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Increased Glomerular Hydrostatic Pressure is Associated with Tubular Creatinine Reabsorption in Healthy Subjects

Akihiro Tsuda1, Eiji Ishimura2,3, Yuri Machiba4

  • 1Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan, naranotsudadesu@infoseek.jp.

Kidney & Blood Pressure Research
|November 5, 2020
PubMed

Insights

Creatinine reabsorption in kidney tubules can occur, potentially causing creatinine clearance (Ccr) to underestimate inulin clearance (Cin). This phenomenon is linked to intrarenal hemodynamic factors.

Area of Science:

  • Nephrology
  • Renal Physiology

Background:

  • Creatinine clearance (Ccr) typically overestimates inulin clearance (Cin) due to tubular secretion.
  • However, Ccr can sometimes underestimate Cin, suggesting tubular reabsorption of creatinine.
  • This study investigates factors associated with tubular creatinine reabsorption.

Purpose of the Study:

  • To examine clinical parameters linked to tubular creatinine reabsorption.
  • To understand the relationship between intrarenal hemodynamics and creatinine handling by the tubules.

Main Methods:

  • Simultaneous measurement of inulin clearance (Cin) and para-aminohippuric acid clearance in 80 kidney donor candidates.
  • Calculation of intrarenal hemodynamic parameters using Gomez's formulae.
  • Quantification of the secretory component of Ccr (SFcr) as (Ccr - Cin)/Ccr.

Main Results:

  • 31.3% of subjects exhibited negative SFcr values, indicating net tubular reabsorption.
  • Negative SFcr significantly correlated with higher efferent arteriolar resistance (Re) and glomerular hydrostatic pressure (Pglo).
  • Multiple regression analysis confirmed Re and Pglo as significant negative predictors of SFcr.

Conclusions:

  • Tubular creatinine reabsorption can occur in a subset of individuals.
  • Intrarenal hemodynamic burden, specifically efferent arteriolar resistance and glomerular hydrostatic pressure, may contribute to tubular creatinine reabsorption.
  • This reabsorption process could lead to an underestimation of true renal function by Ccr.
Abstract

Keywords:
Intrarenal hemodynamicsInulin clearanceLiving kidney donorTubular creatinine secretion and reabsorption

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