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THE KIDNEY

Filtration, Secretion, and Reabsorption

A healthy volunteer participates in a clinical research project designed to examine the renal handling of
various substances. The results of the project are given below. Fill in the chart and determine how
substances A, B, C, and D are handled by the kidneys (i.e., filtered only, filtered and reabsorbed, or
filtered and secreted). It is known that 50% of substance B is bound to plasma protein, and 75% of
substance D is bound to plasma protein. Neither substance A nor C is protein bound. The urine flow rate is
0.5 ml/min.

[ANSWER]
This problem makes use of the relationship:

Excretion rate = filtered load - excretion rate + secretion rate

Ux * V = (GFR * Px) - R + S

Insulin: the clearance of inulin provides a measure of the GFR:

GFR = (Ux * V)/Px

Urine [x] Plasma [x] Ux * .V Clearance Filtered load Transport rate

Substance (mg/ml) (mg/ml) (mg/min) (ml/min) (mg/min) (mg/min)

Inulin 5.5 0.025 2.75 110.0 2.75 0


A 0.8 0.040 0.40 10.0 4.40 4.0 Reab.
B 7.5 0.068 3.75 55.1 3.74 ¡Ö0
C 11.0 0.010 5.50 550.0 1.10 4.4 Seert.
D 10.0 0.060 5.0 83.3 1.65 3.4 Seert.
A. This substance is freely filtered and almost entirely reabsorbed.

B. This substance is 50% bound to plasma protein. The total plasma [x] is used to calculate
clearance, but only the free [x] is used to calculate the filtered load. Because the filtered load equals
the excretion rate, there is no tubular transport.

C. This substance is freely filtered and also secreted.

D. This substance is 75% bound to plasma protein. Because the filtered load is less than the
excretion rate, the substance is secreted. Note: if it were not known that substances B and D were
bound to plasma protein, examination of their clearances would have led to the erroneous conclusion
that both were reabsorbed by the nephron.