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Related Concept Videos

Tubular Reabsorption and Secretion01:28

Tubular Reabsorption and Secretion

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Tubular secretion and reabsorption are two critical processes in the nephron tubule of the kidneys. When the fluid filtered from the glomerulus enters the proximal convoluted tubule, it is referred to as filtrate, and its composition changes due to tubular reabsorption and secretion.
Tubular reabsorption is a selective process that starts when the filtrate enters the proximal tubules. It involves substances traveling through the transcellular route (through the tubule cell and peritubular...
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Active tubular secretion is a robust, energy-demanding process that utilizes carrier systems to transport drugs into renal tubules. The active renal secretion systems include the organic anion transporter (OAT) for weak acids and the organic cation transporter (OCT) for weak bases. Structurally similar drugs can compete for the same transporter, potentially leading to drug accumulation and toxicity. However, this principle can be exploited therapeutically. One example is probenecid (Probalan),...
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Physiology of the Genitourinary System II: Tubular Reabsorption and Secretion01:22

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The kidneys maintain homeostasis through filtration, reabsorption, and secretion. Tubular reabsorption and secretion are crucial in forming urine and regulating electrolytes, water balance, and waste elimination.Tubular Reabsorption and Secretion ProcessesTubular reabsorption is the process that reclaims essential substances such as electrolytes, glucose, amino acids, and water from the glomerular filtrate back into the bloodstream. This is achieved through passive and active transport...
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Drug Elimination by Renal Route: Tubular Secretion01:15

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Once the process of glomerular filtration is completed, blood carrying unfiltered drug molecules traverses through efferent arterioles and makes its way into the peritubular capillaries in the proximal tubule. A variety of carriers play a pivotal role in actively secreting drugs from these peritubular capillaries into the tubular fluid. The organic anion transporter transfers acidic drugs, against an electrochemical gradient, from the peritubular capillaries into the renal tubule cells and...
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Chronic Kidney Disease I: Introduction01:25

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Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage renal disease. At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate for...
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Nephrons01:10

Nephrons

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The kidneys are intricate organs with millions of working units known as nephrons. Each nephron features two major structures: the renal corpuscle, which facilitates blood plasma filtration, and the renal tubule, which handles the glomerular filtrate. Blood supply is directly linked to the nephrons. The renal corpuscle consists of the glomerulus, a capillary network, and the Bowman's capsule, a double-walled epithelial structure that encases the glomerulus. The filtering of blood plasma...
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Identification of the Source of Secreted Proteins in the Kidney by Brefeldin A Injection
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Tubular Secretion in CKD.

Astrid M Suchy-Dicey1, Thomas Laha2, Andrew Hoofnagle2

  • 1Departments of Epidemiology and Kidney Research Institute, School of Medicine, astridsd@uw.edu.

Journal of the American Society of Nephrology : JASN
|November 29, 2015
PubMed
Summary
This summary is machine-generated.

Measuring kidney tubular secretion, a key function often overlooked, may predict patient mortality. This study assessed secreted solute clearance in 298 kidney disease patients, finding low clearance linked to increased death risk.

Keywords:
chronic kidney diseaseepidemiology and outcomesproximal tubule

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Area of Science:

  • Nephrology
  • Renal Physiology
  • Biomarker Discovery

Background:

  • Standard assessment of kidney function relies on glomerular filtration rate (GFR) and albuminuria.
  • Proximal tubular secretion, a crucial renal function for solute elimination and drug metabolism, is typically unquantified.
  • Dysfunction in tubular secretion may have significant clinical implications, impacting disease etiology and patient outcomes.

Purpose of the Study:

  • To evaluate the clinical utility of measuring proximal tubular secretion as an independent marker of kidney function.
  • To explore the association between tubular secretion function and participant characteristics, mortality, and chronic kidney disease (CKD) progression.
  • To investigate the relationship between clearance of specific secreted solutes and adverse health events.

Main Methods:

  • A prospective cohort study involving 298 patients with kidney disease.
  • Measurement of secreted solute (hippurate, cinnamoylglycine, p-cresol sulfate, indoxyl sulfate) clearance using liquid chromatography-tandem mass spectrometry.
  • Estimation of GFR using creatinine and urea clearance; evaluation of associations with mortality and progression to dialysis.

Main Results:

  • Tubular secretion rates showed a modest correlation with estimated GFR (eGFR) and were associated with electrolyte excretion.
  • Low clearance of hippurate and p-cresol sulfate independently predicted a higher risk of death (HR 2.3 and 2.5, respectively).
  • Low cinnamoylglycine clearance suggested a potential association with dialysis risk, though not statistically significant.

Conclusions:

  • Estimates of proximal tubular secretion correlate with GFR but exhibit significant variability.
  • Net secretion function is associated with mortality and CKD progression, warranting further investigation.
  • Measuring tubular secretion may offer novel insights into kidney disease and improve risk prediction.