Thin descending limb of Henle

Loop of Henle · Water only AQP1 Mannitol

Water-permeable, salt-impermeable segment that dives from cortex toward papilla, equilibrating with the increasingly hypertonic medullary interstitium so that tubular fluid is concentrated to ~1200 mOsm/kg at the bend of long loops.

Traced from the start

  1. Glomerular filtration barrier
  2. Proximal tubule: Na+/H+ exchange and bicarbonate reclamationProximal tubule: sodium-coupled glucose and amino acid reabsorption
  3. Thin descending limb of Henle

Detail

Reabsorbs
Water (~15-20% of the filtered load) by osmosis via AQP1; essentially no active NaCl transport
Permeability
High to water, low to NaCl; urea enters via UT-A2 as part of urea recycling
Result
Fluid osmolality rises from ~300 to up to ~1200 mOsm/kg at the hairpin in juxtamedullary nephrons (only ~15% of nephrons have long loops)
Hormone
None directly
Diuretic
Osmotic diuretics (mannitol; glucose in hyperglycaemia): trapped luminal solute holds water in the proximal tubule and descending limb, reducing water and secondarily Na+ reabsorption

When it goes wrong

Mannitol infusion

Initial ECF expansion before diuresis (can precipitate pulmonary oedema in heart failure), then hypernatraemia and volume depletion; used to lower intracranial pressure

Medullary washout after loop diuretics or prolonged high-flow states

Less gradient for the descending limb to equilibrate against, so urine cannot be concentrated above ~300 mOsm/kg (isosthenuria)

Practise this structure

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