A new look at electrolyte transport in the distal tubule

Annu Rev Physiol. 2012;74:325-49. doi: 10.1146/annurev-physiol-020911-153225. Epub 2011 Sep 2.


The distal nephron plays a critical role in the renal control of homeostasis. Until very recently most studies focused on the control of Na(+), K(+), and water balance by principal cells of the collecting duct and the regulation of solute and water by hormones from the renin-angiotensin-aldosterone system and by antidiuretic hormone. However, recent studies have revealed the unexpected importance of renal intercalated cells, a subtype of cells present in the connecting tubule and collecting ducts. Such cells were thought initially to be involved exclusively in acid-base regulation. However, it is clear now that intercalated cells absorb NaCl and K(+) and hence may participate in the regulation of blood pressure and potassium balance. The second paradigm-challenging concept we highlight is the emerging importance of local paracrine factors that play a critical role in the renal control of water and electrolyte balance.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adenosine Triphosphate / metabolism
  • Animals
  • Biological Transport / physiology
  • Blood Pressure / physiology
  • Chlorides / metabolism
  • Colon / metabolism
  • Diuretics / pharmacology
  • Electrolytes / metabolism*
  • H(+)-K(+)-Exchanging ATPase / metabolism
  • Homeostasis / physiology
  • Humans
  • Kallikreins / metabolism
  • Kallikreins / physiology
  • Kidney Tubules, Distal / cytology
  • Kidney Tubules, Distal / metabolism*
  • Potassium / metabolism
  • Renin-Angiotensin System / physiology
  • Sodium Channels / physiology
  • Sodium Chloride / metabolism
  • Thiazides / pharmacology


  • Chlorides
  • Diuretics
  • Electrolytes
  • Sodium Channels
  • Thiazides
  • Sodium Chloride
  • Adenosine Triphosphate
  • Kallikreins
  • H(+)-K(+)-Exchanging ATPase
  • Potassium