Calcium reabsorption in the distal tubule: regulation by sodium, pH, and flow
We developed a mathematical model of Ca2+ transport along the late distal convoluted tubule (DCT2) and the connecting tubule (CNT) to investigate the mechanisms that regulate Ca2+ reabsorption in the DCT2-CNT. The model accounts for apical Ca2+ influx across transient receptor potential vanilloid 5 (TRPV5) channels and basolateral Ca2+ efflux via plasma membrane Ca2+-ATPase pumps and type 1 Na+/Ca2+ exchangers (NCX1). Model simulations reproduce experimentally observed variations in Ca2+ uptake as a function of extracellular pH, Na+, and Mg2+ concentration. Our results indicate that amiloride enhances Ca2+ reabsorption in the DCT2-CNT predominantly by increasing the driving force across NCX1, thereby stimulating Ca2+ efflux. They also suggest that because aldosterone upregulates both apical and basolateral Na+ transport pathways, it has a lesser impact on Ca2+ reabsorption than amiloride. Conversely, the model predicts that full NCX1 inhibition and parathyroidectomy each augment the Ca2+ load delivered to the collecting duct severalfold. In addition, our results suggest that regulation of TRPV5 activity by luminal pH has a small impact, per se, on transepithelial Ca2+ fluxes; the reduction in Ca2+ reabsorption induced by metabolic acidosis likely stems from decreases in TRPV5 expression. In contrast, elevations in luminal Ca2+ are predicted to significantly decrease TRPV5 activity via the Ca2+-sensing receptor. Nevertheless, following the administration of furosemide, the calcium-sensing receptor-mediated increase in Ca2+ reabsorption in the DCT2-CNT is calculated to be insufficient to prevent hypercalciuria. Altogether, our model predicts complex interactions between calcium and sodium reabsorption in the DCT2-CNT.