WATER-SALT METABOLISM IN THE BODY

FEATURES OF THE CHEMICAL COMPOSITION OF

INTRACELLULAR AND EXTRACELLULAR FLUIDS.

Intracellular Fluid Composition

The cytosol or intracellular fluid consists mostly of water, dissolved ions, small
molecules, and large, water-soluble molecules (such as proteins). This mixture of
small molecules is extraordinarily complex, as the variety of enzymes that are
involved in cellular metabolism is immense.
Ions: Ions in solution.

These enzymes are involved in the biochemical processes that sustain cells and
activate or deactivate toxins. Most of the cytosol is water, which makes up about
70% of the total volume of a typical cell. The pH of the intracellular fluid is 7.4. The
cell membrane separates cytosol from extracellular fluid, but can pass through the
membrane via specialized channels and pumps during passive and active transport.

The concentrations of the other ions in cytosol or intracellular fluid are quite different
from those in extracellular fluid. The cytosol also contains much higher amounts of
charged macromolecules, such as proteins and nucleic acids, than the outside of the
cell.

In contrast to extracellular fluid, cytosol has a high concentration of potassium ions

and a low concentration of sodium ions. The reason for these specific sodium and
potassium ion concentrations are Na+/K ATPase pumps that facilitate the active
transport of these ions. These pumps transport ions against their concentration
gradients to maintain the cytosol fluid composition of the ions.

Extracellular Fluid Composition

The extracellular fluid is mainly cations and anions. The cations include: sodium
(Na+ = 136-145 mEq/L), potassium (K+ = 3.5-5.5 mEq/L) and calcium (Ca2+ = 8.4-
10.5 mEq/L). Anions include: chloride ( mEq/L) and hydrogen carbonate (HCO3- 22-
26 mM). These ions are important for water transport throughout the body.

Plasma is mostly water (93% by volume) and contains dissolved proteins (the major
proteins are fibrinogens, globulins, and albumins), glucose, clotting factors, mineral
ions (Na+, Ca++, Mg++, HCO3- Cl- etc.), hormones and carbon dioxide (plasma
being the main medium for excretory product transportation). These dissolved
substances are involved in many varied physiological processes, such as gas
exchange, immune system function, and drug distribution throughout the body.

FEATURES OF METABOLISM IN THE KIDNEY.

The kidneys remove, in urine, products of metabolism such as urea, uric
acid and creatinine, and retain substances such as glucose, amino acids,
and proteins. They also metabolize and remove drugs and toxins. They
play a critical role in the regulation of extracellular fluid volume and
composition and in maintaining the acid–base balance (Chapters
24 and 25). These functions are regulated hormonally by vasopressin
(antidiuretic hormone, ADH) produced in the posterior pituitary, and by
the renin–angiotensin system. Kidney function is also controlled by
norepinephrine and dopamine released from nerve terminals in the kidney
itself.

The kidneys also produce calcitriol (1,25-dihydroxycholecalciferol,

1,25(OH) D ), a vitamin involved in calcium homeostasis (Chapter 26) and
2 3

erythropoietin, which controls the production of erythrocytes.

MECHANISM OF URINE SYNTHESIS IN THE

KIDNEYS.
Filtration, Reabsorption, Secretion: The Three Steps of Urine
Formation

The kidneys filter unwanted substances from the blood and produce urine
to excrete them. There are three main steps of urine formation:
glomerular filtration, reabsorption, and secretion. These processes ensure
that only waste and excess water are removed from the body.

1. The Glomerulus Filters Water and Other Substances from the

Bloodstream

Each kidney contains over 1 million tiny structures called nephrons. Each

nephron has a glomerulus, the site of blood filtration. The glomerulus is
a network of capillaries surrounded by a cuplike structure, the glomerular
capsule (or Bowman’s capsule). As blood flows through the glomerulus,
blood pressure pushes water and solutes from the capillaries into the
capsule through a filtration membrane. This glomerular filtration begins
the urine formation process.

2. The Filtration Membrane Keeps Blood Cells and Large Proteins

in the Bloodstream
Inside the glomerulus, blood pressure pushes fluid from capillaries into
the glomerular capsule through a specialized layer of cells. This layer,
the filtration membrane, allows water and small solutes to pass but
blocks blood cells and large proteins. Those components remain in the
bloodstream. The filtrate (the fluid that has passed through the
membrane) flows from the glomerular capsule further into the nephron.

3. Reabsorption Moves Nutrients and Water Back into the

Bloodstream

The glomerulus filters water and small solutes out of the bloodstream.
The resulting filtrate contains waste, but also other substances the body
needs: essential ions, glucose, amino acids, and smaller proteins. When
the filtrate exits the glomerulus, it flows into a duct in the nephron called
the renal tubule. As it moves, the needed substances and some water
are reabsorbed through the tube wall into adjacent capillaries. This
reabsorption of vital nutrients from the filtrate is the second step in urine
creation.

4. Waste Ions and Hydrogen Ions Secreted from the Blood

Complete the Formation of Urine

The filtrate absorbed in the glomerulus flows through the renal tubule,
where nutrients and water are reabsorbed into capillaries. At the same
time, waste ions and hydrogen ions pass from the capillaries into the
renal tubule. This process is called secretion. The secreted ions combine
with the remaining filtrate and become urine. The urine flows out of the
nephron tubule into a collecting duct. It passes out of the kidney through
the renal pelvis, into the ureter, and down to the bladder.

5. Urine Is 95% Water

The nephrons of the kidneys process blood and create urine through a
process of filtration, reabsorption, and secretion. Urine is about 95%
water and 5% waste products. Nitrogenous wastes excreted in urine
include urea, creatinine, ammonia, and uric acid. Ions such as sodium,
potassium, hydrogen, and calcium are also excreted.

HORMONAL REGULATION OF WATER-SALT

BALANCE AND KIDNEY FUNCTION
Sodium and water balance are precisely regulated by the endocrine
system. Osmolality1 of the extracellular fluid is monitored and adjusted by
regulating water excretion by the kidney in response to antidiuretic
hormone (ADH), which is secreted by the posterior lobe of the pituitary
gland. Constancy of blood osmolality ensures constancy of cellular
volume, but if it were attained only by adjusting water retention, the
vascular volume would fluctuate widely. Therefore, blood volume must
also be precisely regulated so that it is sufficient to ensure perfusion of
body tissues but not so expanded that blood pressure is increased.
Because sodium is the major electrolyte in extracellular fluid,
maintenance of vascular volume depends on maintenance of sodium
balance. Renal mechanisms that govern retention or loss of sodium are
regulated by the renin-angiotensin-aldosterone system and the atrial
natriuretic factor. ADH also contributes directly to volume regulation, and
when demands for constancy of osmolality are in conflict with demands
for constancy of volume, the latter prevail. These hormonal mechanisms
operate largely by regulating renal function, but they also regulate salt
and water intake and vascular tone.

ANTIHYPERTENSIVE DRUGS AS INHIBITORS OF

ANGIOTENSIN-CONVERTING ENZYME
Angiotensin-converting enzyme (ACE) inhibitors help relax your veins and arteries to
lower your blood pressure. ACE inhibitors prevent an enzyme in your body from
producing angiotensin II, a substance that narrows your blood vessels. This
narrowing can cause high blood pressure and force your heart to work harder.
Angiotensin II also releases hormones that raise your blood pressure.

Examples of ACE inhibitors

Many ACE inhibitors are available. The best one for you depends on your health and
other factors. For example, people with chronic kidney disease may benefit from
having an ACE inhibitor as one of their medications.
Examples of ACE inhibitors include:

 Benazepril (Lotensin)
 Captopril
 Enalapril (Vasotec)
 Fosinopril
 Lisinopril (Prinivil, Zestril)
 Moexipril
 Perindopril
 Quinapril (Accupril)
 Ramipril (Altace)
 Trandolapril

BIOCHEMICAL COMPOSITION OF URINE IN NORM AND

UNDER PATHOLOGY
Normal Chemical Composition of Urine
Urine is an aqueous solution of greater than 95% water, with a minimum of these
remaining constituents, in order of decreasing concentration:

 Urea 9.3 g/L.

 Chloride 1.87 g/L.
 Sodium 1.17 g/L.
 Potassium 0.750 g/L.
 Creatinine 0.670 g/L .
 Other dissolved ions, inorganic and organic compounds (proteins, hormones,
metabolites).