Proximal tubule reabsorption of bicarbonate
- H+ secretion from cells across the luminal membrane is mostly in exchange for Na+ ions, and to a small extent ,through a proton ATPase.
- Secreted H+ react with filtered HC03- to form H2CO3.
In the presence of carbonic anhydrase (type IV), luminal H2CO3 rapidly dehydrates to CO2 + H20. Drugs that inhibit carbonic anhydrase (e.g., acetazolamide) interfere with proximal reabsorption of NaHCO3 and induce a bicarbonate (osmotic) diuresis.
- Inside the cell, dissociation of H2O into OH- and H+ is promoted by hydroxylation of CO2 (OH- + CO2 => HCO3-) to generate bicarbonate, catalyzed by soluble (type II) carbonic anhydrase.
- H+ is exchanged for Na+ ions through a high capacity isoform (NHE3) of the Na-H exchange proteins.
- Bicarbonate exits the cell through the basolateral membrane in a 3:1 cotransport with Na+.
The net result is that NaHC03 disappears from the lumen and appears in the blood-side of the proximal tubule cells.