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Acidification of Urine
Dr Ambika Jawalkar
Acidification of Urine
• Acid = [] H+ conc
• Alkali =  H+ conc.
• Normal body pH [ECF] = 7.4
• Metabolic functions of body are highly sensitive to pH.
• Compatible for life = pH range 6.8 -7.8 [ECF]
• Acid –Base balance is co–ordinated function of lungs &
kidney.
• Lungs –
• Major excretory route of volatile acids e.g. carbonic acid.
• Kidney –
• pH of urine range – 4.5 to 8. [depend on rate of acid
secretion]
• When body pH changes  kidney excretes acidic OR alkaline
urine  maintain Acid base balance of ECF.
•Buffers in blood –
•NaHCO3 buffers strong acids e.g.
H2SO4 + 2 NaHCO3 Na2SO4 + 2CO2 + 2H2O
HCl + NaHCO3  NaCl + CO2 +H2O
•Functions of kidney –
The acid salts are excreted by kidney
Replacement of blood buffer [NaHCO3]
Buffer system of Kidney
•H+ secretion into tubular fluid is buffered by 3
imp. buffers in kidney.
1. HCO3
- buffer system
2. PO4
- buffer system
3. NH3
- buffer system
1] HCO3
- buffer system
• It is regulated both by Lungs & kidneys.
•  in plasma HCO3
- buffer  metabolic acidosis.
• [] in pCO2  respiratory acidosis
• Note –
• Kidney regulate plasma HCO3
- buffer
• Lungs regulate plasma pCO2 changes.
Acidification of urine
• In PCT –
• For secretion of one H+
ion into tubule there is
gain of one Na+ + one
HCO3
- in plasma.
• H + secretion is in
exchange for Na + by
• 1] secondary active
transport. &
• 2] active transport of H+
ATPase
• Note –
• For one H + secretion = one HCO3- gain in plasma
• Normal plasma HCO3- = 26 mEq/L
• Renal plasma threshold for HCO3- is = 28mEq/L
• If more than 28mEq/L = HCO3- appears in urine [alkaline
urine]
• Limiting pH
• for PCT = 6.9 &
• for Distal tubule = 4.5
• H + secretion stops at limiting pH.
Factors affecting H+ secretion
[] H +secretion [] H +secretion
1] [] In intracellular pH 1] [] In intracellular pH
2] [] intracellular PCO2 2] [] intracellular PCO2
3] [] in filtered load of HCO3 3] [] in filtered load of HCO3
4] [] in ECF volume 4] [] in ECF volume
5] [] in Aldosterone 5] [] in Aldosterone
6] Hypokalemia 6] Hyperkalemia
7] [] in Carbonic anhydrase 7] [] in CA = CA inhibitors
e.g. acetazolamide [Diamox]
PO4 Buffer system
• Primary urinary buffer system.
• Derived from diet.
• Distal nephron –
Alkaline PO4 + H+  Acidic PO4 i.e.
H+ + HPO4
2-  H2PO4
-
• NOTE –
• Titrable acidity = PO4 buffer system. [not measure HCO3
& NH3 buffers]
It is Amount of alkali added to raise pH of urine to 7.4
Substances contributing to titrable acidity = excreted PO4 +
ketoacids + lactic acid + creatinine
NH3 Mechanism
• Production in Kidney.-
• In PCT & DCT
• By metabolism of AA Glutamine
• NH3 is lipid soluble  free passage across tubular
membrane.
• NH3
+ + H +  NH4
• Trapping of NH4 = Non ionic diffusion Or Diffusion
trapping
• In acidosis  [] NH4 in urine
Compensatory Responses of the body in
Acid –Base disturbances
1. Intracellular & Extracellular
buffering.
2. Changes in ventilation.
3. Renal adjustments
Compensatory Responses of the body in Acid –Base disturbances
1] Intracellular & Extracellular buffering.
A.ECF buffers –
 HCO3 buffer
 Plasma protein buffer system
B. Intra cellular buffers –
 HCO3 buffer
 PO4 & histidine group of proteins
 Reduced Hb.
Compensatory Responses of the body in Acid –Base disturbances
2] Changes in ventilation.
• Depend on pCO2 level
1.  in pCO2  respiratory acidosis 
stimulation of peripheral & Central chemoreceptors 
[] hyperventilation
2.  in H+  metabolic acidosis 
 stim of Central chemoreceptors 
[] hyperventilation.
E.g. Diabetic ketoacidosis.  Kussmaul breathing.
Compensatory Responses of the body in Acid –Base disturbances
3] Renal adjustments
•In acidosis  due to  NH4 secretion
• H+ secretion   production of HCO3 
 buffering capacity of blood
Acidification of urine

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Acidification of urine

  • 1. Acidification of Urine Dr Ambika Jawalkar
  • 2. Acidification of Urine • Acid = [] H+ conc • Alkali =  H+ conc. • Normal body pH [ECF] = 7.4 • Metabolic functions of body are highly sensitive to pH. • Compatible for life = pH range 6.8 -7.8 [ECF] • Acid –Base balance is co–ordinated function of lungs & kidney. • Lungs – • Major excretory route of volatile acids e.g. carbonic acid. • Kidney – • pH of urine range – 4.5 to 8. [depend on rate of acid secretion] • When body pH changes  kidney excretes acidic OR alkaline urine  maintain Acid base balance of ECF.
  • 3. •Buffers in blood – •NaHCO3 buffers strong acids e.g. H2SO4 + 2 NaHCO3 Na2SO4 + 2CO2 + 2H2O HCl + NaHCO3  NaCl + CO2 +H2O •Functions of kidney – The acid salts are excreted by kidney Replacement of blood buffer [NaHCO3]
  • 4. Buffer system of Kidney •H+ secretion into tubular fluid is buffered by 3 imp. buffers in kidney. 1. HCO3 - buffer system 2. PO4 - buffer system 3. NH3 - buffer system
  • 5. 1] HCO3 - buffer system • It is regulated both by Lungs & kidneys. •  in plasma HCO3 - buffer  metabolic acidosis. • [] in pCO2  respiratory acidosis • Note – • Kidney regulate plasma HCO3 - buffer • Lungs regulate plasma pCO2 changes.
  • 7. • In PCT – • For secretion of one H+ ion into tubule there is gain of one Na+ + one HCO3 - in plasma. • H + secretion is in exchange for Na + by • 1] secondary active transport. & • 2] active transport of H+ ATPase
  • 8. • Note – • For one H + secretion = one HCO3- gain in plasma • Normal plasma HCO3- = 26 mEq/L • Renal plasma threshold for HCO3- is = 28mEq/L • If more than 28mEq/L = HCO3- appears in urine [alkaline urine] • Limiting pH • for PCT = 6.9 & • for Distal tubule = 4.5 • H + secretion stops at limiting pH.
  • 9. Factors affecting H+ secretion [] H +secretion [] H +secretion 1] [] In intracellular pH 1] [] In intracellular pH 2] [] intracellular PCO2 2] [] intracellular PCO2 3] [] in filtered load of HCO3 3] [] in filtered load of HCO3 4] [] in ECF volume 4] [] in ECF volume 5] [] in Aldosterone 5] [] in Aldosterone 6] Hypokalemia 6] Hyperkalemia 7] [] in Carbonic anhydrase 7] [] in CA = CA inhibitors e.g. acetazolamide [Diamox]
  • 10. PO4 Buffer system • Primary urinary buffer system. • Derived from diet. • Distal nephron – Alkaline PO4 + H+  Acidic PO4 i.e. H+ + HPO4 2-  H2PO4 - • NOTE – • Titrable acidity = PO4 buffer system. [not measure HCO3 & NH3 buffers] It is Amount of alkali added to raise pH of urine to 7.4 Substances contributing to titrable acidity = excreted PO4 + ketoacids + lactic acid + creatinine
  • 11. NH3 Mechanism • Production in Kidney.- • In PCT & DCT • By metabolism of AA Glutamine • NH3 is lipid soluble  free passage across tubular membrane. • NH3 + + H +  NH4 • Trapping of NH4 = Non ionic diffusion Or Diffusion trapping • In acidosis  [] NH4 in urine
  • 12. Compensatory Responses of the body in Acid –Base disturbances 1. Intracellular & Extracellular buffering. 2. Changes in ventilation. 3. Renal adjustments
  • 13. Compensatory Responses of the body in Acid –Base disturbances 1] Intracellular & Extracellular buffering. A.ECF buffers –  HCO3 buffer  Plasma protein buffer system B. Intra cellular buffers –  HCO3 buffer  PO4 & histidine group of proteins  Reduced Hb.
  • 14. Compensatory Responses of the body in Acid –Base disturbances 2] Changes in ventilation. • Depend on pCO2 level 1.  in pCO2  respiratory acidosis  stimulation of peripheral & Central chemoreceptors  [] hyperventilation 2.  in H+  metabolic acidosis   stim of Central chemoreceptors  [] hyperventilation. E.g. Diabetic ketoacidosis.  Kussmaul breathing.
  • 15. Compensatory Responses of the body in Acid –Base disturbances 3] Renal adjustments •In acidosis  due to  NH4 secretion • H+ secretion   production of HCO3   buffering capacity of blood

Hinweis der Redaktion

  1. HCO