Urine concentration and dilution

Dr. Niranjan Murthy HL Associate Professor Dept of Physiology SSMC, Tumkur

 Daily urine output- 1.5 to 2 ltrs Dilute urine- 15% of filtered volume Concentrated urine- 0.5% of filtered volume

Water Reabsorption
By osmosis: 1. Obligatory reabsorption- PCT- 65% 2. Countercurrent mechanism- 20% 3. Facultative reabsorption- ADH influence- 15%

Obligatory reabsorption: Seen in PCT 65% of filtered load Follows solute reabsorption AQP 1

Countercurrent mechanism
Countercurrent multiplier- loop of henle Countercurrent exchanger- vasa recta

 Requirement for countercurrent mechanism: 1. Countercurrent flow 2. Active transport 3. Differential water permeability

Countercurrent multiplier

Descending limb: Freely permeable to water Thin ascending limb: Permeable to sodium, chloride and urea Thick ascending limb: Active transport of sodium, chloride and potassium

 Active reabsorption of sodium and chloride from thick ascending limb facilitates water reabsorption1. from cortical collecting duct in presence of ADH by delivering hypotonic fluid to cortical collecting duct 2. from medullary collecting duct by establishing osmotic gradient

 Countercurrent mechanism increases medullary interstitial concentration and gradient which is necessary for water reabsorption in collecting tubule

 Role of urea:

Role of urea: Contributes to 50% of osmolality at medullary interstitium Permeable in presence of ADH Recirculation Urinary concentration without expenditure of energy

Facultative reabsorption of water: Facilitated by ADH and Aldosterone DCT and collecting duct

ADH: antidiuretic hormone Peptide hormone Posterior pituitary V2 receptors in distal tubule AQP2 Contributes to 15% of water reabsorption

 Gradient for water reabsorption in distal tubule is established by1. Sodium Chloride co-transport in thick ascending limb 2. Sodium potassium counter-transport in collecting duct by the influence of aldosterone

Countercurrent exchanger
Maintains medullary osmotic gradient established by countercurrent multiplier

 Small lag in equilibration between the blood and the adjacent peritubular fluid Volume of blood leaving vasa recta is slightly greater than that entering because of1. Lag in equilibration 2. Oncotic forces

 Blood flow to medulla is 10% of total RBF Blood flow is sluggish

Protection for medullary cells against high osmotic gradient: Formation of highly osmotic inositol, sorbitol, etc by medullary epithelium

Other areas of countercurrent mechanism in body: Testis Intestinal villi Skin

Free water clearance

Cosm = (Uosm x V) / Posm CH2O= V Cosm = V (Uosm x V) / Posm If negative- concentrated urine If positive- dilute urine

Factors affecting concentrating and diluting mechanisms of kidneys

1. ADH levels 2. Active reabsorption of NaCl by thick ascending limb of loop of Henle (loop diuretics)length of loop and percentage of nephrons with long loops- Psammomys (35%) 3. Availability of urea- protein diet 4. Rate of flow through loop of henle and collecting duct

5. Rate of flow through vasa recta 6. Presence of prostaglandins PGE2: increases blood flow vasa recta and reduces active reabsorption of NaCl