Abstract
The goal of this review is to integrate the possible contributions of changes in total body and plasma chloride and/or renal chloride transport (especially the recently described transport processes examined in detail in other chapters in this section) to the control of acid-base balance by the kidney. We emphasize a new hypothesis based on studies in rat and man that the state of chloride depletion per se is responsible for the maintenance phase of chronic metabolic alkalosis, whereas plasma volume depletion is a commonly associated epiphe nomenon. This view is based on our findings that chloride repletion can correct metabolic alkalosis despite the persistence, or even worsening of plasma volume depletion. We also briefly consider metabolic alkalosis caused by potassium depletion or mineralocorticoid excess, one type of renal tubular acidosis, and respiratory acidosis.
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