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Physiological Reviews, Vol. 80, No. 1, January 2000, pp. 277-313
Copyright ©2000 by the American Physiological Society
Department of Medicine, University of Colorado School of Medicine and Department of Veterans Affairs Medical Center, Denver, Colorado
Reilly, Robert F. and
David H. Ellison.
Mammalian Distal Tubule: Physiology, Pathophysiology, and
Molecular Anatomy. Physiol. Rev. 80: 277-313, 2000.
The distal tubule of the
mammalian kidney, defined as the region between the macula densa and
the collecting duct, is morphologically and functionally heterogeneous.
This heterogeneity has stymied attempts to define functional properties
of individual cell types and has led to controversy concerning
mechanisms and regulation of ion transport. Recently, molecular
techniques have been used to identify and localize ion transport
pathways along the distal tubule and to identify human diseases that
result from abnormal distal tubule function. Results of these studies
have clarified the roles of individual distal cell types. They suggest
that the basic molecular architecture of the distal nephron is
surprisingly similar in mammalian species investigated to date. The
results have also reemphasized the role played by the distal tubule in regulating urinary potassium excretion. They have clarified how both
peptide and steroid hormones, including aldosterone and estrogen, regulate ion transport by distal convoluted tubule cells. Furthermore, they highlight the central role that the distal tubule plays in systemic calcium homeostasis. Disorders of distal nephron function, such as Gitelman's syndrome, nephrolithiasis, and adaptation to diuretic drug administration, emphasize the importance of this relatively short nephron segment to human physiology. This review integrates molecular and functional results to provide a contemporary picture of distal tubule function in mammals.
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