When the extracellular fluids tend towards acidity, the renal tubular cells secrete the H+ ions into the tubular fluid from where they exit the body via the urine. The HCO−3 ions are simultaneously secreted into the blood plasma, thus raising the bicarbonate ion concentration in the plasma, lowering the carbonic acid/bicarbonate ion ratio, and consequently raising the pH of the plasma. The converse happens when the plasma pH rises above normal: bicarbonate ions are excreted into the urine, and hydrogen ions into the plasma. These combine with the bicarbonate ions in the plasma to form carbonic acid (H+ + HCO−3 
  
    
      
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    {\displaystyle \rightleftharpoons }
   H2CO3), thus raising the carbonic acid:bicarbonate ratio in the extracellular fluids, and returning its pH to normal.In general, metabolism produces more waste acids than bases. Urine produced is generally acidic and is partially neutralized by the ammonia (NH3) that is excreted into the urine when glutamate and glutamine (carriers of excess, no longer needed, amino groups) are deaminated by the distal renal tubular epithelial cells. Thus some of the "acid content" of the urine resides in the resulting ammonium ion (NH4+) content of the urine, though this has no effect on pH homeostasis of the extracellular fluids.
Prurigo simplex is a chronic, itchy, idiopathic skin condition characterized by extremely itchy skin nodules and lesions. : 57  Typically, there is no known direct cause of prurigo simplex, but some factors are known to trigger or aggravate it. This condition falls between chronic and acute, sometimes transitioning into a chronic condition. Many people experience a recurrence of the condition after periods of remission. Middle-aged patients are the most prone age group to this condition. Presentation
The most common prurigo simplex symptoms are skin nodules resembling insect bites that are intensely itchy. These nodules are frequently scratched open, becoming lesions that continue to itch. Sometimes the skin thickens and becomes discolored around the nodules. The scalp, arms, legs and trunk of the body are the most frequent sites of the bumps and lesions. Itching can become severe and habitual, worsening the condition and possibly causing infections in the open sores. Treatment
Treatment is challenging, with narrow band UVB or pimozide sometimes helpful. Prognosis
Sometimes the nodules become less itchy and eventually disappear leaving a discolored area or scar tissue. The same nodules can persist for months or even years, though, without healing. Patients may experience a remission but then relapse with new nodules forming. The condition might also become chronic, with no periods of improvement and relief. == References ==