Sodium is the main ion of the extracellular compartments, and it is through control of sodium reabsorption that the kidneys maintain volume homoeostasis and systemic blood pressure. The amount of sodium that is first filtered by the glomerulus and then reabsorbed in the tubule is quite staggering: assuming a glomerular filtration rate of 100 mL/min and a serum sodium concentration of 140 mmol/L, an average-sized person filters about 20,000 mmol of sodium per day, equivalent to the amount in 1.2 kg of cooking salt. In the steady state, the amount of sodium excreted is equal to the amount ingested. An average Western diet contains about 8–10 g of salt per day; a low-salt diet may be around 2 g per day. Under physiological conditions, the tubules reabsorb about 99% of filtered sodium. This enormous task is accomplished by a combination of distinct and sequentially oriented sodium or sodium-coupled transport systems along the nephron and the concerted and parallel action of some of these systems within the kidney. These are described, along with the consequences of disorders of the processes.
A diagnostic approach to salt-losing states such as Fanconi, Bartter Gitelman and other syndromes, and hypoaldosteronism, is described.