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Renal metabolism of amino acids: its role in interorgan amino acid exchange^1,2,3

¹ From the Department of Surgery, Maastricht University, Maastricht, Netherlands (MCGvdP, PBS, NEPD, and CHCD), and the Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (KCHF).

The kidneys play a role in the synthesis and interorgan exchange of several amino acids. The quantitative importance of renal amino acid metabolism in the body is not, however, clear. We review here the role of the kidney in the interorgan exchange of amino acids, with emphasis on quantitative aspects. We reviewed relevant literature by using a computerized literature search (PubMed) and checking relevant references from the identified articles. Our own data are discussed in the context of the literature. The kidney takes up glutamine and metabolizes it to ammonia. This process is sensitive to pH and serves to maintain acid-base homeostasis and to excrete nitrogen. In this way, the metabolism of renal glutamine and ammonia is complementary to hepatic urea synthesis. Citrulline, derived from intestinal glutamine breakdown, is converted to arginine by the kidney. Renal phenylalanine uptake is followed by stoichiometric tyrosine release, and glycine uptake is accompanied by serine release. Certain administered oligopeptides (eg, glutamine dipeptides) are converted by the kidneys to their constituent components before they can be used in metabolic processes. The kidneys play an important role in the interorgan exchange of amino acids. Quantitatively, for several important amino acids, the kidneys are as important as the gut in intermediary metabolism. The kidneys may be crucial "mediators" of the beneficial effects of specialized, disease-specific feeding solutions such as those enriched in glutamine dipeptides.

Key Words: Kidney • amino acids • urea • ammonia • glutamine • citrulline • arginine • phenylalanine • tyrosine • glycine • serine • asymmetrical dimethylarginine • homocysteine • dipeptides • nutrition • gut • liver • interorgan nitrogen exchange • acidosis • renal failure

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