Distal Convoluted Tubule: Renal physiology USMLE Step 1

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Distal Convoluted Tubule: Renal physiology USMLE Step 1

The distal convoluted tubule (DCT) is a segment of the nephron in the kidney that plays an important role in regulating electrolyte balance and acid-base homeostasis. The DCT is located between the thick ascending limb of the loop of Henle and the collecting duct. It is primarily responsible for reabsorbing sodium ions and chloride ions, while secreting potassium ions and hydrogen ions.

The physiology of the DCT can be broken down into several key processes:

Sodium reabsorption: The DCT is a major site for the reabsorption of sodium ions. Sodium is actively transported out of the tubule cells into the interstitial fluid, which creates an electrochemical gradient that drives the passive reabsorption of other solutes, such as chloride ions and water.

Potassium secretion: The DCT also secretes potassium ions into the tubular fluid. This is facilitated by the activity of potassium channels on the apical membrane of the DCT cells.

Hydrogen ion secretion: The DCT plays an important role in maintaining acid-base balance by secreting hydrogen ions into the tubular fluid. This is mediated by the activity of hydrogen ion pumps (proton pumps) on the apical membrane of the DCT cells.

Calcium reabsorption: The DCT reabsorbs calcium ions via both active and passive mechanisms. Parathyroid hormone (PTH) plays a key role in regulating calcium reabsorption in the DCT.

Regulation of blood pressure: The DCT is also involved in regulating blood pressure by secreting the hormone renin in response to decreased blood volume or pressure. Renin catalyzes the formation of angiotensin II, which stimulates the release of aldosterone from the adrenal glands. Aldosterone, in turn, promotes sodium reabsorption in the DCT, which increases blood volume and pressure.

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