Development And Maintenance Of Medullary Hyperosmolality

Thus far, this chapter has discussed the effects of the hyperosmotic medullary interstitium on the abstraction of water from the thin descending limb and from the medullary collecting duct in the presence of vasopressin. How does this medullary hyperosmolality develop, and how is it maintained in the face of plasma flow through the medulla? In any other tissue, one would expect that the constant blood flow, as well as the constant water entry from the thin descending limb of the loop of Henle and the medullary collecting duct, would dilute the medullary hypertonicity, soon causing it to become isotonic. Water reabsorption from the thin descending limb actually does not dilute the medullary interstitium because salt is actively reabsorbed from the thick ascending limb, keeping the medullary salt concentration high. That is why the urine delivered to the distal convoluted tubule is always dilute; in essence, a hyperosmotic fluid is being reabsorbed from the loop

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