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Review
. 2018 Oct;23 Suppl 4(Suppl Suppl 4):44-49.
doi: 10.1111/nep.13465.

Salt, water and nephron: Mechanisms of action and link to hypertension and chronic kidney disease

Qi Qian  1
Affiliations
Review

Salt, water and nephron: Mechanisms of action and link to hypertension and chronic kidney disease

Qi Qian. Nephrology (Carlton). 2018 Oct.

Abstract

Our knowledge on sodium and water homeostasis and regulation continues to evolve. A considerable amount of new information in this area has emerged in recent years. This review summarizes existing and new literature and discusses complex multi-organ effects of high-salt and low-water intake and role of arginine vasopressin in this process, as well as the potential clinical significance of non-osmotic sodium storage pool and rhythmicity of urine sodium excretion. It has become clear that sodium and water dysregulation can exert profound effects on kidney and vascular health, far greater than previously recognized. Maladaptation to a combined high-salt and low-water intake can be linked to the growing epidemic of hypertension and chronic kidney disease.

Keywords: arginine vasopressin (AVP); chronic kidney disease (CKD); hypertension; non-osmotic pool of sodium; salt and water regulation; skin.

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Figures

Figure 1
Figure 1
(A) and (B) Arginine vasopressin (AVP)‐mediated intraglomerular hypertension (HTN), a consequence of combined afferent vasodilation (modulation of tubuloglomerular feedback, TGF) and efferent vasoconstriction (activation of renin angiotensin‐aldosterone system, RAAS). AVP positively influences renal sodium absorption at the levels of thick‐ascending limb and distal tubules. It also increases urea cycling and intramedullary urea retention by upregulating urea transporters A1 (UT‐A1) and A3 (UT‐A3) expression. (C) AVP V2 receptor‐mediated regulation of aquaporin 2 (AQP2) and ENaC. Additionally, hypertonicity of extracellular fluids can efficiently activate tonicity response element binding protein (TonEBP) which upregulates AQP2 expression (independent of AVP). TonEBP also upregulates the expression of osmoprotective genes in the renal epithelial cells, critical in preserving medullary structural integrity.
Figure 2
Figure 2
Combined effects of high‐salt and low‐water intake and their link to hypertension (HTN) and kidney dysfunction.
See this image and copyright information in PMC

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