1. What clinical conditions produce concentrated urine? Dilute urine?

Concentrated (or hyperosmotic) urine occurs when there is decreased ECF volume.
In other words, there is volume contraction or increased plasma osmolality. Some
conditions which produce concentrated (i.e. hyperosmotic) urine include water
deprivation, syndrome of inappropriate antidiuretic hormone (SIADH), diarrhea,
congestive heart disease, and hepatic cirrhosis.

Dilute (or hyposmotic) urine occurs when there is increased ECF volume. In other
words, there is volume expansion or decreased plasma osmolality. Some conditions
which produce dilute (i.e. hyposmotic) urine include excessive water drinking and
central and nephrogenic diabetes insipidus.

2. What happens if a drug inhibits the area of the thick ascending limb of loop of
Henle?

Drugs that block the action of the Na-K-2Cl cotransporter in the thick ascending
limb are called loop diuretics. Examples of these drugs are Furosemide,
Bumetanide, and Ethacrynic acid. With administration of loop diuretics, sodium (and
water) reabsorption in the TAL of the Loop of Henle will be impaired. This results in
increased urinary sodium excretion (natriuresis) and water excretion (polyuria).

4. What happens in persons with marasmus in terms of concentration

gradient?

Marasmus is a form of severe energy-protein malnutrition characterized by

energy deficiency. In patients with marasmus, there is a decrease in the production
of urea, a by-product of protein metabolism. The concentration gradient in the
medullary interstitium is due to urea recycling and the Na-K-2Cl cotransporter in the
thick ascending limb. This concentration gradient is used to move NaCl from the
tubular fluid in the thin ascending limb to the medullary interstitial fluid. Without
urea, the production of the corticopapillary osmotic gradient is disrupted. The
maximum osmolarity in the bend of the loop of Henle cannot reach 1200-1400
mOsm/L due to lack of urea. Disruption of this osmotic gradient reduces the driving
force of water reabsorption in many parts of the renal tubule.