The Acidosis Of Chronic Renal Failure.
1. Med Clin North Am. 1983 Jul;67(4):845-58. The acidosis of chronic renal failure is not due to bicarbonate wastage per se;rather, bicarbonate reabsorption per nephron is markedly enhanced. The ability tolower the urine pH is preserved. While overall ammonium production may bedecreased in chronic renal failure, both ammonium production and excretion aremarkedly increased when expressed per remaining nephron. Titratable acidexcretion in chronic renal failure is essentially maximal, owing to the effect ofparathyroid hormone on phosphate excretion by the kidney. Thus, it appears thatthe acidosis of chronic renal failure is solely the consequence of the reduction in functional renal mass. Extrarenal buffering may contribute substantially tothe maintenance of a near normal acid-base status in patients with markedreduction in glomerular filtration rate. That homeostasis is so well preserveduntil glomerular filtration rate falls to approximately 10 per cent of normal is remarkable; the price, however, may be considerable. Prolonged acidosis maymagnify the tendency of renal failure to cause osteodystrophy. An obvioustreatment for the acidosis of renal failure is exogenous alkali therapy. Continue reading >>