Sodium balance is not just a renal affair
Open accessAbstract
PURPOSE OF REVIEW: The equilibration theory of extracellular body fluids is tightly linked to sodium (Na) metabolism. It is accepted that with changes in salt intake, renal sodium elimination will prevent any change in interstitial Na content and concentration. This review summarizes recent anomalous findings regarding salt and water homeostasis that are inconsistent with current assumptions. RECENT FINDINGS: Recent findings from chemical analysis studies of laboratory animals, as well as noninvasive quantitative Na MRI (Na-MRI) studies in patients, have shown that remarkable amounts of Na are stored in muscle and in skin without commensurate water retention. Furthermore, an ultra-long Na balance study in humans suggests the presence of endogenous clocks that generate weekly and monthly infradian rhythmicity of Na storage independent of salt intake. Animal experiments suggest that fluids in the skin interstitium are hypertonic compared with plasma, and that interstitial osmotic stress induces local extrarenal immune cell and lymph-capillary driven mechanisms for electrolyte clearance and maintenance of the internal environment. SUMMARY: Recent quantitative evidence challenges current ideas on salt and water homeostasis, and suggests that Na homeostasis cannot be maintained without additional previously unappreciated extrarenal regulatory mechanisms.
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Inclusion of the peripheral storage mechanism is supported by the growing understanding of the role of nonosmotic Na+ storage in skin, muscle, and other tissue in regulating Na+.
“Inclusion of this mechanism is supported by the growing understanding of the role of nonosmotic Na ϩ storage in skin, muscle, and other tissue in regulating Na ϩ (34,44).”
From Evaluation of renal and cardiovascular protection mechanisms of SGLT2 inhibitors: model-based analysis of clinical data (2018) · cites this paper as [34]
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- Authors
- Titze, J.
- Affiliations
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- Corresponding author
- Titze, Jens
- ORCID
- Titze, Jens
- Venue
- Current Opinion in Nephrology and Hypertension
- Published
- 2014-03
- Volume
- 23
- Issue
- 2
- Pages
- 101-105
- ISSN
- 1062-4821 (ISSN-L)
- PMC
- PMC4932095
- OpenAlex
- W2087230333
- Cited by
- 130
- References
- 22
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 4 · 2023: 8 · 2022: 12 · 2021: 7 · 2020: 14 · 2019: 12 · 2018: 8 · 2017: 14 · 2016: 9 · 2015: 15 · 2014: 10
- FWCI
- 14.90
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Current Opinion in Nephrology & Hypertension (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL118579)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Ion Transport and Channel Regulation
- Keywords
- sodium homeostasis, muscle sodium, skin sodium, salt and water homeostasis, sodium MRI, immune cells
- MeSH terms
- Animals, Body Water, Humans, Immune System, Kidney, Magnetic Resonance Imaging, Osmotic Pressure, Skin, Sodium, Sodium, Dietary, Time Factors, Water-Electrolyte Balance, Muscle, Skeletal
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