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In respiratory acidosis, how does the kidney compensate?
AIt excretes more bicarbonate and retains H+
BIt conserves more chloride and secretes K+
CIt excretes more chloride and retains Na+
DIt conserves more bicarbonate and secretes H+
Answer & Solution
Correct answer: D. It conserves more bicarbonate and secretes H+
1. Respiratory acidosis is an excess of carbon dioxide, so carbonic acid is too high.
2. The lungs are the failing arm here, so compensation must come from the kidney.
3. The kidney increases the conservation of bicarbonate from the filtrate.
4. At the same time it increases the secretion of hydrogen ions into the filtrate.
5. Blood bicarbonate rises, restoring the 20 to 1 ratio against the raised carbonic acid.
6. Excreting bicarbonate instead would deepen the acidosis, which is the trap in the first option.
7. In respiratory alkalosis the kidney does the reverse, making less bicarbonate and reabsorbing hydrogen ions.
_Source: OpenStax Anatomy and Physiology (CC BY 4.0), Ch 26 "Fluid, Electrolyte, and Acid-Base Balance", section Metabolic Compensation_
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