Chapter 3: The Proximal Tubule

Chapter Three: How the proximal tubule is like Elizabeth Warren and other truths my friends from Boston taught me

References for Chapter 3:

1. Faisy C, Meziani F, PLanquette B et al. Effect of Acetazolamide vs. Placebo on Duration of Invasive Mechanical Ventilation among patients with chronic obstructive pulmonary disease: a randomized clinical trial. JAMA 2016 https://pubmed.ncbi.nlm.nih.gov/26836730/

This randomized controlled double blinded multi-center study of acetazolamide to shorten the duration of mechanical ventilation (known as DIABLO) there was no statistically significant difference (though it may have been underpowered to do so).

1. Salazar H, Swanson J, Mozo K, White AC, Cabda MM Acute Mountain sickness impact among travelers to Cusco, Peru J Travel Med 2012 https://pubmed.ncbi.nlm.nih.gov/22776382/ 

Investigators found that altitude sickness is common and alters travel plans for 1 in 5 travelers but was prescribed infrequently.

1. Buzas GM and Supuran CT. Journal of enzyme inhibition and medicinal chemistry 2015 https://www.tandfonline.com/doi/full/10.3109/14756366.2015.1051042

This review describes the use of acetazolamide to treat peptic ulcers and how it was later learned that H. pylori have carbonic anhydrase

1.  NORDIC idiopathic intracranial Hypertension Study Writing Committee. The effect of acetazolamide on visual function in patients with idiopathic intracranial hypertension and mild visual loss: the idiopathic intracranial hypertension treatment trial. JAMA 2014 https://pubmed.ncbi.nlm.nih.gov/24756514/

In this multi-centered trial, acetazolamide and low sodium weight reduction diet improved mild visual loss more than diet alone. 

1. Mullens W et al. Rationale and design of the ADVOR (acetazolamide in decompensated heart failure with volume overload trial) Eur J Heart Failure 2018 https://pubmed.ncbi.nlm.nih.gov/30238574/

This reference explains the rationale for this ongoing trial.

1. Gordon CE, Vantzelfde S and Francis JM. Acetazolamide in Lithium-induced nephrogenic diabetes insipidus NEJM 2016 https://www.nejm.org/doi/full/10.1056/NEJMc1609483

A case report of efficacy of acetazolamide in a patient with severe polyuria.

1. Zehnder D et al. Expression of 25-hydroxyvitamin D-1alpha hydroxylase in the human kidney. JASN 1999 

This report explores the activity in the enzyme in nephron segments and suggests that the distal nephron may play an important part in the formation of 1,25 vitamin D https://jasn.asnjournals.org/content/10/12/2465

Outline: Chapter 3

    - This is chapter three, kind of the first real chapter of the book

- Proximal Tubule

- Reabsorbs 55-60% of the filtrate

    - Active sodium resorption

        - 65% of the sodium

        - 55% of the chloride

        - 90% of HCO3

        - 100% glucose and amino acids

    - Passive water resorption

    - Water resorption is isosmotic

    - Secretion of

        - Hydrogen