title: Light-chain-induced renal tubular acidosis: effect of sodium bicarbonate on sodium-proton exchange.
abstract: We measured sodium-proton (Na+/H+) exchange in lymphocytes and platelets of a 46-year-old woman with the adult Fanconi syndrome before, during, and after treatment with NaHCO3. Kappa light chains in her urine and unique but rarely observed crystalline structures confirmed the presence of light-chain nephropathy. Her glomerular filtration rate was only moderately impaired at 72 ml/min. NaHCO3 at 1, 3, and 5 mmol/kg/day for 5 days increased her serum HCO3 and pH from 17 to 21 mmol/l and 7.28 to 7.39 respectively. Plasma renin and aldosterone values were decreased by NaHCO3. Na+/H+ exchange (delta Hi/min) was measured with the fluorescent marker BCECF after acidification of lymphocytes and platelets with sodium propionate at five (10-50 mM) doses. Na+/H+ exchange was accelerated in this patient compared to normal controls. NaHCO3 treatment significantly decreased Na+/H+ exchange in lymphocytes, but not in platelets. These findings suggest that Na+/H+ exchange can be influenced by NaHCO3 ingestion at doses that only modestly affect systemic pH. Since Na+/H+ exchange is involved in stimulus response coupling, cell growth regulation, cell differentiation, and perhaps the progression of nephrosclerosis, these observations may have clinical relevance.
authors.affiliation: Department of Internal Medicine, Nephrology University of Erlangen, Nürnberg, Germany.
authors.forename: H P
authors.initials: HP
authors.lastname: Reusch
authors.forename: J F
authors.initials: JF
authors.lastname: Mann
authors.forename: M J
authors.initials: MJ
authors.lastname: Mihatch
authors.forename: W
authors.initials: W
authors.lastname: Siffert
authors.forename: F C
authors.initials: FC
authors.lastname: Luft
mesh_terms: D000141:Acidosis, Renal Tubular / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism* / Q000473:pathology; D001792:Blood Platelets / Q000187:drug effects / Q000378:metabolism; D005198:Fanconi Syndrome / Q000150:complications; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007145:Immunoglobulin kappa-Chains / Q000652:urine*; D007678:Kidney Glomerulus / Q000473:pathology / Q000648:ultrastructure; D008214:Lymphocytes / Q000187:drug effects / Q000378:metabolism*; D008875:Middle Aged; D012964:Sodium / Q000378:metabolism; D017693:Sodium Bicarbonate / Q000494:pharmacology / Q000627:therapeutic use*; D017923:Sodium-Hydrogen Exchangers / Q000378:metabolism* / Q000502:physiology
chemical_list: D007145:Immunoglobulin kappa-Chains; D017923:Sodium-Hydrogen Exchangers; D017693:Sodium Bicarbonate; D012964:Sodium