20 Urine & Renal Function

Urine Concentrations
Dilute Urine
● If there is too much water in the body or too few ions, dilute urine must be made to reestablish balance
● This is because if you have too much dilute blood you will have water intoxication
● This urine has to be more dilute in ions than the blood (less than 300 mol)
Creating Dilute Urine
● The more short loop nephrons we have we make more dilute urine, opposite happens for long loop nephrons
1. In the PCT solutes are reabsorbed and water follows them out of the tubule
2. Filtrate enters descending LOH. the loss of water makes the filtrate more concentrated and the
osmolarity goes up
3. The filtrate enters the thick ascending LOH and solutes are pumped put by symporters but water cannot
follow (because impermeable to water). The filtrate loses solute and the osmolarity goes down
4. Filtrate follows to the distal convoluted tubule and loses more solute (but not water and so osmolality
falls further
5. Filtrate enters the collecting ducts which are permeable to water only in the presence of ADH. As it goes

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down more solute is pumped until it reaches a concentration of 65

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Concentrate Urine
● There are long loop nephrons, and when it gets to the bottom of LOH, the concentration is up to 1200

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● These nephrons are called juxtameduallary nephrons
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● We have concentrated urine if we have too little water or too many ions in the body, the urine will reestablish the
balance
Creating concentrated urine
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● The urine has to be more concentrated than the blood, so more than 300 mOsm/L
● Steps 1-4 are the same between dilute and concentrated urine
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○ Step 5: there are small water in which water can exit but not ions. Filtrate enters the collecting ducts
which, in the presence of ADH are permeable to water. Water flows out to match the extremely high
osmolarity of the surrounding interstitial fluid
● Diuretics work by inhibiting the Na-K-2Cl pumps the ascending loop of henle so there is decreased water
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reuptake and more urine

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● ADH works to fuse aquaporin 2 molecules together and they make holes in the basolateral membrane of the
collecting ducts
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Hormonal Regulation of Tubular Reabsorption

ADH (vasopressin)
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● Made from hypothalamus, comes from posterior pituitary

● The hypothalamus is constantly tasting our blood
1. When osmolarity in plasma is concentrated we release ADH
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2. This stimulate the neurosecretory cells in the hypothalamus to release ADH and then goes to collecting
ducts
● ADH also increases the activity of the Na-K-2Cl symporter

Angiotensin II and Blood Pressure

● Angiotensin II raises BP by constricting arterioles
Angiotensin II, Aldosterone & Filtration
● Angiotensin II: We increase sodium reabsorption by Na+/H+ antiporters
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 ● Angiotensin II also releases aldosterone from adrenal glands which increases Na+ and Cl- reabsorption by
collecting ducts and so H2O follows
● All these increase BP

Measures of Kidney Function

Evaluating Kidney Function
● Urinalysis: looking at volume, physical, chemical, and microscopic properties of urine
● Blood analysis: looking at the levels of waste products

Urinalysis
● Less than 1 L, means dehydrated
● More than 2 L, maybe a diabetic
● Dark red colour: liver problems
● Milky: bacteria
● Cloudy: infection (UTI)
● Fruity: diabetes
● Foul: bacteria

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● Low pH means metabolic acidosis

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Blood Analysis

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● Blood urea nitrogen (BUN)

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○ Urea is a protein breakdown product (body does not want it)
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○ When you pee a lot you excrete a lot of urea and when you do not pee a lot you do not excrete it
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○ BUN will increase in the blood when the GFR decreases sharply (renal disease) and urine production is
low such as with dehydration
● Plasma Creatinine
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○ When you exercise a lot you break down skeletal muscle and creatinine, and we want to get rid of
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creatinine
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○ Creatinine at levels above 110 umol/L can be a indication of poor kidney function

Renal Function Tests

● Renal Clearance
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○ Determines how effectively the kidneys are removing a given substance per unit time
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○ You can use it to figure out how well the kidneys are working
○ Drugs are often cleared by the kidneys so you need to know how much to put in
○ If they have poor kidney function you would probably give them less drug
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○ High plasma clearance: indicated efficient excretion (penicillin)

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○ Low plasma clearance: indicated inefficient excretion (glucose)

○ Renal clearance can be assessed by collecting samples of blood and urine and measuring the urea
concentration in each and measuring the rate of urine output
○ You need to know amount in blood (P), amount in urine (U) and how much urine you are making (V)
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○ Renal clearance = UV/P

■ This means that 60 ml of blood plasma is cleared of urea per minute
● GFR
○ Best measure to use when wanting to determine stage of kidney disease

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