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Most of its clinical manifestations are the result of hypokalemia. The diagnosis is one of exclusion, mainly of surreptitious vomiting and diuretic abuse. The primary cause remains unknown but the most likely candidate is reduced sodium chloride reabsorption in the thick ascending limb of Henle's loop. Current therapy focuses on multiple agents to reduce massive potassium loss.

These experiments were designed to test the thesis that prostaglandins produced by the cortical collecting tubule cells could modulate the vasopressin-induced osmotic water permeability (Pf). The dose-response curve for vasopressin-sensitive Pf showed the Km to be 1 microU ml-1. Exogenous PGE2 and PGF2 alpha (0.1 microM) inhibited the Pf induced by 1 microU ml-1 vasopressin when they were present in the bath solution. PGE2 (0.1 microM) in the lumen failed to inhibit the normal vasopressin-induced Pf, thus indicating an asymmetrical effect. Exposure of the tubule to 10 microM meclofenamate following stimulation of Pf by 0.2, 1.0, 10, or 100 microU ml-1 vasopressin failed to further increase the Pf. Pretreatment with meclofenamate or arachidonic acid (AA) failed to produce a different Pf response from controls. Neither naproxen (10 microM) nor AA altered significantly the Pf induced by 1 microU ml-1 vasopressin while methylisobutylxanthine, as expected, significantly enhanced Pf. The stable endoperoxide analogs U-44069 and U-46619, which mimic the actions of thromboxane A2 in many systems and which can stimulate osmotic water flow in the toad bladder, had no effect on Pf. Acidifying the lumen to pH 5.2 enhanced the Pf induced by 1 microU ml-1 vasopressin but subsequent exposure to meclofenamate did not cause an additional increment. These experiments demonstrate that exogenous prostaglandins are effective only from the basolateral surface of the cortical collecting tubule; that endogenous prostaglandins, if produced by these epithelial cells, do not produce demonstrable effects on vasopressin-sensitive Pf; and that endogenously produced thromboxane is not the likely reason for these results. Finally, the cortical collecting tubule response to many factors modulating Pf is considerably different from salientian urinary bladders.

Lactate production and ion fluxes were measured in isolated rat papillary collecting duct cells (PCD) to gain further insight into the transport properties of the papillary collecting duct. Lactate production was found to be inhibited by bumetanide in a dose-dependent manner, a maximum inhibition of 22% was obtained at 10(-4) M bumetanide and an apparent Ki of 10(-8) M was determined. Bumetanide inhibition of lactate production was dependent on the presence of sodium and chloride. Chloride removal inhibited lactate production also by 20%. Bumetanide (10(-4) M) inhibited by 35% sodium uptake into PCD cells exposed to 10 mM ouabain and chloride uptake into ion depleted PCD cells by 40%. In addition, this bumetanide-sensitive chloride uptake was dependent on the presence of sodium and potassium in the incubation medium. Furthermore, 86Rb uptake into these cells was significantly reduced in the presence of 10(-4) M bumetanide. These data provide evidence for the operation of a Na-K-Cl cotransport system in rat papillary collecting duct cells. This transport system might be involved in active chloride transport in the papillary collecting duct and/or volume regulation of the PCD cells.