TRC: Tubular reabsorption

Tubular reabsorption

Only about 1% of the glomerular filtrate actually leaves the body because the rest (the other 99%) is reabsorbed into the blood. Tubular reabsorption is the process by which solutes, drugs, metabolites and water are removed from the tubular fluid. These transport processes are mostly driven by diffusion and upon occasion, active transport.

In the distal tubule the membrane is readily permeable to lipids so filtered lipid soluble substances undergo passive diffusion down the concentration gradient. They are extensively reabsorbed and little is lost in urine. Polar drugs are unable to be reabsorbed and are voided in urine.

Many drugs are either weak bases or acids and thus the pH of the filtrate can greatly influence the extent of tubular re-absorption for many drugs. When urine is alkaline, weak acid drugs won’t be reabsorbed. Alternatively when urine is more acidic, basic drugs are more extensively secreted in urine because the low pH favours ionisation and thus absorption is inhibited. This is called the ion-trapping effect. These changes can be quite significant as urine pH can vary from 4.5 to 8.0 depending on the diet (e.g. meat can cause a more acidic urine) or drugs (which can increase or decrease urine pH).

See how the effect of a change in pH can influence drugs moving across a membrane by clicking here.

A patient has taken a toxic dose of aspirin. The active substance in aspirin (acetylsalicylic acid, ASA) is a weak acid. Which measure can be taken to increase the ASA in the urine?
Intravenous administration of an isotonic salt solution with a(n)…..

Extra info: To trap ASA in the urine, reabsorption needs to be minimalised. To reduce the movement over membranes increase fraction ionized ASA. Since ASA is an acid, the following equilibrium takes place: HA ⇌ H+ + A- . To increase the fraction of charged ASA (A- in the equation), the pH should be increased (alkalinisation). Thus, a base solution needs to be added (e.g. sodium bicarbonate).

Option explanation:

... acid, as it will increase the fraction of ionized ASA in the urine

... acid, as it will increase the fraction of non-ionized ASA in the urine

... base, as it will increase the fraction of ionized ASA in the urine

... base, as it will increase the fraction of non-ionized ASA in urine

Tubular reabsorption

Tubular reabsorption

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