Symposium on Potassium Homeostasis

Kidney International (1977) 11, 415–432; doi:10.1038/ki.1977.60

Sites and mechanisms of potassium transport along the renal tubule

Fred S Wright1

1Department of Physiology, Yale University School of Medicine, New Haven, Connecticut

Correspondence: Dr Fred S Wright, Department of Physiology, Yale University School of Medicine, New Haven, Connecticut 06510, U.S.A.

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Abstract

Renal tubules are capable of transporting potassium in both reabsorptive and secretory directions. Reabsorption is the principal process in the proximal portions of the nephron, whereas in the more distal segments secretion usually dominates.a That most potassium excreted by the kidney is not derived from filtered potassium, but is actually secreted, was indicated by clearance [1,2] and stop-flow experiments [3–5], and ultimately confirmed by measurements made on tubule fluid samples obtained by microcatheterization [6] and by micropuncture [7–9]. The distinction between proximal reabsorption and distal secretion should not be overdrawn, however. Some secretion occurs in segments of the proximal part of the nephron, and reabsorption appears to occur along the collecting duct. Thus, although secretion by cells of the distal nephron is recognized as the main process regulating the rate of potassium excretion, other secretory and reabsorptive processes may modify the total amount of excreted potassium and, in so doing, may affect the simultaneous transport rates of water and other electrolytes.

Evidence establishing numerous features of the several processes regulating renal potassium excretion, particularly the distal secretory processes, has been reviewed extensively [10–20], A picture has emerged from experimental work that to some extent explains changes seen in the rates of renal potassium excretion in response to a number of factors, including potassium intake, sodium excretion, miner-alocorticoids, hydration, acid-base balance, and the anion composition of plasma. As will become evident, however, the exact secretory site or sites along the distal nephron affected by these factors and the nature of the cellular mechanisms involved are still not known with certainty. Recent structural and biochemical observations from experiments with isolated tubule fragments have provided some additional insights into the questions both of transport sites and transport mechanisms. In the following this information will be incorporated—at times quite speculatively—into our present understanding of renal potassium transport across different segments of the renal tubule system.

aReabsorption means net transport from lumen to blood, and secretion means net transport from blood to lumen — mechanism is not specified. Nephron is used in the general sense, meaning the tubule system from the glomerulus to the end of the collecting system.

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