Formation Of Concentrated

Urine

Dr .imrana ehsan

 OBLIGATORY URINE VOLUME: The

minimum amount of urine that must
be excreted.(to excrete 600 mosm of
solute each day.
600mosm/day/1200mosm
/L=0.5L/day
Human kidneys have limited ability
to concentrateurine-1200mosm/L
Dehydration develops if drinking sea
water

Mechanism of urine dilution and concentration

CONDITIONS IN WHICH DILUTE URINE IS FORMED

Dilute urine is called hypotonic urine, in which

urine osmolality is less than blood osmolality.
It is produced under the following conditions:
1. Low levels of ADH ,central diabetes insipidus
2. ADH is ineffective

The principal factors governing formation of

dilute and concentrated urine are
hyperosmolality medullary gradient and the
presence or absence of ADH.

Production of concentrated urine:

Concentrated urine is also called hyperosmotic
urine, osmolality is greater than that of blood.
Hyper osmolality of medullary interstitium :50
to 60 %of hyperosmolality is contributed by
counter current multiplier and exchange system
Role of urea: 40 to 50%
It is produced when circulating ADH levels are
high e.g Water deprivation,Haemorrahage,
Syndrome of inappropriate antidiuretic hormone
(SIADH)

Principal factors governing

formation of concentrated urine
The high level of ADH is the main factor
for governing the formation of
concentrated urine; because it increases
the size of hyperosmolarity medullary
gradient
Augments the urea cycling from the inner
medullary collecting ducts into the
medullary interstitial fluid.

Segmental changes in the tubular

fluid during formation of
concentrated urine.

From proximal tubule to ascending thick limb and

even early distal tubule, the changes occurring in
the tubular fluid is same as during formation of
dilute urine.
Only change is that the ADH stimulates NaCl
reabsorption in the thick ascending limb and
increases the size of medullary gradient by
counter current multiplier, which is important for
the formation of conc urine.
Tubular fluid entering the late distal tubule is
hypo-osmolar (osmolality about 150mOsm/L)
In the presence of ADH, H20 permeability of the
principal cells is increased and consequently H20
is reabsorbed until the osmolality of distal tubular
fluid equals that of the surrounding cortical
interstitium (300m0sm/L)

 The initial portion of the collecting duct is

impermeable to urea, hence it remains the
tubular fluid, its conc in the tubular fluid inceases.
In the presence of ADH, urea permeability of the
last portion of the medullary collecting duct is
increased. Hence urea diffuses out into the
medullary interstitium.
The final osmolalityof urine is about 1200m0sm/L
and high conc of urea and other non reabsorbed
solutes.

Collecting ducts:
As the tubular fluid flows through the collecting
ducts, it passes through the corticopapillary
gradient( regions of increasingly higher
osmolality, from 300m0sm/L to 1200m0sm/L) that
is previously established by counter current
multiplier and urea cycling.
Consequently H20 is reabsorbed from the
collecting ducts until the osmolality of tubular
fluid equals that of the surrounding interstitial
fluid.
Osmolality may reach upto 1400m0smol/L,
almost five times that of plasma, with a total of
95.7% or more of the filtered water being
reabsorbed.

Other systems of counter current mechanism

Heat exchange taking place between

arteries & veins of limbs.
Human intestinal villi
diaadvantageous
Brain for regulation of brain
temperature.
Testes for maintaning high levels of
testoterone.

Assessment of renal diluting and

concentrating ability:

Measurement of urine osmolality,

Measurement of urine specific gravity,
The urine concentration test,
The urine dilution test and
Estimation of free water clearance test.

 Applied aspect:
Clinical

Serum
ADH

Ser Osm/
Ser Na+

Urine
Urine
osmolality flow
rate

Primary
polydypsia

decrease decreased hyposmoti high

d
c

positive

Central
diabetes
insipidus

decrease increased
d

hyposmoti high
c

positive

Nephrogeni
c DI

increase
d

increased

hyposmoti high
c

positive

Water
deprivation

increase
d

High/nom
al

hyperosm
o

negative

low

Free
water
clearence

Thank you