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Physiology

Renal

Question 157 of 180

All of the following increase renal phosphate excretion EXCEPT for:

Answer:

PO43- renal excretion is regulated by:
  • PTH (increases excretion by inhibiting reabsorption in the proximal tubule)
  • activated vitamin D (decreases excretion by increasing reabsorption in the distal tubule)
  • acidosis (increases excretion)
  • glucocorticoids (increases excretion)
  • calcitonin (increases excretion)

Phosphate is abundant in the body and is an important intracellular and extracellular anion (but is predominantly intracellular). About 65% of dietary phosphate is absorbed, mainly in the duodenum and jejunum by a transcellular process which is enhanced by vitamin D.

Ca2+ and PO43- precipitate to form insoluble calcium phosphate and their concentrations in the blood are close to the saturation point at which calcium phosphate complexes precipitate out of solution onto the bone matrix. Therefore an increase in one of the ions results in the precipitation of some calcium phosphate and thus some of the other ion is removed from the solution; Ca2+ and PO43- concentrations are thus inversely proportional.

Renal Phosphate Handling

Unbound PO43- is filtered freely at the glomerulus and there is reabsorption along the nephron. The maximum rate of reabsorption is limited and and excess filtered phosphate above a threshold level is excreted. Of filtered phosphate, 80% is reabsorbed in the proximal tubule by a transcellular process. The distal tubules reabsorb a further 10% of the filtered phosphate and the collecting ducts a further 2 - 3%.

PO43- renal excretion is regulated by:

  • PTH (increases excretion by inhibiting reabsorption in the proximal tubule)
  • activated vitamin D (decreases excretion by increasing reabsorption in the distal tubule)
  • acidosis (increases excretion)
  • glucocorticoids (increases excretion)
  • calcitonin (increases excretion)

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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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