Foreign substances which cannot be filtered by the glomerulus because they are bound to plasma proteins enter the peritubular capillaries, where they dissociate from their carrier proteins because of strong affinity for tubular cells. The major site for removal of the nonfiltered substances is the proximalconvoluted tubule.
CONCENTRATION AND DILUTION OF URINE
The regulation of plasma osmolarity is accomplished by varying the amount of water excreted bythe kidneys. It is due to the response to water deprivation or to water intake. When the osmolality is toolow, nervous and hormonal feedback mechanisms cause the kidneys to excrete a great excess of water inurine causing a dilute urine, but removes water from the body to increase the body fluid osmolality back to normal. When the osmolality of body fluids is too great, the kidneys excrete an excess of solutes toreduce the body fluid osmolality again back to normal, but at the same time excreting a concentratedurine.OSMOLAL CONCENTRATION CHANGES IN THE DIFFERENT SEGMENTS OF THE TUBULES
Osmolality of the fluid remains almost exactly equal to that of the glomerular filtrate, 300mOsm/L throughout the entire extent of the proximal tubule.
Loop of Henle
The osmolality rises rapidly because of the countercurrent mechanism. During high concentrationof ADH, the loop of Henle osmolality rises much higher than when a dilute urine is being formed becauseof large quantity of urea that is passively reabsorbed into the medullary interstitium from the collectingducts.
Thick Ascending Limb
The osmolality falls to a very low level usually about 100 mOsm/L.
Late Distal Tubule, Cortical Collecting Duct, and Collecting Duct
The osmolality depends entirely on ADH. In the absence of ADH, very little water is reabsorbed,osmolality remains less than 100 mOsm/L, very dilute urine is formed.In the presence of excess ADH, these segments become highly permeable to water, most of thewater is reabsorbed, thus producing a very concentrated urine.
TESTS DONE ON URINE SPECIMENS
VOLUMEUrine volume depends on the amount of water that the kidneys excrete. The amount excreted isusually determined by the body’s state of hydration. Factors that influence urine volume include fluidintake, fluid loss from nonrenal sources, variations in the secretion of antidiuretic hormone and the