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López-González Z, Padilla-Flores T, León-Aparicio D, Gutiérrez-Vásquez E, Salvador C, León-Contreras JC, Hernández-Pando R, Escobar LI. Metabolic acidosis and hyperkalemia differentially regulate cation HCN3 channel in the rat nephron. J Mol Histol 2020; 51:701-716. [PMID: 33070272 DOI: 10.1007/s10735-020-09916-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 10/01/2020] [Indexed: 12/31/2022]
Abstract
The kidney controls body fluids, electrolyte and acid-base balance. Previously, we demonstrated that hyperpolarization-activated and cyclic nucleotide-gated (HCN) cation channels participate in ammonium excretion in the rat kidney. Since acid-base balance is closely linked to potassium metabolism, in the present work we aim to determine the effect of chronic metabolic acidosis (CMA) and hyperkalemia (HK) on protein abundance and localization of HCN3 in the rat kidney. CMA increased HCN3 protein level only in the outer medulla (2.74 ± 0.31) according to immunoblot analysis. However, immunofluorescence assays showed that HCN3 augmented in cortical proximal tubules (1.45 ± 0.11) and medullary thick ascending limb of Henle's loop (4.48 ± 0.45) from the inner stripe of outer medulla. HCN3 was detected in brush border membranes (BBM) and mitochondria of the proximal tubule by immunogold electron and confocal microscopy in control conditions. Acidosis did not alter HCN3 levels in BBM and mitochondria but augmented them in lysosomes. HCN3 was also immuno-detected in mitoautophagosomes. In the distal nephron, HCN3 was expressed in principal and intercalated cells from cortical to medullary collecting ducts. CMA did not change HCN3 abundance in these nephron segments. In contrast, HK doubled HCN3 level in cortical collecting ducts and favored its basolateral localization in principal cells from the inner medullary collecting ducts. These findings further support HCN channels contribution to renal acid-base and potassium balance.
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Affiliation(s)
- Zinaeli López-González
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), 04510, Mexico, Mexico
| | - Teresa Padilla-Flores
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), 04510, Mexico, Mexico
| | - Daniel León-Aparicio
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), 04510, Mexico, Mexico
| | - Erika Gutiérrez-Vásquez
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), 04510, Mexico, Mexico
| | - Carolina Salvador
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), 04510, Mexico, Mexico
| | - Juan C León-Contreras
- Departamento de Patología, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, 14080, Mexico, Mexico
| | - Rogelio Hernández-Pando
- Departamento de Patología, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, 14080, Mexico, Mexico
| | - Laura I Escobar
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), 04510, Mexico, Mexico.
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Yamaji Y. Interstitial acidosis around the collecting ducts in dRTA. Kidney Int 2008; 73:1094-5. [DOI: 10.1038/ki.2008.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Paulais M, Lourdel S, Teulon J. Properties of an inwardly rectifying K(+) channel in the basolateral membrane of mouse TAL. Am J Physiol Renal Physiol 2002; 282:F866-76. [PMID: 11934697 DOI: 10.1152/ajprenal.00238.2001] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We investigated the properties of K(+) channels in the basolateral membrane of the cortical thick ascending limb (CTAL) using the patch-clamp technique. Approximately 34% of cell-attached patches contained an inwardly rectifying K(+) channel (K(+)-to-Na(+) permeability ratio approximately 22), having an inward conductance (G(in)) of 44 pS and an outward conductance (G(out)) of approximately 10 pS (G(in)/G(out) approximately 4). Channel activity (NP(o)) increased with depolarization. When the cytosolic sides of inside-out patches were exposed to an Mg(2+)-free medium, the channel had a G(in) of 50 pS and was weakly inwardly rectifying (G(in)/G(out) approximately 1). Cytosolic Mg(2+) reduced G(out), yielding a G(in)/G(out) of 3.8 at 1.3 mM Mg(2+). Internal Na(+) also yielded a G(in)/G(out) of 1.6 at 20 mM Na(+). Spermine reduced NP(o) on inside-out membrane patches. Sensitivity to spermine at depolarizing voltages [half-maximal inhibitory concentration (K(i)) = 0.2 microM] was much greater than at hyperpolarizing voltages (K(i) = 26 microM). Half-inactivation by 0.5 microM spermine occurred at a clamp potential of 43 mV, with an effective valence of 1.25. A sigmoid relationship between bath pH and NP(o) of inside-out membrane patches was observed, with a pK of 7.6 and a Hill coefficient of 1.8. Intracellular acidification also reduced the NP(o) of cell-attached patches. This channel is probably a major component of K(+) conductance in the CTAL basolateral membrane.
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Affiliation(s)
- Marc Paulais
- Institut National de la Santé et de la Recherche Médicale U.426, Institut Fédératif de Recherche 02, Faculté de Médecine Xavier Bichat, Université Paris 7, 75018 Paris, France.
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Guinamard R, Paulais M, Teulon J. Inhibition of a small-conductance cAMP-dependent Cl- channel in the mouse thick ascending limb at low internal pH. J Physiol 1996; 490 ( Pt 3):759-65. [PMID: 8683473 PMCID: PMC1158712 DOI: 10.1113/jphysiol.1996.sp021183] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
1. A small-conductance Cl- channel that is stimulated by ATP and protein kinase A has been identified in the basolateral membranes of cortical thick ascending limbs (CTALs) of the mouse nephron. The present study uses the cell-attached and inside-out variants of the patch-clamp technique to investigate the pH sensitivity of this channel. 2. The open-state probability (Po) was dependent upon the internal pH in inside-out patches. Expressed as a percentage of the Po value at pH 7.2, Po increased to about 180% at pH 7.6, and decreased to 25% at pH 6.8. Po was close to zero at pH 6.4. The internal pH had no effect on the channel unit conductance. 3. The effect of pH on the CTAL Cl- channel was assessed in intact cells using NH4Cl to acidify the intracellular compartment. Experiments with the pH-sensitive fluorescent dye 2',7'-(carboxyethyl)-5'(6')-carboxy fluorescein penta-acetoxymethyl ester (BCECF) indicated that 1 mmol l-1 NH4Cl acidified the cytoplasm by 0.15 pH units and 5 mmol l-1 NH4Cl by 0.34 pH units. These concentrations of NH4Cl reduced the activity of the CTAL Cl- channel by 24 and 82% in cell-attached patches, showing that moderate changes in internal pH substantially altered the activity of this channel. NH4+ had no direct effect on channel activity. 4. Inhibition at low pH is a newly discovered property of small-conductance Cl- channels in epithelia, which might help discriminate between types of Cl- channel.
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Affiliation(s)
- R Guinamard
- INSERM Unité 323, Faculté de Médecine Necker Enfants-Malades, Paris, France
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Watts BA, Good DW. Effects of ammonium on intracellular pH in rat medullary thick ascending limb: mechanisms of apical membrane NH4+ transport. J Gen Physiol 1994; 103:917-36. [PMID: 8035168 PMCID: PMC2219218 DOI: 10.1085/jgp.103.5.917] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
UNLABELLED The renal medullary thick ascending limb (MTAL) actively reabsorbs ammonium ions. To examine the effects of NH4+ transport on intracellular pH (pHi) and the mechanisms of apical membrane NH4+ transport, MTALs from rats were isolated and perfused in vitro with 25 mM HCO3(-)-buffered solutions (pH 7.4). pHi was monitored using the fluorescent dye BCECF. In the absence of NH4+, the mean pHi was 7.16. Luminal addition of 20 mM NH4+ caused a rapid intracellular acidification (dpHi/dt = 11.1 U/min) and reduced the steady state pHi to 6.67 (delta pHi = 0.5 U), indicating that apical NH4+ entry was more rapid than entry of NH3. Luminal furosemide (10(-4) M) reduced the initial rate of cell acidification by 70% and the fall in steady state pHi by 35%. The residual acidification observed with furosemide was inhibited by luminal barium (12 mM), indicating that apical NH4+ entry occurred via both furosemide (Na(+)-NH4(+)-2Cl- cotransport) and barium-sensitive pathways. The role of these pathways in NH4+ absorption was assessed under symmetric ammonium conditions. With 4 mM NH4+ in perfusate and bath, mean steady state pHi was 6.61 and net ammonium absorption was 12 pmol/min/mm. Addition of furosemide to the lumen abolished net ammonium absorption and caused pHi to increase abruptly (dpHi/dt = 0.8 U/min) to 7.0. Increasing luminal [K+] from 4 to 25 mM caused a similar, rapid cell alkalinization. The pronounced cell alkalinization observed with furosemide or increasing [K+] was not observed in the absence of NH4+. In symmetric 4 mM NH4+ solutions, addition of barium to the lumen caused a slow intracellular alkalinization and reduced net ammonium absorption only by 14%. CONCLUSIONS (a) ammonium transport is a critical determinant of pHi in the MTAL, with NH4+ absorption markedly acidifying the cells and maneuvers that inhibit apical NH4+ uptake (furosemide or elevation of luminal [K+]) causing intracellular alkalinization; (b) most or all of transcellular ammonium absorption is mediated by apical membrane Na(+)-NH4(+)-2Cl- cotransport; (c) NH4+ also permeates a barium-sensitive apical membrane transport pathway (presumably apical membrane K+ channels) but this pathway does not contribute significantly to ammonium absorption under physiologic (symmetric ammonium) conditions.
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Affiliation(s)
- B A Watts
- Department of Internal Medicine, University of Texas Medical Branch, Galveston 77555-0562
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Grantham JJ, Welling LW, Edwards RM. Evaluation of Function in Single Segments of Isolated Renal Blood Vessels, Nephrons, and Collecting Ducts. Compr Physiol 1992. [DOI: 10.1002/cphy.cp080109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Kikeri D, Sun A, Zeidel ML, Hebert SC. Cellular NH4+/K+ transport pathways in mouse medullary thick limb of Henle. Regulation by intracellular pH. J Gen Physiol 1992; 99:435-61. [PMID: 1588302 PMCID: PMC2216601 DOI: 10.1085/jgp.99.3.435] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Fluorescence and electrophysiological methods were used to determine the effects of intracellular pH (pHi) on cellular NH4+/K+ transport pathways in the renal medullary thick ascending limb of Henle (MTAL) from CD1 mice. Studies were performed in suspensions of MTAL tubules (S-MTAL) and in isolated, perfused MTAL segments (IP-MTAL). Steady-state pHi measured using 2,7-biscarboxyethyl-5(6)-carboxyfluorescein (BCECF) averaged 7.42 +/- 0.02 (mean +/- SE) in S-MTAL and 7.26 +/- 0.04 in IP-MTAL. The intrinsic cellular buffering power of MTAL cells was 29.7 +/- 2.4 mM/pHi unit at pHi values between 7.0 and 7.6, but below a pHi of 7.0 the intrinsic buffering power increased linearly to approximately 50 mM/pHi unit at pHi 6.5. In IP-MTAL, NH4+ entered cells across apical membranes via both Ba(2+)-sensitive pathway and furosemide-sensitive Na+:K+(NH4+):2Cl- cotransport mechanisms. The K0.5 and maximal rate for combined apical entry were 0.5 mM and 83.3 mM/min, respectively. The apical Ba(2+)-sensitive cell conductance in IP-MTAL (Gc), which reflects the apical K+ conductance, was sensitive to pHi over a pHi range of 6.0-7.4 with an apparent K0.5 at pHi approximately 6.7. The rate of cellular NH4+ influx in IP-MTAL due to the apical Ba(2+)-sensitive NH4+ transport pathway was sensitive to reduction in cytosolic pH whether pHi was changed by acidifying the basolateral medium or by inhibition of the apical Na+:H+ exchanger with amiloride at a constant pHo of 7.4. The pHi sensitivities of Gc and apical, Ba(2+)-sensitive NH4+ influx in IP-MTAL were virtually identical. The pHi sensitivity of the Ba(2+)-sensitive NH4+ influx in S-MTAL when exposed to (apical+basolateral) NH4Cl was greater than that observed in IP-MTAL where NH4Cl was added only to apical membranes, suggesting an additional effect of intracellular NH4+/NH3 on NH4+ influx. NH4+ entry via apical Na+:K+ (NH4+):2Cl- cotransport in IP-MTAL was somewhat more sensitive to reductions in pHi than the Ba(2+)-sensitive NH4+ influx pathway; NH4+ entry decreased by 52.9 +/- 13.4% on reducing pHi from 7.31 +/- 0.17 to 6.82 +/- 0.14. These results suggest that pHi may provide a negative feedback signal for regulating the rate of apical NH4+ entry, and hence transcellular NH4+ transport, in the MTAL. A model incorporating these results is proposed which illustrates the role of both pHi and basolateral/intracellular NH4+/NH3 in regulating the rate of transcellular N H4+ transport in the MTAL.
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Affiliation(s)
- D Kikeri
- Harvard Center for the Study of Kidney Disease, Harvard Medical School
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Shanley PF, Johnson GC. Adenine nucleotides, transport activity and hypoxic necrosis in the thick ascending limb of Henle. Kidney Int 1989; 36:823-30. [PMID: 2615191 DOI: 10.1038/ki.1989.268] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Thick ascending limb of Henle (TAL) necrosis in the isolated perfused kidney is an important model of renal hypoxia, but physiologic and metabolic correlation with this morphologic damage has been inadequate. More precise estimation of TAL adenine nucleotides in this model was obtained in the present study by high pressure liquid chromatography analysis of biopsy samples from the inner stripe of the outer medulla during perfusion. The inner stripe, which is the zone where TAL are concentrated, showed ATP depletion and low adenylate energy charge (AEC) early in perfusion prior to the appearance of TAL necrosis. Free water clearance (CH2O) was used as an estimate of TAL transport activity; the CH2O observed during 90 minute perfusions was found to be predictive of the extent of TAL necrosis in each experiment. The results support the idea that there is significant medullary hypoxia in the isolated perfused kidney and that TAL solute transport is a determinant of injury in this model. In further studies, the effects of ouabain (10(-3) M), furosemide (10(-4) M) or acidosis (pH 7.0 rather than the usual pH 7.4) on TAL transport activity and adenine nucleotide levels were compared. All three maneuvers have been shown previously to reduce TAL injury in the isolated perfused kidney. Addition of ouabain or furosemide reduced CH2O and TAL necrosis in parallel while acidosis had no effect on CH2O during perfusion. Both ouabain and furosemide attenuated ATP depletion and resulted in higher AEC while acidosis had no effect on these indices of cellular hypoxia. Therefore, the mechanism of cytoprotection by acidosis appears distinct from that of ouabain or furosemide.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- P F Shanley
- Department of Pathology, University of Colorado Health Sciences Center, Denver
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Feldman GM, Ziyadeh FN, Mills JW, Booz GW, Kleinzeller A. Propionate induces cell swelling and K+ accumulation in shark rectal gland. THE AMERICAN JOURNAL OF PHYSIOLOGY 1989; 257:C377-84. [PMID: 2548391 DOI: 10.1152/ajpcell.1989.257.2.c377] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Small organic anions have been reported to induce cell solute accumulation and swelling. To investigate the mechanism of swelling, we utilized preparations of rectal gland cells from Squalus acanthias incubated in medium containing propionate. Propionate causes cells to swell by diffusing across membranes in its nonionic form, acidifying cell contents, and activating the Na+-H+ antiporter. The Na+-H+ exchange process tends to correct intracellular pH (pHi), and thus it maintains a favorable gradient for propionic acid diffusion and allows propionate to accumulate. Activation of the Na+-H+ antiport also facilitates Na+ entry into the cell and Nai accumulation. At the same time Na+-K+-ATPase activity, unaffected by propionate, replaces Nai with Ki, whereas the K+ leak rate, decreased by propionate, allows Ki to accumulate. As judged by 86Rb+ efflux, the reduction in K+ leak was not due to propionate-induced cell acidification or reduction in Cli concentration. Despite inducing cell swelling, propionate did not disrupt cell structural elements and F actin distribution along cell membranes.
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Affiliation(s)
- G M Feldman
- Mount Desert Island Biological Laboratory, Salsbury Cove, Maine 04672
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Wingo CS. Active proton secretion and potassium absorption in the rabbit outer medullary collecting duct. Functional evidence for proton-potassium-activated adenosine triphosphatase. J Clin Invest 1989; 84:361-5. [PMID: 2544629 PMCID: PMC303992 DOI: 10.1172/jci114165] [Citation(s) in RCA: 120] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
We examined the hypothesis that proton-potassium-activated adenosine triphosphatase (H-K-ATPase) mediates K absorption and acidification in the inner stripe of the outer medullary collecting duct (OMCDi). Rabbits were fed a low-K diet (0.55% K) for 7-14 d because we have demonstrated previously that this low-K diet stimulates K-absorptive flux by the OMCDi. Proton secretion was measured as net total CO2 flux (JTCO2) by microcalorimetry. After basal collections, either vehicle or an inhibitor of gastric H-K-ATPase, omeprazole (0.1 mM), was added to the perfusate during the second period. Addition of vehicle to the perfusate changed neither the transepithelial voltage (VT, in millivolts) nor the JTCO2. In contrast, the addition of omeprazole (0.1 mM) to the perfusate abolished JTCO2 (from 14.5 +/- 5.6 to -0.1 +/- 3.1 pmol.mm-1.min-1) without significantly affecting VT. In additional experiments, in 16 tubules there was significant net K absorption (JK) of 5.0 +/- 1.0 pmol.mm-1.min-1 during the basal period, which exceeded the rate of K absorption that could be attributed to a paracellular voltage-mediated pathway (JKP = 1.0 +/- 0.4 pmol.mm-1.min-1, P less than 0.01). Administration of vehicle did not significantly affect either VT or JK. However, omeprazole abolished JK (from 5.1 +/- 1.0 to 0.1 +/- 2.5 pmol.mm-1.min-1) without affecting VT or JNa. The present results demonstrate that the OMCDi possesses an active, omeprazole-sensitive acidification and K-absorptive mechanism. These findings are consistent with the presence of H-K-ATPase activity in this nephron segment.
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Affiliation(s)
- C S Wingo
- Division of Nephrology and Hypertension, University of Florida, Gainesville
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Shanley PF, Shapiro JI, Chan L, Burke TJ, Johnson GC. Acidosis and hypoxic medullary injury in the isolated perfused kidney. Kidney Int 1988; 34:791-6. [PMID: 3210540 DOI: 10.1038/ki.1988.251] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The effects of acidosis on renal function and morphology were examined in the isolated perfused rat kidney (IPK). Kidneys were perfused with oxygenated Krebs-Henseleit-albumin medium for 60 minutes at pH 7.4 or pH 7.0. At the lower pH, GFR was reduced by 25%, TRNa by 32% and oxygen consumption by 41% as compared to perfusion at pH 7.4 (all P less than 0.05). In addition, the usual hypoxic injury observed in the medullary thick ascending limb of the Loop of Henle (TAL) in the IPK at pH 7.4 (consisting of nuclear pyknosis and focal fragmentation necrosis) was reduced by acidosis from 62% to 14% of tubules involved (P less than 0.005). This cytoprotection was not the result of improved oxygenation since O2 delivery was actually slighty reduced at pH 7.0 compared to pH 7.4. Furthermore, acidosis was protective even after perfusion with non-oxygenated media (42% tubules damaged at pH 7.0 vs. 95% of tubules damaged at pH 7.4; P less than 0.01), making it very unlikely that the effect of acidosis is to improve TAL oxygenation. Since previous studies indicate that the TAL lesion is transport dependent and prevented in the non-filtering kidney, it was possible that the decrease in GFR associated with acidosis could account for decreased injury. The GFR was manipulated by alterations in perfusion pressure or albumin concentration, and no consistent relationship between the extent of injury and GFR could be shown at either pH over a wide range of GFR values. Therefore, acidosis protected the TAL from hypoxic injury by a mechanism apparently independent of oxygen or solute delivery.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- P F Shanley
- Department of Pathology, University of Colorado Health Sciences Center, Denver
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Batlle DC, Hizon M, Cohen E, Gutterman C, Gupta R. The use of the urinary anion gap in the diagnosis of hyperchloremic metabolic acidosis. N Engl J Med 1988; 318:594-9. [PMID: 3344005 DOI: 10.1056/nejm198803103181002] [Citation(s) in RCA: 167] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We evaluated the use of the urinary anion gap (sodium plus potassium minus chloride) in assessing hyperchloremic metabolic acidosis in 38 patients with altered distal urinary acidification and in 8 patients with diarrhea. In seven normal subjects given ammonium chloride for three days, the anion gap was negative (-27 +/- 9.8 mmol per liter) and the urinary pH under 5.3 (4.9 +/- 0.03). In the eight patients with diarrhea the anion gap was also negative (-20 +/- 5.7 mmol per liter), even though the urinary pH was above 5.3 (5.64 +/- 0.14). In contrast, the anion gap was positive in all patients with altered urinary acidification, who were classified as having classic renal tubular acidosis (23 +/- 4.1 mmol per liter, 11 patients), hyperkalemic distal renal tubular acidosis (30 +/- 4.2, 12 patients), or selective aldosterone deficiency (39 +/- 4.2, 15 patients). When the data on all subjects studied were pooled, a negative correlation was found between the urinary ammonium level and the urinary anion gap. We conclude that the use of the urinary anion gap, as a rough index of urinary ammonium, may be helpful in the initial evaluation of hyperchloremic metabolic acidosis. A negative anion gap suggests gastrointestinal loss of bicarbonate, whereas a positive anion gap suggests the presence of altered distal urinary acidification.
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Affiliation(s)
- D C Batlle
- Department of Medicine (Nephrology Section), Northwestern University Medical School, Chicago, IL 60611
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