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Drug Elimination by Renal Route: Tubular Reabsorption

Drug Elimination by Renal Route: Tubular Reabsorption

During the process of renal excretion, as the glomerular filtrate progresses to the distal convoluted tubule (DCT), drugs that are highly permeable, lipophilic, and nonionized undergo passive reabsorption from the tubular fluid into the surrounding peritubular capillaries. This reabsorption process restricts their elimination through the kidneys. However, the majority of drugs are either weak acids or weak bases, and their ionization level is dependent on pH. By altering the pH of urine, the...

Enhanced Elimination of Poison

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Poison can be effectively removed from the gastrointestinal (GI) tract through various decontamination procedures.
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Factors Influencing Drug Absorption: Drug Dissolution

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The pharmacokinetic journey of drugs from solid oral dosage forms into systemic circulation is multifaceted. It begins with disintegration, a prerequisite ensuring a solid dosage form's subdivision into minute particles. Dissolution occurs next as these granulated entities solubilize in gastrointestinal fluids. This solubilization is crucial for the succeeding stage, permeation, which describes the traversal of the drug across the intestinal membrane and its subsequent entry into the blood...

Factors Affecting Dissolution: Particle Size and Effective Surface Area

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Renal Drug Excretion: Tubular Reabsorption

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Tubular reabsorption, a process occurring post-glomerular filtration of drugs in the renal tubule, is a critical determinant of drug half-life. During the process of renal excretion, as the glomerular filtrate progresses to the distal convoluted tubule (DCT), drugs that are highly permeable, lipophilic, and nonionized undergo passive reabsorption from the tubular fluid into the surrounding peritubular capillaries. This reabsorption process restricts their elimination through the kidneys. This...

Renal Drug Excretion: Tubular Secretion

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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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Related Experiment Video

Updated: Jun 26, 2025

Rapid Model to Evaluate the Anti-Obesity Potential of a Combination of Syzygium aromaticum Clove and Cuminun cyminum Cumin on C57BL6/j Mice Fed High-Fat Diet

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Refractory uric acid nephrolithiasis dissolution using phentermine/topiramate: A case report.

Logan Buchanan¹, Benjamin Canales², Akira Yamamoto²

¹University of Tennessee Health Science Center, United States.

Urology Case Reports

|May 17, 2024

Summary

Phentermine/topiramate (Qsymia) dissolved recalcitrant uric acid kidney stones in an obese patient. This weight loss medication offers a novel non-alkaline approach for uric acid stone dissolution.

Keywords:

Alkalinization Nephrolithiasis Obesity Phentermine Topiramate Uric acid

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Estimation of Urinary Nanocrystals in Humans using Calcium Fluorophore Labeling and Nanoparticle Tracking Analysis

Estimation of Urinary Nanocrystals in Humans using Calcium Fluorophore Labeling and Nanoparticle Tracking Analysis

Published on: February 9, 2021

Area of Science:

Nephrology
Metabolic Disorders
Pharmacology

Background:

Uric acid stones are challenging to dissolve, typically requiring oral alkalinization therapies like potassium citrate.
Obesity is a significant risk factor for uric acid nephrolithiasis.

Observation:

A case study of an obese female patient with persistent uric acid kidney stones is presented.
The patient was treated with phentermine/topiramate (Qsymia), a combination medication known for its effects on metabolism and carbonic anhydrase inhibition.

Findings:

Phentermine/topiramate successfully dissolved the patient's recalcitrant uric acid stones.
Pre- and post-treatment 24-hour urine studies and CT scans demonstrated stone dissolution.
A proposed mechanism of action for phentermine/topiramate in uric acid stone dissolution is discussed.

Implications:

This represents the first report of a non-alkaline oral therapy, phentermine/topiramate, used as a sole agent for uric acid stone dissolution.
Further research into phentermine/topiramate for uric acid stone formers, particularly those who are obese or diabetic, is recommended.