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1 Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
2 Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
* To whom correspondence should be addressed. E-mail: hassane.amlal{at}uc.edu.
Chronic metabolic acidosis (CMA) is associated with decreased NaCl reabsorption in the proximal tubule (PT). However, the effect of CMA on Na+ transport in the distal tubule (DT) and collecting duct (CD) is poorly understood. Rats were placed in metabolic cages and had access to water (control), 0.28M NH4Cl, or 0.28M KCl solutions in a pair-feeding protocol for five days (5d). Metabolic acidosis developed within 24h in NH4Cl-, but not in KCl-loaded rats. Interestingly, NH4Cl- but not KCl-loaded rats exhibited a significant natriuresis after 24h of treatment. Urinary Na+ excretion increased from 1.94 to 2.97 mEq/24h, P<0.001, and returned to below baseline level (1.67 mEq/l) after 5d of CMA. The protein abundance of cortical Na-Cl cotransporter (NCC) remained unchanged at 24h, but increased significantly (P<0.01) after 5d of CMA. The protein abundance of alpha-, beta-, and gamma-subunits of ENaC in the cortex decreased sharply during the first 24h, and then returned to baseline levels after 5d of CMA. Interestingly, Sgk1 expression decreased after 24h (-31%, P<0.05), and then returned to baseline after 5d of CMA. Nedd4-2 expression was not altered during CMA. CMA enhanced serum aldosterone levels by 54% and increased the expression of aldosterone synthase in the adrenal gland by 134% after 5d of CMA. In conclusion, metabolic acidosis has dual effects on urinary Na+ excretion. The early natriuresis results from decreased Na+ reabsorption in the PT and Sgk1-related decreased ENaC activity in the DT and CD. Aldosterone-induced upregulation of NCC, Sgk1, and ENaC likely contributes to the anti-natriuretic phase of metabolic acidosis. This adaptation prevents Na+ wasting and volume depletion during chronic acid insult.
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