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RENAL BICARBONATE REABSORPTION AND HYDROGEN ION EXCRETION IN CHILDREN WITH RECURRENT URINARY TRACT INFECTIONS: The Effect of Fluorohydrocortisone
Author(s) -
APERIA A.,
BERG U.,
BROBERGER O.
Publication year - 1974
Publication title -
acta pædiatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/j.1651-2227.1974.tb04786.x
Subject(s) - bicarbonate , endocrinology , medicine , acidosis , urinary system , reabsorption , renal tubular acidosis , excretion , renal physiology , sodium bicarbonate , renal function , metabolic acidosis , kidney , chemistry
Abstract. Aperia, A., Berg, U. and Broberger, O. (Department of Paediatrics, Karolinska Institutet, S:t Göran's Children's Hospital, Stockholm, Sweden). Renal bicarbonate reabsorption and hydrogen ion excretion in children with recurrent urinary tract infections. The effect of fluorohydrocortisone. Acta Paediat Scand, 63: 209, 1974.–Delayed renal response to ammonium chloride induced acidosis appears to be the earliest detectable residual dysfunction in recurrent urinary tract infections. Control of renal acidifying mechanisms was' therefore studied in 11 girls with recurrent urinary tract infections, but with normal glomerular filtration rates. The renal response to ammonium chloride induced acidosis was normal in 7 and pathological in 4 children. Bicarbonate infusion studies demonstrated that the pathological response to the ammonium chloride load was due to depression of the renal bicarbonate threshold. When, however, the plasma bicarbonate level exceeded the normal renal threshold, i.e. 24.5 mEq/litre, the reabsorptive capacity for bicarbonate was the same in the patients with pathological and normal ammonium chloride tests. Treatment with tluorohydrocortisone resulted in an increase in bicarbonate reabsorption and hydrogen ion secretion in all patients studied. It is suggested that the low bicarbonate threshold in some patients depends on selective tubular damage in a limited number of nephrons. The enhancement of bicarbonate reabsorption by bicarbonate infusion and by fluorohydrocortisone suggests that in the majority of the nephrons renal acidifying mechanisms are intact. It is also suggested that fluorohydrocortisone acts on renal acidifying mechanism mainly by increasing the availability of sodium for exchange with hydrogen ions.