Lithium clearance in mineralocorticoid escape in humans
Lithium clearance (C/sub Li/) has been advanced as an indicator of Na delivery from the proximal tubules. The authors studied C/sub Li/ in eight healthy males before and after mineralocorticoid escape, a maneuver that may induce suppression of fractional proximal Na reabsorption (FPR/sub Na/). FPR/sub Na/ was also estimated from changes in maximal free water clearance (C/sub H/sub 2/O/). Plasma volume was measured as the /sup 131/I-labeled albumin distribution space. Extracellular fluid volume was estimated as the /sup 82/Br vector distribution volume. According to the latter method, FPR/sub Na/ dropped whereas inulin clearance rose. The changes in C/sub Li/ were surprisingly large. If lithium is a valid marker of Na handling in the proximal tubule in humans, this change would imply a fall in FPR/sub Na/, suggesting a much larger shift in tubular Na reabsorption in escape than hitherto suspected. In addition, it would suggest that the inevitable back diffusion of a part of the solute-free water in the distal nephron, and thus overestimation of FPR/sub Na/ by the C/sub H/sub 2/O/ method, increases importantly during escape. Alternately, lithium may not be a good marker of proximal tubular Na handling. For instance, both lithium reabsorption and escape may take place beyond the proximal tubule, or lithium may be excreted in the distal nephron in certain conditions. Present methods do not permit further analysis of these options in the human model.
- Research Organization:
- University Hospital, Utrecht, Netherlands
- OSTI ID:
- 5970502
- Journal Information:
- Am. J. Physiol.; (United States), Vol. 252:3
- Country of Publication:
- United States
- Language:
- English
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