology. 

Technetium-99m mertiatide (A/-[Ai-[A/-[(benzoylthio)acetyl]glycyl]glycine) is a renal imaging agent. It is excreted by the kidneys via active tubular secretion and glomerular filtration. The kit vial is reconstituted by using 740—3700 MBq (20—100 mCi) of Tc pertechnetate and boiling for 10 minutes. 

The co-administration of drugs which inhibit the transporters involved in renal tubular secretion can reduce the urinaty excretion of drugs which are substrates of the transporter, leading to elevated plasma concentrations of the drugs. For example, probenecid increases the plasma concentration and the duration of effect of penicillin by inhibiting its renal tubular secretion. It also elevates the plasma concentration of methotrexate by the same mechanism, provoking its toxic effects. 

Urinary tract Early ionic urographic agents including iodamide Uromiro Tubular secretion Difazio LT et al (1978) Pharmacokinetics of iodamide in normal subjects and in patients with renal impairment. J Clin Pharmacol 18 35-41... 

Impairs proximal tubular secretion of creatinine ° Cimetidine, pyrimethamine, and trimethoprim... 

CF patients have larger volumes of distribution of many antibiotics due to an increased ratio of lean body mass to total body mass and lower fat stores. CF patients also have an enhanced total body clearance, although the exact mechanism has not been determined. Increased renal clearance, increased glomerular filtration rate, decreased protein binding, increased tubular secretion, decreased tubular reabsorption, extrarenal elimination, and increased metabolism have all been proposed as possible reasons for the increased clearance. 

Potassium balance is also primarily regulated by the kidney via the distal tubular cells. Reduction in nephron mass decreases tubular secretion of potassium, leading to hyperkalemia. Hyperkalemia is estimated to affect more than 50% of patients with stage 5 CKD.28... 

As nephron mass decreases, both the distal tubular secretion and GI excretion are increased because of aldosterone stimulation. Functioning nephrons increase FEK up to 100% and GI excretion increases as much as 30% to 70% in CKD,30 as a result of aldosterone secretion in response to increased potassium levels.30 This maintains serum potassium concentrations within the normal range through stages 1 to 4 CKD. Hyperkalemia begins to develop when GFR falls below 20% of normal, when nephron mass and renal potassium secretion is so low that the capacity of the GI tract to excrete potassium has been exceeded.30... 

While carboplatin has the same mechanism of action as cisplatin, it has a much less toxic side-effect profile than cisplatin. The pharmacokinetics of carboplatin are best described by a two-compartment model, with an a half-life of 90 minutes and a terminal half-life of 180 minutes. Carboplatin is eliminated almost entirely by the kidney by glomerular filtration and tubular secretion. Many chemotherapy regimens dose carboplatin based on an area under the curve (AUC), which is referred to... 

The glomerular filtration rate (GFR) in normal males is estimated to be 125mL/min, and the results of the example calculation suggest that the drug is cleared by GFR. If the RCR had been less than 125 mL/min, tubular reabsorption of the drug would have been suspected. If it had been greater than 125 mL/min, tubular secretion would have been involved in the drug elimination. 

The renal excretion of drugs depends on glomerular filtration, tubular secretion, and tubular absorption. A twofold increase in glomerular filtration occurs in the first 14 days of life [36], The glomerular filtration rate continues to increase rapidly in the neonatal period and reaches a rate of about 86 mL/min per 1.73 m2 by 3 months of age. Children 3-13 years of age have an average clearance of 134 mL/min per 1.73 m2 [37]. Tubular secretion approaches adult values between 2 and 6 months [11], There is more variability observed in maturation of tubular reabsorption capacity. This is likely linked to fluctuations in urinary pH in the neonatal period [38],... 

Abbreviations GER. gastric-emptying rate Vj, volume of distribution /, 2r half-life GFR, glomerular filtration rate ARTS active renal tubular secretion. 

The answer is c. (Hardman7 p 906. Katzung, p 1127) Cimetidine inhibits proximal tubular secretion of procainamide, resulting in increased plasma concentrations of procainamide and its active metabolite, N-acetylprocainamide. 

The rate of total body clearance accounted for by the kidney. Its magnitude is determined by the net effects of glomerular filtration, tubular secretion and reabsorption, renal blood flow, and protein binding. 

NRC 1993 Vieira et al. 1996). Whether differences in xenobiotic metabolism make the child more or less suseeptible also depends on whether the relevant enzymes are involved in activation of the parent compound to its toxic form or in detoxification. There may also be differences in excretion, particularly in the newborn who has a low glomerular filtration rate and has not developed efficient tubular secretion and resorption capacities (Altman and Dittmer 1974 NRC 1993 West et al. 1948). Children and adults may differ in their capacity to repair damage Irom chemical insults. Children also have a longer lifetime in which to express damage Irom chemicals this potential is particularly relevant to cancer. 

The value for unbound renal clearance of 6 mL min kg is in excess of GFR in the dog ( 4 mL min kg ) indicating a degree of tubular secretion in the renal clearance of these basic molecules (pKa values of 7.8-8.2). The unbound renal clearance of compound 4 is about 1.5 mL min kg and indicates substantial tubular reabsorption of this, the most lipophilic member of the series. This compound is also substantially less basic than the others (ipK of 7.3) and as such may be subject to reduced tubular secretion. 

As a clearance route the renal route has attractive features for the design of drugs. For instance clearance rates, certainly for neutral compounds, are low. Moreover, the clearance process by filtration is not saturable and tubular secretion is only saturated at high doses with acidic and basic compounds. In a similar vein drug interactions... 

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