The purpose of this study is to assess the effect of an apparent alteration in intracellular pH and the effect of amiloride on the activity of the Na+/H+ antiporter in perfused rat kidney. Rat kidney-Na+ retention was determined using tracer Na-22 in perfusate composed of HCl-glycine buffer (pH 3.80 to pH 5.92) or NH4OH-glycine buffer (pH 6.22-7.95) containing Na+ to match physiologic concentrations. Plotting renal Na+ retention for 10 min versus pH in absence of amiloride showed two classical uncompetitive activator curves for H+, one curve from pH 4.19 to 5.10 and another from pH 6.22 to 7.95. H+ acts as an uncompetitive reversible binding substrate with the receptor triggering activation of the exchanger already sequestered with Na+ thus yielding two K-a values for the exchanger suggesting non-first order kinetics. Using an equation derived for uncompetitive-activation binding of Na-o(+) and H-i(+), plotting [mM Na+ mg protein(-1) 10 min(-1)](-1) versus [H+], two linear plots are observed on Cartesian coordinates with abscissa intersecting at 47 +/- 1 mu M, pK(a) = 4.32 +/- 0.02 (pH 4.19-5.10) and 4.21 +/- 0.02 mu M, pK(a) 5.38 +/- 0.01 (pH 6.22-7.95), respectively. Perfusing buffer containing 2 mM amiloride, completely inactivated the antiporter showing stronger inhibition between pH 3.50 and 5.92. Results suggest the presence of two uncompetitive binding sites for H+ with the Na+/H+ exchanger. One is a high affinity binding site at physiological intracellular apparent pH, and another is a low affinity binding site at ischaemic apparent pH, implying the existence of two titration sites for intracellular pH regulation. (C) 1999 Elsevier Science Inc. All rights reserved.