PROBLEM SOLVING WORKSHOP #2

Quantitative Integration: Assessment of Tubular Function

FREE WATER CLEARANCE

Dr. A. Haramati
One of the ways of quantitating the renal contribution to the regulation of body-fluid
osmolarity is by determination of the amount of "solute-free" water that is excreted by the
kidney.
V = Cosm + CH2O
Where:
V = urine flow (ml/min)
Cosm = solute clearance: Uosm x V (ml/min)
Posm
CH2O = free water clearance (ml/min)
Thus:
CH2O = V - Uosm x V
Posm
NOTE: CH2O is not a conventional clearance term but rather an indication of the
amount of pure (or solute-free) water that would have to be added to or removed from the
urine to make the urine isosmotic to plasma.
Accordingly, if a urine hypotonic to plasma is formed, free water clearance is positive.
However, when a hyperosmotic urine is formed, free water clearance will have a negative
value (i.e. solute-free water is being reabsorbed, not excreted, in order to form urine more
concentrated than plasma). A symbol for "negative free water clearance" is TcH2O
which refers to "the volume of free water transported."

PROBLEM # 1:
a. Calculate free water clearance (CH2O) from the values given below:
WATER DIURESIS WATER
DEPRIVATION
V 6 ml/min 0.5 ml/min
Uosm 100 mOsm/L 1200 mOsm/L
Posm 300 mOsm/L 300 mOsm/L
b. What is the CH2O if the urine formed is isosmotic to plasma?
c. What factors influence the formation of either positive or negative CH2O?
Dr. A. Haramati Problem SolvingWorkshop #2 Page 2

PROBLEM #2:

An astute medical student, eager to please his/her professor, volunteers to participate in

an experiment in the renal lab. He/she is asked to empty his/her bladder and then drinks
1 liter of water. Urine is collected 45 minutes later and the following results are
obtained:

Uosm = 140 mOsm/L

Posm = 280 mOsm/L
V = 4 ml/min

a. Calculate the free water clearance (CH2O).

The student is then injected with a drug and the following data are obtained 60 minutes
later:

Uosm = 570 mOsm/L

Posm = 285 mOsm/L
V = 1 ml/min

b. Calculate the free water clearance (CH2O).

c. Explain the changes that occurred following ingestion of the water and after
injection of the drug. Suggest a possible substance that the drug might resemble.
Dr. A. Haramati Problem SolvingWorkshop #2 Page 3

PROBLEM #3:

The following laboratory results are obtained on urine collected from a patient over a 24
hour period:

total volume 2880 ml

urine creatinine concentration 50 mg/100 ml
urine sodium concentration 75 mM
urine PAH concentration 50 mg/100 ml
urine osmolarity 600 mOsm/L
plasma creatinine concentration 1 mg/100 ml
plasma sodium concentration 150 mM
plasma PAH concentration 0.2 mg/100 ml
hematocrit 50%
plasma osmolarity 300 mOsm/L

Calculate the following parameters:

a) GFR (per minute and per day)
b) ERPF (per minute)
c) ERBF (per minute)
d) filtration fraction
e) rate of sodium filtered
f) rate of sodium excretion
g) rate of sodium reabsorption
h) fractional excretion of sodium
i) fractional reabsorption of sodium
j) osmolar clearance
k) free water clearance
l) total amount of water reabsorbed
m) total amount of sodium filtered
n) total amount of sodium excreted
o) total amount of sodium reabsorbed
p) fractional excretion of water (% GFR excreted)

Question to ponder: How does FEH2O differ from CH2O?