Titratable acidity: A Pitts concept revisited

Résumé fourni par la source

Titratable Acidity (TA) in urine can be measured directly or calculated from actual and reference pH, by using the pKa₂ 6,8 for phosphate. In urine, H₂PO₄(-) represents the excretion of filtered H₂PO₄(-), filtrated HPO₄(2-) being completely reabsorbed by the proximal tubule (the Van Slyke approach). Since excretion of H₂PO₄(-) frequently exceeds its glomerular filtration, this approach is considered inadequate by Pitts. He claimed that it is the tubular H(+) secretion which converts filtered HPO₄(2-) to H₂PO₄(-), thereafter excreted in urine. This is only true under conditions of inorganic acid or neutral phosphate loading, when the maximum tubular phosphate reabsorption (TmPi) is overcharged. In controls, H₂PO₄(-) excretion is lower than its glomerular filtration, provided that acid-base status is normal and tubular phosphate reabsorption is below the TmPi. The TmPi is lower than its glomerular filtration, provided that acid-base status is normal and tubular phosphate reabsorption is below the TmPi. When the TmPi is exceeded, a portion of HPO₄(2-) escapes proximal reabsorption, reaching the distal tubule where its absorption is precluded, while tubular H(+) secretion converts HPO₄(2-) to H₂PO₄(-). In man and dog, the attainment of TmPi is evidenced by a FE% of 20%, and only beyond this limit H₂PO₄(-) excretion exceeds glomerular filtration. When FE% is lower than 20%, H₂PO₄(-) filtration exceeds excretion, HPO4(2-) being completely reabsorbed at the proximal tubule by NaPi-2a and 2c cotransporters. While Van Slyke's approach is always valid, Pitts' approach is only valid under loading conditions, when the two processes of H₂PO₄(-) excretion overlap each other. NH (+4) increases inversely to TA excretion in conditions of acidosis and tP restriction, but is independent of TA in Pi-replete dogs, independently of acidosis.

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