, a LANGE medical book
p p p
Vander’sRenal p p
Physiology
Eighth Edition
p
Douglasp C.p Eaton,p PhD
DistinguishedpProfessorpofpPhysiologypan
dpProfessorpofpPediatricspDepartment
pofpPhysiology
EmorypUniversitypSchoolpofpMedicinepAtl
anta,pGeorgia
JohnpP.pPooler,pPhD
ProfessorpofpPhysiologypEmerituspDepart
mentpofpPhysiology
EmorypUniversitypSchoolpofpMedicinepAtl
anta,pGeorgia
NewpYorkp Chicagop SanpFranciscop Lisbonp Londonp Madridp MexicopCit
ypMilanp NewpDelhip SanpJuanp Seoulp Singaporep Sydneyp Toronto
,Copyrightp©p2013pbypMcGraw-
HillpEducation,pLLC.pAllprightspreserved.pExceptpasppermittedpunderpthep UnitedpStatespCopyrightpActp
ofp1976,pnoppartpofpthisppublicationpmaypbepreproducedporpdistributedpinpanyp formporpbypanypmeans,po
rpstoredpinpapdatabaseporpretrievalpsystem,pwithoutptheppriorpwrittenppermissionp ofptheppublisher.
ISBN:p978-0-07-179749-8
MHID:p0-07-179749-1
ThepmaterialpinpthispeBookpalsopappearspinpthepprintpversionpofpthisptitle:pISBN:p978-0-07-179748-
1,p MHID:p0-07-179748-3.
Allptrademarkspareptrademarkspofptheirprespectivepowners.pRatherpthanpputpaptrademarkpsymbolpafterpeve
ryp occurrencepofpaptrademarkedpname,pwepusepnamespinpanpeditorialpfashionponly,pandptopthepbenefitpo
fpthep trademarkpowner,pwithpnopintentionpofpinfringementpofptheptrademark.pWherepsuchpdesignationspa
ppearpinp thispbook,ptheyphavepbeenpprintedpwithpinitialpcaps.
McGraw-
HillpEducationpeBooksparepavailablepatpspecialpquantitypdiscountsptopusepasppremiumspandpsalesp promo
tions,porpforpusepinpcorporateptrainingpprograms.pTopcontactpaprepresentativeppleasepe-
mailpuspatp .
Notice
Medicinepispanpever-
changingpscience.pAspnewpresearchpandpclinicalpexperiencepbroadenpourpknowledge,p changespinptreatm
entpandpdrugptherapypareprequired.pThepauthorspandptheppublisherpofpthispworkphavep checkedp withp so
urcesp believedp top bep reliablep inp theirp effortsp top providep informationp thatp isp completep andpgenerally
pinpaccordpwithpthepstandardspacceptedpatptheptimepofppublication.pHowever,pinpviewpofpthep possibility
p ofp humanp errorp orp changesp inp medicalp sciences,p neitherp thep authorsp norp thep publisherp norp anypot
herppartypwhophaspbeenpinvolvedpinptheppreparationporppublicationpofpthispworkpwarrantspthatpthep info
rmationpcontainedphereinpispinpeveryprespectpaccurateporpcomplete,pandptheypdisclaimpallpresponsibilityp f
orpanyperrorsporpomissionsporpforpthepresultspobtainedpfrompusepofpthepinformationpcontainedpinpthispwor
k.p Readersparepencouragedptopconfirmpthepinformationpcontainedphereinpwithpotherpsources.pForpexampl
epandp inpparticular,preadersparepadvisedptopcheckpthepproductpinformationpsheetpincludedpinptheppackag
epofpeachp drugptheypplanptopadministerptopbepcertainpthatpthepinformationpcontainedpinpthispworkpispacc
uratepandpthatp changesphavepnotpbeenpmadepinptheprecommendedpdoseporpinpthepcontraindicationspforp
administration.p Thisprecommendationpispofpparticularpimportancepinpconnectionpwithpnewporpinfreque
ntlypusedpdrugs.
TERMSpOFpUSE
ThispispapcopyrightedpworkpandpMcGraw-
HillpEducation,pLLC.pandpitsplicensorspreservepallprightspinpandp top thep work.p Usep ofp thisp workp isp sub
jectp top thesep terms.p Exceptp asp permittedp underp thep CopyrightpActp ofp1976pandptheprightptopstorepand
pretrieveponepcopypofpthepwork,pyoupmaypnotpdecompile,pdisassemble,p reversepengineer,preproduce,pm
odify,pcreatepderivativepworkspbasedpupon,ptransmit,pdistribute,p disseminate,psell,ppublishporpsublicens
epthepworkporpanyppartpofpitpwithoutpMcGraw-
HillpEducation’sppriorp consent.pYoupmaypusepthepworkpforpyourpownpnoncommercialpandppersonalpuse;p
anypotherpusepofpthepworkp ispstrictlypprohibited.pYourprightptopusepthepworkpmaypbepterminatedpifpyoupfa
ilptopcomplypwithpthesepterms.
THEpWORKpISpPROVIDEDp“ASpIS.”pMcGRAW-
HILLpEDUCATIONpANDpITSpLICENSORSp MAKEpNOpGUARANTEESpORpWARRANTIESpASp
TOpTHEpACCURACY,pADEQUACYpORp COMPLETENESSpOFpORpRESULTSpTOpBEpOBTAINE
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p McGraw-Hillp Education
andpitsplicensorspdopnotpwarrantporpguaranteepthatpthepfunctionspcontainedpinpthepworkpwillpmeetpyourp
requirementsp orp thatp itsp operationp willp bep uninterruptedp orp errorp free.p Neitherp McGraw-
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ssion,p regardlesspofpcause,pinpthepworkporpforpanypdamagespresultingptherefrom.pMcGraw-
HillpEducationphaspnop responsibilitypforpthepcontentpofpanypinformationpaccessedpthroughpthepwork.pUnd
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HillpEducationpand/orpitsplicensorspbepliablepforpanypindirect,pincidental,pspecial,ppunitive,p consequenti
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pbeenpadvisedpofptheppossibilitypofpsuchpdamages.pThisplimitationpofpliabilitypshallpapplyptopanyp claimp
orpcausepwhatsoeverpwhetherpsuchpclaimporpcauseparisespinpcontract,ptortporpotherwise.
p p p
Vander’sRenal p p
Physiology
Eighth Edition
p
Douglasp C.p Eaton,p PhD
DistinguishedpProfessorpofpPhysiologypan
dpProfessorpofpPediatricspDepartment
pofpPhysiology
EmorypUniversitypSchoolpofpMedicinepAtl
anta,pGeorgia
JohnpP.pPooler,pPhD
ProfessorpofpPhysiologypEmerituspDepart
mentpofpPhysiology
EmorypUniversitypSchoolpofpMedicinepAtl
anta,pGeorgia
NewpYorkp Chicagop SanpFranciscop Lisbonp Londonp Madridp MexicopCit
ypMilanp NewpDelhip SanpJuanp Seoulp Singaporep Sydneyp Toronto
,Copyrightp©p2013pbypMcGraw-
HillpEducation,pLLC.pAllprightspreserved.pExceptpasppermittedpunderpthep UnitedpStatespCopyrightpActp
ofp1976,pnoppartpofpthisppublicationpmaypbepreproducedporpdistributedpinpanyp formporpbypanypmeans,po
rpstoredpinpapdatabaseporpretrievalpsystem,pwithoutptheppriorpwrittenppermissionp ofptheppublisher.
ISBN:p978-0-07-179749-8
MHID:p0-07-179749-1
ThepmaterialpinpthispeBookpalsopappearspinpthepprintpversionpofpthisptitle:pISBN:p978-0-07-179748-
1,p MHID:p0-07-179748-3.
Allptrademarkspareptrademarkspofptheirprespectivepowners.pRatherpthanpputpaptrademarkpsymbolpafterpeve
ryp occurrencepofpaptrademarkedpname,pwepusepnamespinpanpeditorialpfashionponly,pandptopthepbenefitpo
fpthep trademarkpowner,pwithpnopintentionpofpinfringementpofptheptrademark.pWherepsuchpdesignationspa
ppearpinp thispbook,ptheyphavepbeenpprintedpwithpinitialpcaps.
McGraw-
HillpEducationpeBooksparepavailablepatpspecialpquantitypdiscountsptopusepasppremiumspandpsalesp promo
tions,porpforpusepinpcorporateptrainingpprograms.pTopcontactpaprepresentativeppleasepe-
mailpuspatp .
Notice
Medicinepispanpever-
changingpscience.pAspnewpresearchpandpclinicalpexperiencepbroadenpourpknowledge,p changespinptreatm
entpandpdrugptherapypareprequired.pThepauthorspandptheppublisherpofpthispworkphavep checkedp withp so
urcesp believedp top bep reliablep inp theirp effortsp top providep informationp thatp isp completep andpgenerally
pinpaccordpwithpthepstandardspacceptedpatptheptimepofppublication.pHowever,pinpviewpofpthep possibility
p ofp humanp errorp orp changesp inp medicalp sciences,p neitherp thep authorsp norp thep publisherp norp anypot
herppartypwhophaspbeenpinvolvedpinptheppreparationporppublicationpofpthispworkpwarrantspthatpthep info
rmationpcontainedphereinpispinpeveryprespectpaccurateporpcomplete,pandptheypdisclaimpallpresponsibilityp f
orpanyperrorsporpomissionsporpforpthepresultspobtainedpfrompusepofpthepinformationpcontainedpinpthispwor
k.p Readersparepencouragedptopconfirmpthepinformationpcontainedphereinpwithpotherpsources.pForpexampl
epandp inpparticular,preadersparepadvisedptopcheckpthepproductpinformationpsheetpincludedpinptheppackag
epofpeachp drugptheypplanptopadministerptopbepcertainpthatpthepinformationpcontainedpinpthispworkpispacc
uratepandpthatp changesphavepnotpbeenpmadepinptheprecommendedpdoseporpinpthepcontraindicationspforp
administration.p Thisprecommendationpispofpparticularpimportancepinpconnectionpwithpnewporpinfreque
ntlypusedpdrugs.
TERMSpOFpUSE
ThispispapcopyrightedpworkpandpMcGraw-
HillpEducation,pLLC.pandpitsplicensorspreservepallprightspinpandp top thep work.p Usep ofp thisp workp isp sub
jectp top thesep terms.p Exceptp asp permittedp underp thep CopyrightpActp ofp1976pandptheprightptopstorepand
pretrieveponepcopypofpthepwork,pyoupmaypnotpdecompile,pdisassemble,p reversepengineer,preproduce,pm
odify,pcreatepderivativepworkspbasedpupon,ptransmit,pdistribute,p disseminate,psell,ppublishporpsublicens
epthepworkporpanyppartpofpitpwithoutpMcGraw-
HillpEducation’sppriorp consent.pYoupmaypusepthepworkpforpyourpownpnoncommercialpandppersonalpuse;p
anypotherpusepofpthepworkp ispstrictlypprohibited.pYourprightptopusepthepworkpmaypbepterminatedpifpyoupfa
ilptopcomplypwithpthesepterms.
THEpWORKpISpPROVIDEDp“ASpIS.”pMcGRAW-
HILLpEDUCATIONpANDpITSpLICENSORSp MAKEpNOpGUARANTEESpORpWARRANTIESpASp
TOpTHEpACCURACY,pADEQUACYpORp COMPLETENESSpOFpORpRESULTSpTOpBEpOBTAINE
DpFROMpUSINGpTHEpWORK,p INCLUDINGp ANYp INFORMATIONp THATp CANp BEp ACCESS
EDp THROUGHp THEp WORKp VIApHYPERLINKpORpOTHERWISE,pANDpEXPRESSLYpDISCLA
IMpANYpWARRANTY,p EXPRESSpORpIMPLIED,pINCLUDINGpBUTpNOTpLIMITEDpTOpIMPLIE
DpWARRANTIESpOFp MERCHANTABILITYp ORp FITNESSp FORp Ap PARTICULARp PURPOSE.
p McGraw-Hillp Education
andpitsplicensorspdopnotpwarrantporpguaranteepthatpthepfunctionspcontainedpinpthepworkpwillpmeetpyourp
requirementsp orp thatp itsp operationp willp bep uninterruptedp orp errorp free.p Neitherp McGraw-
Hillp Educationpnorpitsplicensorspshallpbepliableptopyouporpanyonepelsepforpanypinaccuracy,perrorporpomi
ssion,p regardlesspofpcause,pinpthepworkporpforpanypdamagespresultingptherefrom.pMcGraw-
HillpEducationphaspnop responsibilitypforpthepcontentpofpanypinformationpaccessedpthroughpthepwork.pUnd
, erpnopcircumstancespshallp McGraw-
HillpEducationpand/orpitsplicensorspbepliablepforpanypindirect,pincidental,pspecial,ppunitive,p consequenti
alporpsimilarpdamagespthatpresultpfrompthepusepofporpinabilityptopusepthepwork,pevenpifpanypofp themphas
pbeenpadvisedpofptheppossibilitypofpsuchpdamages.pThisplimitationpofpliabilitypshallpapplyptopanyp claimp
orpcausepwhatsoeverpwhetherpsuchpclaimporpcauseparisespinpcontract,ptortporpotherwise.
