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Osmoregulation (Urine Dilution & Concentration) - Dr. Gawad

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Osmoregulation (Urine Dilution & Concentration) - Dr. Gawad

  1. 1. OSMOREGULATION URINE DILUTION & CONCETRATION Mohammed Abdel Gawad Nephrology Specialist Kidney & Urology Center (KUC) - Alexandria drgawad@gmail.com DNG Meeting – Mansoura – 20 June 2014 Nephrology – Back to Basics Series Physiology Concepts
  2. 2. It is the number of particles - osmoles (mmol) contained in 1 liter of water. (it is the concentration by number) Osmolality (mmol/L) 2
  3. 3. normally ranges between 285 and 295 mmol/L Calculated Osmolality 3
  4. 4. Osmolar Gap 4
  5. 5. Specific gravity is the mass of one milliliter of solution in grams. This gives an indication of both the number and weight of the particles in the urine. Osmolality vs Specific Gravity 5
  6. 6. M.Gawad www.nephrotubecne.com Goce Spasovski et al, Nephrol Dial Transplant (2014) 29 (Suppl. 2): ii1–ii39 Normally: ICF Osmolality = ECF Osmolality Intracellular Extracellular Effect of Plasma Osmolality Changes on Cell Size
  7. 7. Intracellular Extracellular Intracellular swelling & edema H2O M.Gawad www.nephrotubecne.com Goce Spasovski et al, Nephrol Dial Transplant (2014) 29 (Suppl. 2): ii1–ii39 Effect of Plasma Osmolality Changes on Cell Size Consequences of Low Plasma Osmolality
  8. 8. Intracellular Extracellular Intracellular Shrinkage M.Gawad www.nephrotubecne.com Goce Spasovski et al, Nephrol Dial Transplant (2014) 29 (Suppl. 2): ii1–ii39 Effect of Plasma Osmolality Changes on Cell Size Consequences of High Plasma Osmolality H2O
  9. 9. 9 Effect of Plasma Osmolality Changes on Cell Size
  10. 10. A change in plasma osmolality of only 1% is detectable by the hypothalamus 10 Plasma Osmolality Monitoring General Concept
  11. 11. Mechanism of Changes in Plasma Osmolality General Concept 11
  12. 12. Mechanism of Changes in Plasma Osmolality General Concept 12
  13. 13. 13 How Body Adjust Plasma Osmolality? General Concept
  14. 14. 14 How Body Adjust Plasma Osmolality? General Concept
  15. 15. 15 How Body Adjust Plasma Hypo-Osmolality? (1) Suppress Thirst
  16. 16. 16 How Body Adjust Plasma Hypo-Osmolality? (2) Suppress ADH Secretion
  17. 17. 17 How Body Adjust Plasma Hyper-Osmolality? (1) Stimulate Thirst Thirst (causing the ingestion of water) is the most effective defense against increases in osmolality. This defense is so effective that, with ready access to water, alert people cannot develop significant increases in osmolality
  18. 18. 18 How Body Adjust Plasma Hyper-Osmolality? (2) Stimulate ADH Secretion
  19. 19. Anti Diuretic Hormone (ADH) 19
  20. 20. ADH – Stimulation 20 • Arthur C. Guyton, John E. Hall. TEXTBOOK OF MEDICAL PHYSIOLOGY. 11th Edition, 2006. • Sarah Faub el, Jo el Topf.The Fluid, Electrolyte and Acid-Base Companion. Chapter 4, 1999.
  21. 21. ADH – Stimulation 21
  22. 22. ADH Formation, Storage & Release 22
  23. 23. ADH Formation, Storage & Release 23
  24. 24. 24 ADH Formation, Storage & Release Osmoreceptors in the hypothalamus
  25. 25. 25 ADH - Action Formation of concentrated urine Facultative water reabsorption
  26. 26. 26 ADH - Action Formation of concentrated urine Facultative water reabsorption
  27. 27. 27 ADH - Action Formation of concentrated urine Facultative water reabsorption
  28. 28. 28 ADH - Action For completed action of ADH, we need Concentrated Medullary Interstitium
  29. 29. 29 Concentrated Medullary Interstitium The renal medullary interstitium surrounding the collecting ducts is normally hyperosmotic
  30. 30. 30 Loop of Henle (Countercurrent Multiplier) Vasa Recta (Countercurrent Exchange Mechanism) Concentrated Medullary Interstitium The renal medullary interstitium surrounding the collecting ducts is normally hyperosmotic
  31. 31. 31 65% 8-10% 25% Basics - Tubular Na Handling Concentrated Medullary Interstitium
  32. 32. 32 65% by osmosis (obligatory reabsorption) 15-20% by osmosis (obligatory reabsorption) 15% Under effect of ADH (Facultative reabsorption) Basics - Tubular Water Handling Concentrated Medullary Interstitium
  33. 33. 33 Loop of Henle (Countercurrent Multiplier) Vasa Recta (Countercurrent Exchange Mechanism) Concentrated Medullary Interstitium The renal medullary interstitium surrounding the collecting ducts is normally hyperosmotic
  34. 34. 34 Loop of Henle (Countercurrent Multiplier) Vasa Recta (Countercurrent Exchange Mechanism) Concentrated Medullary Interstitium The renal medullary interstitium surrounding the collecting ducts is normally hyperosmotic To form a hyperosmolar medullary interstitium
  35. 35. Loop of Henle: Countercurrent Multiplication 35
  36. 36. Loop of Henle: Countercurrent Multiplication 36
  37. 37. 37 Loop of Henle (Countercurrent Multiplier) Vasa Recta (Countercurrent Exchange Mechanism) Concentrated Medullary Interstitium The renal medullary interstitium surrounding the collecting ducts is normally hyperosmotic
  38. 38. 38 Loop of Henle (Countercurrent Multiplier) Vasa Recta (Countercurrent Exchange Mechanism) Concentrated Medullary Interstitium The renal medullary interstitium surrounding the collecting ducts is normally hyperosmotic To preserve the hyperosmolar medullary interstitium
  39. 39. 39 Vasa Recta: Countercurrent Exchange
  40. 40. Vasa Recta: Countercurrent Exchange 40
  41. 41. 41 ADH - Action Formation of concentrated urine Urea Reabsorption
  42. 42. 42 ADH - Action Formation of concentrated urine Urea Reabsorption
  43. 43. Mohammed Abdel Gawad Thank You
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