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MECHANISM OF RENAL TRANSPORT OF SODIUM & GLUCOSE

MECHANISM OF RENAL TRANSPORT OF SODIUM & GLUCOSE

1. RENAL SODIUM TRANSPORT:

Occurs in all regions except thin descending tubule.

– Via, Active reabsorption – In all regions.

– Passive resorption – Only in thin ascending tubule

RENAL PART	MECHANISM BEHIND SODIUM TRANSPORT
Proximal Convoluted Tubule (PCT)	Na²⁺reabsorption driven by Na²⁺-K⁺ATPase located on basolateral membrane. – 60-70% filtered Na²⁺ reabsorbed. Na²⁺entry coupled to H⁺secretion via NHE3 antiporter.
Proximal Straight Tubule (PST)	Cl^– driven Na²⁺ transport (Paracellular pathway)
Descending Thin Limb (DTL)	Highly permeable to water & relatively permeable to solutes like sodium, chloride & urea. Hence, no sodium resorption.
Thick Ascending Limb (TAL)	30% filtered Na²⁺ reabsorbed (60% reabsorbed in proximal tubule). Major transporter: Na²⁺– K⁺-2Cl^– symporter/co-transporter (NKCC). Transports one Na²⁺& K⁺ & 2 Cl^– ions.
Distal Convoluted Tubule (DCT)	Apical membrane contains Na⁺– Cl^– symporter/Co-transporter (NCC). Approx. 7% Na²⁺ reabsorbed.
Collecting Tubule (CT)	Via apical sodium channels (ENaC)-P cell. Aldosterone -Important for Na²⁺& water resorption.

Factors affecting renal sodium transport:

Increasing sodium resorption:

Angiotensin II

Renin increase

Aldosterone

Decreasing sodium resorption:

Atrial Natriuretic Peptide (ANP)

Brain Natriuretic Peptide (BNP)

Dopamine

2. RENAL GLUCOSE TRANSPORT:

Glucose is reabsorbed by secondary active transport.

Complete reabsorption in proximal tubule.

Via sodium-glucose cotransporter – 2 (SGLT 2) in brush border(luminal membrane)

Factors influencing resorption:

1. Transport maximum for glucose (TmG)-

i.e. Maximum rate of glucose absorption by tubule

– 375 mg/min in males

– 300 mg/min in females

2. Actual value of renal threshold – (much less than TmG)

Arterial blood – 200mg/dl.

– Is “Glucose Threshold value” in blood to activate urinary excretion

– Urinary glucose is mildly positive.

In venous blood – 180mg/dl.

SPLAY EFFECT:

Deviation in renal threshold (from calculated predicted value)

– Due to nephron heterogeneity.

– Not all nephrons have TmG of 375 mg/min

Once T_m for kidneys (375 mg/min) is reached, all nephrons reached maximal capacity to reabsorb glucose.

– Further, not all nephrons are maximally active simultaneously.

Exam Important

MECHANISM OF RENAL TRANSPORT OF SODIUM & GLUCOSE

1. RENAL SODIUM TRANSPORT:

RENAL PART

MECHANISM BEHIND SODIUM TRANSPORT

Proximal Convoluted Tubule (PCT)

Driven by Na²⁺-K⁺ATPase located on basolateral membrane

– 60-70% filtered Na²⁺reabsorbed.

Na²⁺entry coupled to H⁺secretion, via NHE3 antiporter.

Descending Thin Limb (DTL)

Highly permeable to water & relatively permeable to solutes like sodium, chloride & urea.

Hence, no sodium resorption.

Thick Ascending Limb (TAL)

30% filtered Na²⁺reabsorbed.

Via Na²⁺– K⁺-2Cl^– symporter/co-transporter (NKCC).

Transports one Na²⁺& K⁺ & 2 Cl^– ions.

Distal Convoluted Tubule (DCT)

Apical membrane contains Na⁺– Cl^– symporter/Co-transporter (NCC).

Approx. 7% filtered Na²⁺ reabsorbed.

Collecting Tubule (CT)

Via apical sodium channels (ENaC)-P cell.

Aldosterone – Important for Na²⁺ & water resorption.

2. RENAL GLUCOSE TRANSPORT:

Glucose reabsorption by 2º active transport.

Complete reabsorption in proximal tubules.

Occurs by sodium-glucose cotransporter – 2 (SGLT-2) in brush border(luminal membrane)

Factors influencing resorption:

1. Transport maximum for glucose (TmG)-

375 mg/min in males

300 mg/min in females

2. Actual value of renal threshold.

In arterial blood – 200mg/dl.

“Glucose threshold value” in blood to activate urinary excretion.

When glucose filtered load – 250mg/min → urinary glucose is mildly positive.

SPLAY EFFECT:

Deviation in renal threshold from calculated predicted value

Overall T_m for kidneys (375 mg/min) is reached, all nephrons reached their maximal capacity for glucose reabsorption.

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MECHANISM OF RENAL TRANSPORT OF SODIUM & GLUCOSE