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The kidney is the most important organ in the
regulation of water balance in the body. Under normal
circumstances, the sensitive hypothalamic osmoreceptors detect
any change in extracellular tonicity and respond by altering
secretion of ADH from the posterior pituitary. The volume
receptors are much less sensitive and really function as a
backup sensor. Most water intake is not due to thirst. The
thirst mechanism functions as a backup effector mechanism.
The kidney is the effector organ for body
water balance.
Glomerular filtration rate (GFR) is very
large (180 l/day) in comparison to the amount of urine that is
typically produced. Most of the water in the filtrate is
reabsorbed because of renal processes which are independent of
ADH action.
The diagram below summarises the percentages
of water reabsorbed in the various renal segments. The two
extreme examples of absence of ADH and maximal ADH production
are outlined. The kidney adjusts the water reabsorption between
these two extremes (under the influence of ADH) in order to
maintain a constant plasma osmolality. The minimum (or
obligatory) urine volume is determined by the size of the daily
solute load and the maximal urine osmolality that can be
achieved. The maximum urine osmolality decreases with increasing
age in adults so the obligatory urine volume is higher for a
given solute load in the elderly.
All water reabsorption in the kidney is
passive.
Water moves in response to osmotic
gradients. These osmotic gradients are all directly or
indirectly due to the reabsorption of solute particularly
sodium. There are no water pumps in the body.
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Fig 5.5 Quantitative Summary of Renal Water Handling
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GFR (180 l/day)
65% Reabsorbed Proximal Tubule
15% Reabsorbed Loop of Henle (thin descending
limb)
20% of filtrate Enters Distal Tubule
In absence of ADH With maximal ADH
8% Reab in CD >19% Reab in CD
& &
12% of filtered H2O
<1% of filtered H2O
in urine in urine
(22 l/day at 30-60
mOsm/l) (500 mls at 1200 mOsm/day)
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