Last edited: 9/13/2021

1. THE COLLECTING DUCT

The Collecting Duct Medical Editor: Mariel Antoinette L. Perez

OUTLINE III) INTERCALATED A-CELL

I) REVIEW Responds to acidosis

II) OVERVIEW o Respiratory acidosis
III) INTERCALATED A-CELL o Metabolic acidosis
IV) INTERCALATED B-CELL Scenario: there’s CO2 in the blood
V) PRINCIPAL CELL
o In an acidosis, there is low pH = many protons (H+)
VI) REABSORPTION
o Very little bases to counteract the protons
VII) VASA RECTA
VIII) UREA RECYCLING CO2 + H2O  H2CO3  H+ + HCO3–
IX) APPENDIX o Carbon Dioxide (CO2)
X) REVIEW QUESTIONS  Found in our blood; moves into the cell, and
XI) REFRENCES combines with water to form H2CO3
 Catalyzed by enzyme carbonic anhydrase
I) REVIEW o Sodium Bicarbonate (H2CO3)
NaCl reabsorption in early DCT via NaCl symporters  Unstable; dissociates into proton and HCO3–
Calcium reabsorption dependent upon PTH o Protons (H+)
o PTH: parathyroid hormone  H-K-ATPase
• ATP-dependent pathway
Aldosterone can cause sodium reabsorption and o Both ions are moving against their
potassium secretion concentration gradients
Presence of ADH increases aquaporin-II expression
• K+ goes into the cell
o Allows water to flow into the blood
• H+ goes out of the cell
o Decreases potassium levels
 Body needs to secrete substances it doesn’t like
o Increases sodium levels
• Ammonia (NH3)
o Increases water  increases volume
o Can be excreted out into the urine where it
o Increases blood pressure
combines with the protons to produce
II) OVERVIEW ammonium (NH4+)
o Bicarbonate (HCO3–)
Principal Cell  Can be pumped out of the cell into the blood via
o maintain mineral and water balance the HCO3–/Cl– transporter
Intercalated A and B cells
IV) INTERCALATED B-CELL
o Maintain acid-base balance
o Helps keep body within homeostatic range Responds to alkalosis
o found in the late distal tubule and collecting duct o Respiratory alkalosis
o Note: o Metabolic alkalosis
 Intercalated A cells: acidic condition
The same pathway as intercalated-A cell, but flipped.
 Intercalated B cells: basic condition
o Get rid of bicarbonate instead of the proton
There are also other cells that could be secreting drugs. o Reabsorb proton into the blood instead of bicarbonate
Toxins, and creatinine
pH, H+, HCO3–
o Also others such as ammonia, protons, bicarbonate
CO2 + H2O  H2CO3  H+ + HCO3–
o Carbon Dioxide (CO2)
 Found in our blood; moves into the cell, and
combines with water to form H2CO3
 Catalyzed by enzyme carbonic anhydrase
o Sodium Bicarbonate (H2CO3)
 Unstable; dissociates into proton and HCO3–
o Bicarbonate (HCO3–)
 HCO3–/Cl– transporter
• HCO3– goes out of the cell
o pumped out of the cell into the urine
• Cl– goes into the cell
o Cl– will exit the cell via the chloride
channels on the basolateral membrane
o Protons (H+)
 H-K-ATPase
• ATP-dependent pathway
o Both ions are moving against their
concentration gradients
• K+ goes into the cell
• H+ goes out of the cell into the blood

THE COLLECTING DUCT RENAL PHYSIOLOGY: Note #5. 1 of 3

 V) PRINCIPAL CELL
Cells that maintain mineral and water balance
Hypothalamus
o Collection of neurons from the supraoptic nucleus
o Axons move through from the hypothalamus to the
posterior pituitary
o When stimulated, it will release ADH
(A) ANTIDIURETIC HORMONE (ADH) / VASOPRESSIN
released whenever the plasma osmolality is changing
can work in the late distal tubule and collecting duct
(1) Osmolality
(i) Hypertonic
 osmolality
 solutes (e.g., Na+,Cl–), H2O
 hypertonic
(ii) Hypotonic
 osmolality
 solutes (e.g., Na+,Cl–), H2O
(iii) Isotonic
 solutes = H2O
(2) Stimulus
High plasma osmolality
o ADH wants to have more water in the blood, which
means that the plasma osmolality was initially high
Angiotensin-II
o To increase blood pressure
(3) Process
ADH binds to the vasopressin receptor (on the principal
cell) in the collecting duct of the kidneys,
o Will activate the secondary messenger system
o Activates G-stimulatory protein  GTP
o Becomes active and activates another effector
enzyme, adenylate cyclase
Adenylate cyclase converts ATP  cAMP
cAMP activates Protein Kinase A
o Phosphorylates the proteins on the vesicles:
 Pre-synthesized vesicles with proteins and
channels (aquaporins)
o Activates aquaporin-II
 Fuses with the cell membrane
 There’s aquaporin-III and aquaporin-IV in the
basolateral membrane
Water goes out aquaporin-II, then passes through
aquaporins III & IV  goes into the blood  increases
blood volume, and increases blood pressure
o Also reaches normal plasma osmolality  isotonic
2 of 3 RENAL PHYSIOLOGY: Note #5
VI) REABSORPTION
(1) Calcium reabsorption
Dependent on the presence of PTH
(2) Water reabsorption
65% reabsorbed in the PCT
15% reabsorbed in the descending limb of Loop of Henle
20% reabsorbed in DCT
Water reabsorption dependent on aquaporin-II, which is
dependent on ADH
o ADH = more water reabsorption
o ADH = less water reabsorption
(3) Sodium reabsorption
65% reabsorbed in the PCT
25% reabsorbed in the descending limb of Loop of Henle
5-6% was reabsorbed in early DCT
Remaining 4-5% is reabsorbed depending on the
presence of aldosterone
VII) VASA RECTA
Peritubular capillary network present within the deep part
of the medulla
Known as the “Counter-Current Exchanger”
As the ascending limb goes up, it pumps the solutes out
 pulling water out of the descending limb
o Solutes: Mg2+, Ca2+, K+, Cl–, Na+
Vasa Recta gets saltier as we go down
o due to the Counter-Current Multiplier Mechanism
o Water wants to flow out towards where it’s salty
 Obligatory Water Reabsorption
o NaCl is pulled into the Vasa Recta
Processes reverses when vasa recta turns and goes up
o Water now wants to go back inside
o NaCl is being pushed back inside as we go up
Two functions
o Prevents rapid removal of sodium chloride
 When blood enters, it’s 300 mosm
 When blood leaves, it’s 325 mosm
• This implies that the vasa recta kept a bit of
NaCl with it to prevent rapid removal
o Carries Oxygen
 Cells depend on oxygen
 Vasa recta also delivers oxygen and nutrients
VIII) UREA RECYCLING
A lot of urea still gets lost in the urine, but some are
recycled
(1) Process
Urea gets reabsorbed in the last part of the collecting duct
o after all the water has been reabsorbed, [urea] starts
increasing
It then moves out of the collecting duct and into the
medullary interstitium via facilitated diffusion
o It gets reabsorbed in the ascending limb of Loop of
Henle
o At the same time, urea accumulates outside
 This helps makes the medulla more salty
(2) Purpose of Urea
(i) To make concentrated urine
(ii) To contribute to medullary gradient
THE COLLECTING DUCT
 IX) APPENDIX

Figure 1. Summary of The Collecting Duct

X) REVIEW QUESTIONS XI) REFRENCES

1) Presence of ADH increases the expression of which ● Sabatine MS. Pocket Medicine: the Massachusetts General
Hospital Handbook of Internal Medicine. Philadelphia: Wolters
of the following? Kluwer; 2020.
a) aquaporin-I ● Le T. First Aid for the USMLE Step 1 2020. 30th anniversary
b) aquaporin-II edition: McGraw Hill; 2020.
● Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL,
c) aquaporin-III Loscalzo J. Harrison's Principles of Internal Medicine, Twentieth
d) aquaporin-IV Edition (Vol.1 & Vol.2). McGraw-Hill Education / Medical; 2018
● Marieb EN, Hoehn K. Anatomy & Physiology. Hoboken, NJ:
2) Which of the following is incorrectly matched? Pearson; 2020.
a) Water : aquaporin-II ● Boron WF, Boulpaep EL. Medical Physiology.; 2017.
b) Calcium : ADH Guyton and Hall Textbook of Medical Physiology. Philadelphia, PA:
Elsevier; 2021.
c) Sodium : aldosterone
3) Which of the following is true?
a) Principal cells maintain mineral and water balance
b) Intercalated-A cells respond to alkalosis
c) Both a and b are true
d) Neither a nor b are true

CHECK YOUR ANSWERS

THE COLLECTING DUCT RENAL PHYSIOLOGY: Note #5. 3 of 3