Mechanisms of Sodium Balance: Total Body Sodium, Surrogate Variables and Renal Sodium Excretion

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Resumé

The classical concepts of human sodium balance include 1) a total pool of Na + of ≈4,200 mmol (total body sodium, TBS) distributed primarily in the extracellular fluid (ECV) and bone, 2) intake variations of 0.03 to ≈6 mmol·kg body mass –1·day –1, 3) asymptotic transitions between steady states with a halftime (T½) of 21 h, 4) changes in TBS driven by sodium intake measuring ≈1.3 day [ΔTBS/Δ(Na + intake/day)], 5) adjustment of Na + excretion to match any diet thus providing metabolic steady state, and 6) regulation of TBS via controlled excretion (90–95% renal) mediated by surrogate variables. The present focus areas include 1) uneven, nonosmotic distribution of increments in TBS primarily in “skin,” 2) long-term instability of TBS during constant Na + intake, and 3) physiological regulation of renal Na + excretion primarily by neurohumoral mechanisms dependent on ECV rather than arterial pressure. Under physiological conditions 1) the nonosmotic distribution of Na + seems conceptually important, but quantitatively ill defined; 2) long-term variations in TBS represent significant deviations from steady state, but the importance is undetermined; and 3) the neurohumoral mechanisms of sodium homeostasis competing with pressure natriuresis are essential for systematic analysis of short-term and long-term regulation of TBS. Sodium homeostasis and blood pressure regulation are intimately related. Real progress is slow and will accelerate only through recognition of the present level of ignorance. Nonosmotic distribution of sodium, pressure natriuresis, and volume-mediated regulation of renal sodium excretion are essential intertwined concepts in need of clear definitions, conscious models, and future attention.

OriginalsprogEngelsk
TidsskriftAmerican Journal of Physiology: Regulatory, Integrative and Comparative Physiology
Vol/bind315
Udgave nummer5
Sider (fra-til)R945-R962
ISSN0363-6119
DOI
StatusUdgivet - nov. 2018

Fingeraftryk

Natriuresis
Renal Elimination
Homeostasis
Arterial Pressure
Diet
Skin

Citer dette

@article{6c5e349aca854db7baca00c852911339,
title = "Mechanisms of Sodium Balance: Total Body Sodium, Surrogate Variables and Renal Sodium Excretion",
abstract = "The classical concepts of human sodium balance include 1) a total pool of Na + of ≈4,200 mmol (total body sodium, TBS) distributed primarily in the extracellular fluid (ECV) and bone, 2) intake variations of 0.03 to ≈6 mmol·kg body mass –1·day –1, 3) asymptotic transitions between steady states with a halftime (T½) of 21 h, 4) changes in TBS driven by sodium intake measuring ≈1.3 day [ΔTBS/Δ(Na + intake/day)], 5) adjustment of Na + excretion to match any diet thus providing metabolic steady state, and 6) regulation of TBS via controlled excretion (90–95{\%} renal) mediated by surrogate variables. The present focus areas include 1) uneven, nonosmotic distribution of increments in TBS primarily in “skin,” 2) long-term instability of TBS during constant Na + intake, and 3) physiological regulation of renal Na + excretion primarily by neurohumoral mechanisms dependent on ECV rather than arterial pressure. Under physiological conditions 1) the nonosmotic distribution of Na + seems conceptually important, but quantitatively ill defined; 2) long-term variations in TBS represent significant deviations from steady state, but the importance is undetermined; and 3) the neurohumoral mechanisms of sodium homeostasis competing with pressure natriuresis are essential for systematic analysis of short-term and long-term regulation of TBS. Sodium homeostasis and blood pressure regulation are intimately related. Real progress is slow and will accelerate only through recognition of the present level of ignorance. Nonosmotic distribution of sodium, pressure natriuresis, and volume-mediated regulation of renal sodium excretion are essential intertwined concepts in need of clear definitions, conscious models, and future attention.",
keywords = "Hormonal control, Renal function, Sodium distribution, Sodium excretion, Total body sodium, Water-Electrolyte Balance/physiology, Homeostasis/physiology, Humans, Renin-Angiotensin System/physiology, Sodium/metabolism, Animals, Biological Transport/physiology, Body Fluids/physiology, Natriuresis/physiology",
author = "Peter Bie",
year = "2018",
month = "11",
doi = "10.1152/ajpregu.00363.2017",
language = "English",
volume = "315",
pages = "R945--R962",
journal = "American Journal of Physiology: Regulatory, Integrative and Comparative Physiology",
issn = "0363-6119",
publisher = "American Physiological Society",
number = "5",

}

TY - JOUR

T1 - Mechanisms of Sodium Balance

T2 - Total Body Sodium, Surrogate Variables and Renal Sodium Excretion

AU - Bie, Peter

PY - 2018/11

Y1 - 2018/11

N2 - The classical concepts of human sodium balance include 1) a total pool of Na + of ≈4,200 mmol (total body sodium, TBS) distributed primarily in the extracellular fluid (ECV) and bone, 2) intake variations of 0.03 to ≈6 mmol·kg body mass –1·day –1, 3) asymptotic transitions between steady states with a halftime (T½) of 21 h, 4) changes in TBS driven by sodium intake measuring ≈1.3 day [ΔTBS/Δ(Na + intake/day)], 5) adjustment of Na + excretion to match any diet thus providing metabolic steady state, and 6) regulation of TBS via controlled excretion (90–95% renal) mediated by surrogate variables. The present focus areas include 1) uneven, nonosmotic distribution of increments in TBS primarily in “skin,” 2) long-term instability of TBS during constant Na + intake, and 3) physiological regulation of renal Na + excretion primarily by neurohumoral mechanisms dependent on ECV rather than arterial pressure. Under physiological conditions 1) the nonosmotic distribution of Na + seems conceptually important, but quantitatively ill defined; 2) long-term variations in TBS represent significant deviations from steady state, but the importance is undetermined; and 3) the neurohumoral mechanisms of sodium homeostasis competing with pressure natriuresis are essential for systematic analysis of short-term and long-term regulation of TBS. Sodium homeostasis and blood pressure regulation are intimately related. Real progress is slow and will accelerate only through recognition of the present level of ignorance. Nonosmotic distribution of sodium, pressure natriuresis, and volume-mediated regulation of renal sodium excretion are essential intertwined concepts in need of clear definitions, conscious models, and future attention.

AB - The classical concepts of human sodium balance include 1) a total pool of Na + of ≈4,200 mmol (total body sodium, TBS) distributed primarily in the extracellular fluid (ECV) and bone, 2) intake variations of 0.03 to ≈6 mmol·kg body mass –1·day –1, 3) asymptotic transitions between steady states with a halftime (T½) of 21 h, 4) changes in TBS driven by sodium intake measuring ≈1.3 day [ΔTBS/Δ(Na + intake/day)], 5) adjustment of Na + excretion to match any diet thus providing metabolic steady state, and 6) regulation of TBS via controlled excretion (90–95% renal) mediated by surrogate variables. The present focus areas include 1) uneven, nonosmotic distribution of increments in TBS primarily in “skin,” 2) long-term instability of TBS during constant Na + intake, and 3) physiological regulation of renal Na + excretion primarily by neurohumoral mechanisms dependent on ECV rather than arterial pressure. Under physiological conditions 1) the nonosmotic distribution of Na + seems conceptually important, but quantitatively ill defined; 2) long-term variations in TBS represent significant deviations from steady state, but the importance is undetermined; and 3) the neurohumoral mechanisms of sodium homeostasis competing with pressure natriuresis are essential for systematic analysis of short-term and long-term regulation of TBS. Sodium homeostasis and blood pressure regulation are intimately related. Real progress is slow and will accelerate only through recognition of the present level of ignorance. Nonosmotic distribution of sodium, pressure natriuresis, and volume-mediated regulation of renal sodium excretion are essential intertwined concepts in need of clear definitions, conscious models, and future attention.

KW - Hormonal control

KW - Renal function

KW - Sodium distribution

KW - Sodium excretion

KW - Total body sodium

KW - Water-Electrolyte Balance/physiology

KW - Homeostasis/physiology

KW - Humans

KW - Renin-Angiotensin System/physiology

KW - Sodium/metabolism

KW - Animals

KW - Biological Transport/physiology

KW - Body Fluids/physiology

KW - Natriuresis/physiology

U2 - 10.1152/ajpregu.00363.2017

DO - 10.1152/ajpregu.00363.2017

M3 - Review

C2 - 30110176

VL - 315

SP - R945-R962

JO - American Journal of Physiology: Regulatory, Integrative and Comparative Physiology

JF - American Journal of Physiology: Regulatory, Integrative and Comparative Physiology

SN - 0363-6119

IS - 5

ER -