The loop of Henle is referred to as countercurrent multiplier and vasa recta as

countercurrent exchange systems in concentrating and diluting urine.

Explain what happens to osmolarity of tubular fluid in the various segments of
the loop of Henle when concentrated urine is being produced.
Explain the factors that determine the ability of loop of Henle to make a
concentrated medullary gradient.
Differentiate between water diuresis and osmotic diuresis.
Appreciate clinical correlates of diabetes mellitus and diabetes insipidus.
 Fluid intake
The total body water Antidiuretic
is controled by : hormone
Renal excretion of
water Hyperosmolar
medullary
Changes in the osmolarity of tubular fluid : interstitium

1 2 3
Low osmolarity
The osmolarity
High osmolarity because of active
decrease as it goes up
because of the transport of Na+ and
because of the
reabsorbation of water co-transport of K+ and
reabsorption of NaCl
Cl-

4 5
Low osmolarity because of High osmolarity because of
reabsorption of NaCl , also reabsorption of water in
reabsorption of water in present of ADH ,
present of ADH reabsorption of urea
 Mechanisms responsible for creation of
hyperosmolar medulla:

Active Co- Facilitated diffusion

transport : transport : diffusion : of :

Na+ ions out of the Only of small

thick portion of the K+ , Cl- and other amounts of water
ascending limb of ions out of the thick from the medullary
the loop of henle portion of the Of urea from the tubules into the
into the medullary ascending limb of inner medullary medullary
interstitium the loop of henle collecting ducts into interstitium less
Of ions from into the medullary the medullary than the
collecting ducts into interstitium interstitium reabsorption of
medullary No water diffusion solutes in to the
interstitium like to the medulla medullary
Ca++ interstitium
 Counter current multiplier mechanism
Step no : Action :
Assume that the loop of
henle is filled with a
1 concentration of
300mOsm/L the same as
that leaving the proximal
tubules

The active ion pump of

the thick ascending limb
2 on the loop of henle
reduces the concentration
inside the tubule and
raises the interstitial
concentration
The tubular fluid in the
descending limb and the
3 interstitial fluid quickly
reaches osmotic
equilibrium because of This pump capable to establish only a 200mOsm/L
osmosis of water out of concentration gradient
the descending limb
Step no : Action :

Additional flow of the fluid in to the loop of

henle from the proximal tubule , which causes
the hyper osmotic fluid previously formed in
4 the descending limb to flow into the ascending
limb.
Additional ions pumped into the interstitium
with water remaining in the tubular fluid , until
a 200-mOsm/L osmotic gradient is established .
5
Again , the fluid in the descending limb reaches
equilibrium with the hyperosmotic medullary
interstitial fluid and as the hyperosmotic
6 tubular fluid from the descending limb flows
into the ascending limb ,still more solute is
continuously pumped out of the tubules and
deposited into the medullary interstitium .

These steps are repeated over and over , with

net effect of adding more and more solute to
the medulla in excess of water , with sufficient
7 time, this process gradually traps solutes in the
Counter current multiplier mechanism helps in creation of
medulla and multiplies the concentration
hyperosmolar medulla 1200-1400 mOsm/L
gradient established by the active pumping of
It is maintained by the balanced inflow and outflow of solutes and
ions out of the thick ascending limb , eventually
water in medulla
raising the intestitial fluid osmolarity to 1200-
In this mechanism the inflow is parallel , close to but opposite to
1400 mOsm/L .
outflow
 Urea recycling

As the fluid flows from the proximal tubule

into the thin segments of the loop of henle This urea recirculation provides an additional
urea is more and more concentrated because mechanism for forming a hyper osmotic
of water reabsorption out of the descending renal medulla . Because urea is one of the
limb and passive secretion of urea from most abundant wastes products that most be
medullary interstitium in to the thin loops of excreted by the kidney
henle

The thick limb of the loop of henle , the distal

tubule and the cortical collecting tubule are
all relatively impermeable to urea → the Moderate share of urea that moves into
kidney forms concentrated urine and high medullary interstitium eventually diffuses
levels of ADH → reabsorption of water → into thin loops of henle passes upward
urea is more concentrated → as the urea through the ascending limb, distal tubule ,
flows intramedullary collecting duct, the high cortical collecting tubule and back down into
concentration of urea and specific urea the medullary collecting duct again
transporter causes diffuse of urea in to the
medullary interstitium
 Counter current in exchanger vasa recta

Functoin Maintain the hyperosmolarity of the renal medulla

Descending limb of vasa recta Ascending limb of vasa

How it works ?

recta
Water pass out into hyperosmolar Water will be reabsorbed
medulla carrying O2 and nutrient back to the hyperosmolar
blood carrying water, CO2 and
NaCl will enter the blood waste product
increasing its osmolality. NaCl will leave the blood and
become deposited in the
medulla

The medullary blood flow is slow ( 1- Vasa recta serve as counter

2% of total renal blood flow ) current exchangers :
For metabolic demand To minimize washout of
features Helps to minimize solute loss from solutes from medullary
the medullary interstitium . interstitium . This due to U
shape of vasa recta .
 Water reabsorbed from collecting duct (by osmosis) is
Role of ADH determined by the hormone ADH (anti-diuretic
hormone)

Osmoreceptors in the
ADH makes the wall In the present of ADH
hypothalamus detect the hypothalamus
which releases ADH of the collecting duct more water is
the low levels of sends an impulse to
into the bloodstream. more permeable to reabsorbed and less
(high water the pituitary gland
water. is excreted.
osmolarity)
 Is an increase of urine
Diuresis
output. It has two types :
Water diuresis: Osmotic diuresis:
Drinking large quantity of water → dilute Filtration of excessive osmotic active
ECF→↓ADH→ no water substances → Drag water with it → Large
reabsorption in collecting duct→ large volume of hyperosmolar “concentrated ”
of “diluted” urine. volume urine. Like in diabetic patients we will find an
amount of glucose in their urine.

Diabetes insipidus: is a condition characterized by excessive

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thirst and excretion of large amounts of severely diluted Diabetes mellitus:
urine.
Disorders of
1/ cranial diabetes inspiduse : 2/ Nephrogenic diabetes
urinary Cause : inability to produce or insipidus: High specific gravity
concentrating release ADH Cause : inability of kidney to
Urine : low fixed specific gravity
urine
ability respond to ADH
(concentrated urine )
(diluted urine) Urine : low fixed specific
Polyuria gravity (diluted urine)
Polydypsia
 The kidney can excrete urine as dilute as 50 mOsm/L and as concentrate as high as
1200-1400 mOsm/L depends on water intake .
The kidney can excrete large volume or small volume of urine without affecting the
rate of solute excretion.
Counter current multiplier mechanism is a function of the loops of henle . Its role in
formation of the hyperosmotic medula .
Urea recycling frome the inner medullary collecting duts is the process that
contributes to establishment of hyperosmotic medulla .
Counter current exchanger “ vasa recta “ is for blood supplying to the medulla and for
maintaining hyperosmolar medulla.
Vasa recta has two main features :
•Slow blood flow
•The vasa recta act as a counter current exchanger to minimize washout of solutes from
the medullary interstitium. This is due to the U shape of vasa recta capillaries.
 There is a powerful feedback system for regulating plasma osmolarity and
sodium concentration that operates by altering renal excretion of water
independently of the rate of solute excretion. A primary effector of this
feedback is antidiuretic hormone (ADH), also called vasopressin.
Tha mian difference between water diuresis and osmotic diuresis is the concentration of the
urine .
•Water diuresis : diluted urine
•Osmotic diuresis : concentrated urine

Role of ADH
Q1.When the water concentration in body fluids Q4.The ADH promotes water reabsorption

Ans : 1.B
increases the secretion of ADH increases. through the walls of the:
A. T A. Thick Ascending limb of loop of Henle.
B. F B. Distal convoluted tubule and collecting
duct.
C. Vasa recta.

2.A
Q2.The countercurrent mechanism takes place in: Q5.Which one of the following produces the
A. Juxtamedullary nephron hyperosmotic Medullary interstitium?
B. Cortical nephrone A. NaCl reabsorbed from the thick ascending

3.A
C. Both. limb of loop of henle to medullay
interstitum
B. Urea reabsorbed from collecting duct to
medullary interstitum

4.B
C. Both A and B

Q3.The function of the countercurrent multiplier is Q6.When a persons dehydrated. His

5.C
to: extracellular fluids osmolality is high ; so hir
A. Produces the hyperosmotic Medullary kidney will excrete diluted urine.
Interstitium A. T

6. B
B. Maintains hyperosmolar medulla B. F
C. Secretes ADH
 Ans:
Q7.Reabsorotion of urea will occurs in present of Q10.In water diuresis the urine will be
ADH : concentrated :
A. T A. T

7.A
B. F B. F

8.A 9.B
Q8.Excreton of large volume or small volume of Q11.Nephrogenic diabetes insipidus patients
urine wont affect the rate of solute excretion. will have :
A. T A. No production or releasing of ADH
B. F B. No response from the kidney to ADH
C. High specific gravity urine

10. B 11.B
Q9.If the ECF is hypo-osmotic the excreted urine Q12.The function of the Counter current
will be: exchanger “vasa recta “ :
A. Concentrated A. Produces the hyperosmotic Medullary
B. Diluted Interstitium

12.B
C. Non B. Maintains hyperosmolar medulla
C. Secretes ADH