Hyperosmolar states

The composition of the extracellular fluid (ECF) must remain stable for cells to function properly. In normal individuals vasopressin and thirst zealously maintain the total ECF concentration, or osmolality, within a narrow range. Disruption of these regulatory mechanisms or rapid addition of solute to the ECF can lead to hyperosmolality. The serious neurologic symptoms that accompany many forms of hyperosmolality can be explained by understanding the physiologic response of cells to the osmotic stress. This review describes the physiology, pathophysiology, differential diagnosis, and therapy of hyperosmolar states.

Apical membrane limits urea permeation across the rat inner medullary collecting duct

Urea diffuses across the terminal inner medullary collecting duct (IMCD) via a facilitated transport pathway. To examine the mechanism of transcellular urea transport, membrane-apparent urea (Purea) and osmotic water (Pf) permeabilities of IMCD cells were measured by quantitative light microscopy in isolated IMCD-2 tubules perfused in the absence of vasopressin. Basolateral membrane Pf, determined by addition of raffinose to the bath, was 69 microns/s. Basolateral membrane Purea, determined by substituting urea for raffinose without change in osmolality, was 14 X 10(-5) cm/s. Bath phloretin inhibited basolateral Purea by 85% without a significant effect on Pf. The basolateral reflection coefficient for urea, determined by addition of urea in the presence of phloretin, was 1.0. These results indicate that urea crosses the basolateral membrane by diffusion, and not by solvent drag. In perfused tubules, the rate of cell swelling following substitution of urea for mannitol was significantly greater with bath than lumen changes. After correcting for membrane surface area, the basolateral membrane was twofold more permeable than the apical membrane.

CONCLUSIONS

(a) in the absence of vasopressin, urea permeation across the IMCD cell is limited by the apical membrane; (b) the basolateral membrane contains a phloretin-sensitive urea transporter; (c) transepithelial urea transport occurs by movement of urea through the IMCD cell.

The vasopressin-regulated urea transporter in renal inner medullary collecting duct

The terminal part of the inner medullary collecting duct (terminal IMCD) is unique among collecting duct segments in part because its permeability to urea is regulated by vasopressin. The urea permeability can rise to extremely high levels (greater than 100 x 10(-5) cm/s) in response to vasopressin. Recent studies in isolated perfused IMCD segments have established that the rapid movement of urea across the tubule epithelium occurs via a specialized urea transporter, presumably an intrinsic membrane protein, present in both the apical and basolateral membranes. This urea transporter has properties similar to those of the urea transporters in mammalian erythrocytes and in toad urinary bladder, namely, inhibition by phloretin, inhibition by urea analogues, saturation kinetics in equilibrium-exchange experiments, and regulation by vasopressin. The urea transport pathway is distinct from and independent of the vasopressin-regulated water channel. The increase in transepithelial urea transport in response to vasopressin is mediated by adenosine 3',5'-cyclic monophosphate and is associated with an increase in the urea permeability of the apical membrane. However, little is known about the physical events associated with the activation or insertion of urea transporters in the apical membrane. Because of the importance of this transporter to the urinary concentrating mechanism, efforts toward understanding its molecular structure and the molecular basis of its regulation appear to be justified.

Basolateral membrane sodium-independent Cl-/HCO3- exchanger in rat inner medullary collecting duct cell

Previous studies have shown that the middle third of the rat inner medullary collecting duct (IMCD-2) secretes protons despite the absence of intercalated cells, the cell thought to secrete protons in other portions of the collecting duct. A new cell, the IMCD cell, is the predominant cell in IMCD-2. The mechanism responsible for base exit in the IMCD cell was characterized by measuring cell pH of isolated perfused tubules with 2',7'-bis(carboxyethyl)-5,6-carboxyfluorescein. Reduction of bath HCO3- caused a significant and reversible decrease in cell pH, whereas a similar change in luminal HCO3- had a significantly smaller effect, indicating that the HCO3-/H+ permeability of the basolateral membrane is much larger than the apical membrane. The rate of cell acidification induced by reduction in bath HCO3-, a measure of basolateral HCO3- transport, was significantly decreased in the absence of bath and lumen Cl. Decreases in bath Cl caused a significant and reversible increase in cell pH, which was not changed significantly by complete removal of Na from perfusate and bath, but was significantly inhibited by basolateral 4',5'-diisothiocyanostilbene-2,2'-disulfonic acid. A chemical voltage clamp did not inhibit the rate of cell alkalinization after bath Cl removal, indicating that Cl-/HCO3- exchange is not via parallel Cl and HCO3- conductances. Cell pH was measured in single cells by low-light-level imaging to show that most cells contain the chloride-dependent HCO3- pathway. We conclude that the rat IMCD cell possesses a basolateral Na-independent CL-/HCO3- exchanger which may serve as the base exit step for transepithelial proton secretion.

Quantitation of total carbon dioxide in nanoliter samples by flow-through fluorometry

A new ultramicrofluorometric assay for the measurement of picomole amounts of total CO2 is described. The assay is based on a sequence of two linked enzymatic reactions: HCO3 reacts with phosphoenolpyruvate forming oxaloacetate, and oxaloacetate is then converted to malate with associated oxidation of NADH to NAD+. The fluorescence of NADH is measured in a modified ultramicrofluorometer. The HCO3 content of the sample is proportional to the decrease in NADH fluorescence. The method can resolve differences as small as 5.5 pmol total CO2 in 3-nl samples containing 0-160 pmol. The assay is 5- to 10-fold more sensitive than the widely used microcalorimetric assay. The assay can also measure total CO2 in biological samples. The assay will be useful in measuring transepithelial total CO2 transport in short distal nephron segments with low rates of total CO2 transport without resorting to extremely long collection times.

Calcium and cyclic adenosine monophosphate as second messengers for vasopressin in the rat inner medullary collecting duct

Vasopressin increases both the urea permeability and osmotic water permeability in the terminal part of the renal inner medullary collecting duct (terminal IMCD). To identify the second messengers that mediate these responses, we measured urea permeability, osmotic water permeability, intracellular calcium concentration, and cyclic AMP accumulation in isolated terminal IMCDs. After addition of vasopressin, a transient rise in intracellular calcium occurred that was coincident with increases in cyclic AMP accumulation and urea permeability. Half-maximal increases in urea permeability and osmotic water permeability occurred with 0.01 nM vasopressin. The threshold concentration for a measurable increase in cyclic AMP accumulation was approximately 0.01 nM, while measurable increases in intracellular calcium required much higher vasopressin concentrations (greater than 0.1 nM). Exogenous cyclic AMP (1 mM 8-Br-cAMP) mimicked the effect of vasopressin on urea permeability but did not produce a measurable change in intracellular calcium concentration.

CONCLUSIONS

(a) Cyclic AMP is the second messenger that mediates the urea permeability response to vasopressin in the rat terminal IMCD. (b) Vasopressin increases the intracellular calcium concentration in the rat terminal IMCD, but the physiological role of this response is not yet known.

Disequilibrium pH and ammonia transport in isolated perfused cortical collecting ducts

The present study was carried out to test directly whether isolated perfused rabbit cortical collecting ducts (CCDs) spontaneously generate a luminal disequilibrium pH. We determined disequilibrium pH as the difference between 1) the actual luminal pH measured by perfusing the lumen with a membrane-impermeant pH-sensitive dye [1,4-dihydroxyphthalonitrile (1,4-DHPN)] and 2) equilibrium pH calculated from the measured total CO2 concentration in fluid collected at the end of the tubule. When the peritubular bath and perfusate had the same composition, a statistically significant acidic disequilibrium pH was found (mean -0.14 units). To determine whether the disequilibrium pH is due to an absolute lack of luminal carbonic anhydrase, we measured the effective rate constant for carbonic acid dehydration in the lumen (k-1). To do this, a lumen-to-bath NH3 concentration gradient was imposed, and the luminal pH was measured along the tubule with 1,4-DHPN. NH3 absorption caused a luminal disequilibrium pH (due to dissociation of NH+4 to NH3 and H+), whose profile along the lumen is dependent on k-1 and NH3 permeability (PNH3). PNH3 and k-1 were estimated from the luminal pH profiles using a mathematical model of proton and buffer transport. The measured k-1 (37 s-1) is within the reported range of values for uncatalyzed H2CO3 dehydration. Calculations demonstrate that the measured PNH3 (2 X 10(-3) cm/s) is high enough and the measured k-1 is low enough to explain ammonia secretion rates seen in previous studies. We conclude that proton secretion in the CCD generates an acidic luminal disequilibrium pH, associated with an absolute lack of luminal carbonic anhydrase, which enhances the net rate of NH3 secretion.

Luminal disequilibrium pH and ammonia transport in outer medullary collecting duct [corrected and issued with original paging in Am J Physiol 1987 Aug;253(2 Pt 2)]

We measured bicarbonate, ammonia, and luminal pH in segments of the rabbit outer medullary collecting duct (OMCD) to determine the relationship between luminal pH and ammonia transport. Both the inner-stripe and outer-stripe portions of the OMCD absorbed bicarbonate at high rates. The outer stripe OMCD generated an acidic pH disequilibrium that was reversibly dissipated by exogenous luminal carbonic anhydrase. In contrast, the inner stripe OMCD did not generate a spontaneous pH disequilibrium unless perfused with the carbonic anhydrase inhibitor acetazolamide. Ammonia secretion was three times more rapid in the outer stripe OMCD than in the inner stripe OMCD. We conclude the following. 1) Both the inner-stripe and outer-stripe portions of the rabbit OMCD secrete protons at substantial rates. 2) Functional luminal carbonic anhydrase is present in the inner stripe OMCD but absent from the outer stripe OMCD. 3) Ammonia secretion occurs predominantly by NH3 diffusion in both portions. 4) The luminal pH disequilibrium, which is normally present in the outer stripe OMCD, enhances ammonia secretion.

Bicarbonate secretion and chloride absorption by rabbit cortical collecting ducts. Role of chloride/bicarbonate exchange

Cortical collecting ducts (CCD) from rabbits treated with deoxycorticosterone (DOC) actively secrete bicarbonate at high rates. To investigate the mechanism of bicarbonate secretion, we measured bicarbonate and chloride transport in CCD from rabbits treated with DOC for 9-24 d. Removal of chloride (replaced with gluconate) from both perfusate and bath inhibited bicarbonate secretion without changing transepithelial voltage. Removal of chloride only from the bath increased bicarbonate secretion, while removal of chloride only from the perfusate inhibited secretion. In contrast to the effect of removing chloride, removal of sodium from both the perfusate and bath (replacement with N-methyl-D-glucamine) did not change the rate of bicarbonate secretion. The rate of bicarbonate secretion equaled the rate of chloride absorption in tubules bathed with 0.1 mM ouabain to inhibit any cation-dependent chloride transport. Under these conditions, chloride absorption occurred against an electrochemical gradient. Removal of bicarbonate from both the perfusate and bath inhibited chloride absorption. Removal of bicarbonate only from the bath inhibited chloride absorption, while removal of bicarbonate from the lumen stimulated chloride absorption. We conclude that CCD from DOC-treated rabbits actively secrete bicarbonate and actively absorb chloride by an electroneutral mechanism involving 1:1 chloride/bicarbonate exchange. The process is independent of sodium.