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Under normal conditions the renal regulation of acid excretion is closely coupled to hydrogen ion intake, so that plasma bicarbonate concentration is maintained at stable levels despite wide variations in dietary acid inges tion. With larger hydrogen ion loads resulting from altered intake or pro duction, or with abnormalities in CO2 elimination by the lungs (respiratory acid-base disorders), renal acid excretion responds in a fashion that tends to defend the maintenance of a normal systemic pH. The renal regulation of hydrogen ion homeostasis can be viewed in terms of two distinct, yet intimately linked, processes-hydrogen ion (acid) excre tion and secretion. Acid excretion provides a renal mechanism to modify the body alkali stores. Quantitatively, acid excretion is equivalent to the sum of urinary titratable acid and ammonium, minus the bicarbonate lost in the urine. Hydrogen ion secretion includes the quantity of filtered bicar bonate reabsorbed by the nephron in addition to the amount of acid ex creted. Functionally, it determines the plasma bicarbonate concentration that can be sustained. Under normal conditions more than 98% of hydro gen ion secretion is expended in bicarbonate reabsorption, with only a minor fraction accounting for acid excretion. Despite this quantitative dis crepancy
Annual Review of Medicine – Annual Reviews
Published: Feb 1, 1980
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