AHS 1221

Urine Concentration

Dr. Suzanah Abdul Rahman

Kulliyyah of Allied Health Sciences
International Islamic University Malaysia
Kuantan

Objectives
To describe the processes in the
formation of urine
To describe the involvement of renal
tubule and collecting ducts in the
production of dilute and
concentrated urine

Function of kidneys

The kidneys play an important role in

homeostasis through regulation of
water loss
Rate of GFR controlled according to
the water requirements of the body
The role of ADH in the reabsorption of
water and the formation of
concentrated urine.

Formation of dilute urine

Glomerular filtrate the same osmolarity as

blood plasma (300 mOsm/liter)
Tubular fluid leaving proximal convoluted
tubule still isotonic to plasma
Osmolarity changes along the rest of the
renal tubule usually resulting in a decrease
of osmolarity as low as 65 70 mOsm/liter

Formation of dilute urine

Decrease in osmolarity due to:

Water reabsorption along descending Loop of

Henle due to increasing osmolarity of the
interstitial fluid of the renal medulla
Reabsorption of ions from the thick ascending
Loop of Henle
Ascending Loop of Henle is relatively
impermeable to water blocking water reabsorption
Distal convoluted tubule cells are relatively
impermeable to water and not regulated by ADH
Principal cells of collecting duct impermeable to
water when ADH level is low

Formation of dilute urine

Formation of concentrated urine

Kidney has to conserve water at low water

intake or high water loss while at the same time
excrete wastes and excess ions
ADH role depends on osmotic gradient of
solutes in interstitial fluid of renal medulla

Osmotic gradient 300 mOsm/liter at cortex but 1200

mOsm/liter deep in medulla
Factors contributing to building & maintaining of this
osmotic gradient
Maintained by differences in solute and water
permeability and reabsorption at different sections
of LOH and collecting duct
Countercurrent flow

Formation of concentrated urine

Concentrated urine production involves:

Establishment of osmotic gradient in the renal

medulla
Fluid in the interstitial fluid, ascending LOH &
vasa recta plasma may be of the same
osmolarity
Collecting duct cells reabsorb more water &
urea in the presence of ADH

Increased reabsorption of water causes urea to

concentrate in tubular fluid. Permeability of duct
cells deep in the medulla allows diffusion of urea
into interstitial fluid

Formation of concentrated urine

Concentrated urine production involves (cont):

Urea recycling
Diffusion from interstitial fluid into descending &
thin part of ascending LOH
Urea remain in tubular fluid passing through
thick ascending limb, DCT & cortical portion of
collecting duct
Water reabsorption via osmosis in the presence
of ADH further increases tubular urea
concentration
More urea diffuses into interstitial fluid of inner
renal medulla
Cycle repeats leading to small volume of
concentrated urine

Formation of concentrated urine

Formation of concentrated urine

Countercurrent mechanism:

Contributor to the osmotic gradient

At the long loops of Henle of juxtamedullary
nephrons
Countercurrent flow b/w fluid in descending &
ascending limbs of LOH
Osmolarity highest at the hairpin turn of the
LOH as descending limb is very permeable to
water but impermeable to solutes except urea
Reabsorption of Na+ & Cl- at ascending limb
dilutes tubular fluid

Formation of concentrated urine

Countercurrent mechanism (cont):

At the vasa recta

Similar countercurrent flow in parallel descending &

ascending limbs
Osmolarity of blood entering vasa recta is 300
mOsm/liter
Na+, Cl- & urea diffuses from interstitial fluid into blood
in descending limb increasing blood osmolarity
Blood then flows up the ascending limb in the region
where interstitial fluid is less concentrated resulting in
either:

diffusion of ions & urea from blood into interstitial fluid

reabsorbed water diffusion via osmosis from interstitial
fluid into the vasa recta