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Urea Handling
(1) PCT
About 50% of the filtered urea is passively reabsorbed The wall of PCT is partially permeable to urea but highly permeable to water so water reabsorption from PCT increases urea concentration in tubular lumen. This creates concentration gradient
Urea reabsorption.
(2) Thick ascending limb of loop of Henle, DCT and cortical collecting tubules
All are relatively impermeable to urea. H2O reabsorbed in DCT and cortical collecting tubule (in presence of ADH) increased urea concentration in tubular fluid.
Urea cycle
Urea moves from the medullary interstitium into the thin loop of the Henle and back down into the medullary collecting duct and again to medullary interstitium several times before urea is excreted.
Urea recycling
URINE CONCENTRATION
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N.B. The fact that large amounts of water are reabsorbed into the cortex, rather than into the medulla, helps to preserve the high medullary interstitial fluid osmolarity. Thus, in the presence of ADH, the fluid at the end of CDs has the same osmolarity as the medullary interstitium (1200 mOsm/L).
By reabsorbing as much water as possible, the kidneys form a highly concentrated urine while adding water back to ECF & compensating for deficit of body water.
Urea Recycling
In the presence of ADH, urea contibutes 40% to the medullary interstitial osmolarity (= 500 mOsm/L) by passive urea reabsorption from the inner medullary CDs into the interstitium.
Mechanism: - Ascending limb of loop of Henle, DCT, cortical CDs & outer medullary CDs are impermeable to urea. - As water is reabsorbed from late DCT, cortical & outer medullary CDs, urea concentration rapidly. - In inner medullary CDs, further water reabsorption takes place, so that urea concentration rises even more. Thus, urea diffuses out of the tubule into renal interstitium because this segment is highly permeable to urea, and ADH increases this permeability even more. - A moderate share of the urea that moves into medullary interstitium diffuses into thin descending limb of loop of Henle, so that it passes again in tubular fluid. It recirculates several times before it is excreted. Each time around it contributes to a higher concentration of urea in interstitium. Urea recirculation provides an additional mechanism for forming a 20 hyperosmotic medulla.
UREA RECYCLING
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(A)Thiazides:
e.g. alldactone:
(Diamox).