Urine testing is important because it can detect acid–base imbalances. For instance, uncontrolled diabetes results in highly acidic urine. If the diabetes remains uncontrolled, the kidneys could become over-stressed and malfunction, which could lead to coma or death.
Within the human body, fluids such as blood must be maintained within the narrow range of 7.35 to 7.45, making it slightly alkaline. Outside that range, pH becomes incompatible with life; proteins are denatured and digested, enzymes lose their ability to function, and the body is unable to sustain itself.
To maintain this narrow range of pH the body has a powerful buffering system. Acid–base imbalances that overcome this system are compensated in the short term by changing the rate of ventilation.
Kidneys and Acid–Base Balance
The kidneys have two very important roles in maintaining the acid–base balance:
They reabsorb bicarbonate from urine.
They excrete hydrogen ions into urine.
The kidneys are slower to compensate than the lungs, but renalphysiology has several powerful mechanisms to control pH by the excretion of excess acid or base. The major, homeostatic control point for maintaining a stable pH balance is renal excretion.
Bicarbonate (HCO3-) does not have a transporter, so its reabsorption involves a series of reactions in the tubule lumen and tubular epithelium. In response to acidosis, the tubular cells reabsorb more bicarbonate from the tubular fluid, and the collecting duct cells secrete more hydrogen and generate more bicarbonate, and ammoniagenesis leads to an increase in the formation of the NH3 buffer.
In response to alkalosis, the kidneys may excrete more bicarbonate by decreasing hydrogen ion secretion from the tubular epithelial cells, and lowering the rates of glutamine metabolism and ammonium excretion.