Hydrogen Ion Turnover in Health and in Renal Disease

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Abstract
Definite quantities of H+ ion are produced each day from the metabolic pool in the form of H2SO4 and organic acids, and in various types of disease the normal renal excretion of these protons is interfered with in a variety of ways. There may be too few nephrons. There may be too few proton acceptors or buffers filtered. There may be damage to tubules in parallel with damage to glomeruli. There may be specific defects in the tubular mechanisms of donation of protons to urinary buffers. There may be impairment of tubular production of the proton acceptor NH3. The etiology of these defects may be acquired, developmental, or genetic, but the biochemical lesions responsible for these defects have not been defined.