The troubled quarter, between hope and concern, integrating nephrology and society in the new year

The function of the kidneys is to filter, reabsorb, secrete, and excrete. Every day the kidneys filter nearly 180 liters of blood, initially removing water and solutes but ultimately returning nearly all filtrates into circulation with the help of osmoregulatory hormones. This process removes wastes and toxins but is also crucial to maintain water and electrolyte levels. Most of these functions are performed by the tiny but numerous nephrons contained within the kidneys.

Metabolic reactions in the body produce nonvolatile acids, such as sulfuric acid, which generate an acid load of approximately 1 mEq of H+ per kilogram of body weight daily. Excreting H+ in the urine is essential to balance this acid load.
In the kidneys, cells within the proximal convoluted tubules (PCT) and the collecting ducts secrete hydrogen ions (H+) into the tubular fluid. Specifically, in the PCT, Na+/H+ antiporters secrete H+ while reabsorbing Na+.
However, the intercalated cells in...