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Physiology

Renal

Question 8 of 180

About what percentage of filtered water is reabsorbed in the proximal tubule:

Answer:

The main function of the proximal tubule is reabsorption. The proximal tubule reabsorbs most glucose, amino acids, phosphate and bicarbonate together with about 60 - 70% of filtered Na+, K+, Ca2+, Cl-, urea and water.

The proximal tubule continues from the renal corpuscle. The wall of the proximal tubule is composed of a single layer of columnar epithelial cells which interdigitate extensively at the basal surface increasing their surface area and are connected by tight junctions at their luminal surface limiting diffusion through gaps between cells. The luminal surface of each cell is made up of millions of microvilli, forming a dense brush border that increases the surface area available for reabsorption of tubular filtrate.

The main function of the proximal tubule is reabsorption. The proximal tubule reabsorbs most glucose, amino acids, phosphate and bicarbonate together with about 60 - 70% of filtered Na+, K+, Ca2+, Cl-, urea and water.

Sodium

The concentration of Na+ in the filtrate is ~ 140 mmol/L, but is much lower in the cytosol of epithelial cells, which is also negatively charged. Tubular Na+ is thus absorbed into the epithelial cells of the proximal tubule down its electrochemical gradient, providing the driving force for the secondary transport of other substances. About 80% of the Na+ is reabsorbed via the Na+/H+ antiporter (this secretion of H+ is critical for HCO3- reabsorption) and some is coupled with the transport of other substances e.g. glucose, amino acids and phosphate ions.

Na+ is removed from tubular cells into the interstitial fluid by Na+/K+ ATPase pumps on the basolateral membrane, thus maintaining the electrochemical gradient for reabsorption of further Na+. However only about 20% of transported Na+ diffuses into the capillaries, as there is a significant back flux into the tubule via paracellular pathways.

Water

Water is reabsorbed by osmosis via both transcellular and paracellular pathways, following absorption of Na+ and HCO3as the osmolality of the peritubular interstitial fluid increases and the osmolality of the tubular fluid decreases. The reabsorption of water increases tubular concentration of Cl-, K+, Ca2+ and urea which are therefore reabsorbed into the peritubular space passively down their concentration gradients, largely via paracellular pathways, although the route for Ca2+ may be transcellular.

Glucose

Glucose is reabsorbed by cotransport with Na+ across the apical membrane of epithelial cells and then diffuses out of the cells into the peritubular interstitium.

By OpenStax College [CC BY 3.0 , via Wikimedia Commons

Function of the Proximal Tubule. (Image by OpenStax College [CC BY 3.0 , via Wikimedia Commons)

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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