Urine Concentration Mechanism
Prof. Mona Soliman, MBBS, MSc, PhD
Head, Medical Education Department
Professor of Physiology
& Medical Education
College of Medicine
King Saud University
1
Learning Objectives:
Identify and describe that the loop of Henle is referred to
as countercurrent multiplier and the loop and vasa recta as
countercurrent exchange systems in concentrating and
diluting urine
Explain what happens to osmolarity of tubular fluid in the
various segments of the loop of Henle when concentrated
urine is being produced.
Explain the factors that determine the ability of loop of
Henle to make a concentrated medullary gradient
Differentiate between water diuresis and osmotic diuresis
Appreciate clinical correlates of diabetes mellitus and
diabetes insipidus
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Countercurrent System
• A system in which inflow
runs parallel and in close
proximity but opposite to
the outflow.
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Mechanism for urine
concentration/dilution
• While the loop of Henle reabsorbs another 20% of
the salt/water in tubular fluid, primary function is to
determine osmolarity of urine (i.e. whether
concentrated or diluted) using
countercurrent multiplier system
• While collecting duct is where urine concentration is
determined, osmolarity of interstitial fluid in medulla
must be high and osmolarity of tubular fluid must be
low
– Countercurrent multiplier system achieves this
4
Countercurrent multiplier system
• Is the repetitive reabsorption of NaCl by
the thick ascending loop of Henle and
continued inflow of new NaCl from PCT
into LOH
• The NaCl reabsorbed from the ascending
LOH keeps adding newly arrived NaCl
(into LOH from PCT), thus multiplying its
concentration in the medulla
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• Dilution (low or no How the kidney
ADH): excrete dilute urine ?
• Reabsorb solute don’t
absorb water
• 1) Isoosmotic fluid from
PCT
• 2) Thin descending limb
permeable to water,
less for NaCl
water reabsorbed,
tubule osomolality =
medulla (i.e. high)
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3) Thin ascending limb How the kidney
impermeable to water, excrete dilute urine ?
permeable to NaCl
(passive)
• tubule volume
unchanged, [NaCl]
4) TAL impermeable to
water, NaCl actively
reabsorbed (diluting
segment of nephron)
• diluting tubule fluid 150
mOsm/kg water
7
How the kidney
excrete dilute urine ?
5) Collecting duct
reabsorb NaCl
osmolality, may
reach 50 mOsm/kg
water
8
How the kidney
• Concentration of urine excrete concentrated
(ADH dependent): urine ?
• 1-4 same as dilution
• Reabsorbed NaCl in
loop of Henle
osmolality of
interstitium
• Generated by
Countercurrent
Multiplication
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How the kidney
excrete concentrated
urine ?
5) Fluid reaching CD
hypoosmotic (osm
due urea)
• ADH causes water to
diffuse out up to a
max of 300 mOsm/kg
water
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How the kidney
6) Osmolality of excrete concentrated
medullary tissue high
up to 1200 mOsm/kg
urine ?
water
• due to NaCl
(accounts for 600)
• urea (accounts for
600)
• early CD
impermeable to urea
• ADH allows water
reabsorption
passively
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How the kidney excrete concentrated
urine ?
• When ADH levels high urea levels in
medullary CD & interstitium equilibrate
• Most water absorbed in presence of ADH is
in the cortical collecting duct
12
Countercurrent exchange in the
Vasa Recta
• There are two special features of the
renal medullary blood flow that
contribute to the preservation of the
high solute concentration:
1. The medullary blood flow is low,
accounting for less than 5% of the
renal blood flow. This sluggish blood
flow is sufficient to supply the
metabolic needs of the tissues but
helps to minimize solute loss from the
medullary interstitium
2. The vasa recta serve as
countercurrent exchanger,
minimizing washout of solutes from the
medullary interstitium.
• The vasa recta do not create the
medullary hyperosmolarity, but they
do prevent from being dissipated
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