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maximum, or Tm, transport systems are common; see 4) However, at low plasma concentrations, about 90% of the PAH entering the kidney is removed from the plasma and excreted in the urine Its clearance, therefore, is nearly as great as the renal plasma flow In fact, the PAH clearance is used as a measure of renal plasma flow, usually called the effective renal plasma flow to indicate that its value is slightly less than the true renal plasma flow So far, the freely filtered substances we have discussed have clearance values lying between the GFR and the renal plasma flow Can a freely filtered substance have a clearance value less than the GFR Yes In fact, many freely filtered substances have clearance values of zero! If a filtered substance is completely removed from the nephron by reabsorption or degradation, then none appears in the urine, and the clearance is zero We have already seen one example of this: insulin, which is all degraded Another is glucose, which is normally all reabsorbed Many freely filtered substances have clearance values less than the GFR but greater than zero (eg, sodium, chloride, and urea) On occasion, some freely filtered substances have a clearance greater than the GFR (eg, PAH and potassium) What can the clearance of a substance tell us If we know the GFR (as assessed from inulin clearance) and the clearance of a given substance, then any difference between clearance and GFR represents net secretion or reabsorption (or, in a few rare cases, renal synthesis) If the clearance of a substance exactly equals the GFR, then there has been no net reabsorption or secretion If the clearance is greater than the GFR, there must have been net secretion Finally, if the clearance is less than the GFR, there must have been net reabsorption The word net in this description is important As we will see, a number of substances are reabsorbed in certain regions of the nephron and secreted in other regions The net result of these processes is the sum of everything that happens along the nephron To illustrate these concepts, consider potassium clearance Potassium is a small, freely filtered ion About 70% of the filtered load is reabsorbed in the proximal tubule, and another 20% or so is reabsorbed in the loop of Henle The rest of the nephron has mechanisms to both secrete and reabsorb potassium Under some conditions (eg, when potassium ingestion is low), reabsorption dominates, reducing the excretion of potassium and thus resulting in a clearance less than the GFR In other conditions (eg, after ingesting large amounts of potassium in citrus fruit), secretion dominates In this case, not only is the previously reabsorbed amount secreted back into the tubule, but additional potassium is secreted The result is that more potassium is excreted than is filtered, and potassium clearance is greater than the GFR. rdlc pdf 417 PDF417 Barcode Creating Library for RDLC Reports | Generate ...
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