The renal adenosine triphosphatases: functional integration and clinical significance

The ion-transporting ATPases determine the chemical composition of cells both directly and through their secondary effects. The Na,K-ATPase generates the transmembrane sodium gradient which provides the primary energy for uptake and extrusion of a wide variety of solutes by renal tubular epithelia. The H-ATPase and the H,K-ATPase acidify the urine, and also generates bicarbonate for excretion by the cortical collecting duct. Calcium ATPase regulates the intracellular calcium, which in turn impacts on the myriad of cellular functions for which calcium serves as an intracellular messenger. If one considers the impact of potential pump dysfunction in a purely speculative mode, the list of disorders which might be potentially ascribed to 'pump disease' would be enormous. This article reviews those disorders of renal transport already considered to be 'pump diseases'.