Cortical distal nephron Cl transport in volume homeostasis and blood pressure regulation

SM Wall, AM Weinstein - American Journal of Physiology …, 2013 - journals.physiology.org
SM Wall, AM Weinstein
American Journal of Physiology-Renal Physiology, 2013journals.physiology.org
Renal intercalated cells mediate the secretion or absorption of Cl− and OH−/H+ equivalents
in the connecting segment (CNT) and cortical collecting duct (CCD). In so doing, they
regulate acid-base balance, vascular volume, and blood pressure. Cl− absorption is either
electrogenic and amiloride-sensitive or electroneutral and thiazide-sensitive. However,
which Cl− transporter (s) are targeted by these diuretics is debated. While epithelial Na+
channel (ENaC) does not transport Cl−, it modulates Cl− transport probably by generating a …
Renal intercalated cells mediate the secretion or absorption of Cl and OH/H+ equivalents in the connecting segment (CNT) and cortical collecting duct (CCD). In so doing, they regulate acid-base balance, vascular volume, and blood pressure. Cl absorption is either electrogenic and amiloride-sensitive or electroneutral and thiazide-sensitive. However, which Cl transporter(s) are targeted by these diuretics is debated. While epithelial Na+ channel (ENaC) does not transport Cl, it modulates Cl transport probably by generating a lumen-negative voltage, which drives Cl flux across tight junctions. In addition, recent evidence indicates that ENaC inhibition increases electrogenic Cl secretion via a type A intercalated cells. During ENaC blockade, Cl is taken up across the basolateral membrane through the Na+-K+−2Cl cotransporter (NKCC1) and then secreted across the apical membrane through a conductive pathway (a Cl channel or an electrogenic exchanger). The mechanism of this apical Cl secretion is unresolved. In contrast, thiazide diuretics inhibit electroneutral Cl absorption mediated by a Na+-dependent Cl/HCO3 exchanger. The relative contribution of the thiazide and the amiloride-sensitive components of Cl absorption varies between studies and probably depends on the treatment model employed. Cl absorption increases markedly with angiotensin and aldosterone administration, largely by upregulating the Na+-independent Cl/HCO3 exchanger pendrin. In the absence of pendrin [Slc26a4(−/−) or pendrin null mice], aldosterone-stimulated Cl absorption is significantly reduced, which attenuates the pressor response to this steroid hormone. Pendrin also modulates aldosterone-induced changes in ENaC abundance and function through a kidney-specific mechanism that does not involve changes in the concentration of a circulating hormone. Instead, pendrin changes ENaC abundance and function, at least in part, by altering luminal HCO3. This review summarizes mechanisms of Cl transport in CNT and CCD and how these transporters contribute to the regulation of extracellular volume and blood pressure.
American Physiological Society