Urea handling by the renal countercurrent system: insights from computer simulation.

The renal handling of urea has been investigated with the aid of a computer model of the countercurrent system in which active electrolyte reabsorption occurs along the entire ascending limb of Henle's loop. In this model, summarized in Fig.9, the buildup of a corticopapillary gradient for urea is optimized if there is net addition of urea to loops of Henle only in the outer medulla. This added urea remains within the tubular system until it is reabsorbed from collecting ducts in the inner medulla. Thus, a net transfer of urea from outer to inner medulla is accomplished (via distal tubule and cortical collecting duct). There is no net addition of urea to loops of Henle within the inner medulla; in this region, the loops act simply as countercurrent exchangers for urea. Computer simulation of systematic variation in the urea permeabilities of each nephron segment shows that interference with any element of the above schema results in impairment of the medullary accumulation of urea relative to plasma. Simulation of varying rates of urinary urea excretion demonstrates that this model can account for the ability of the kidney to excrete substantial amounts of urea without an accompanying osmotic loss of water. The major insight gained from this study is that net addition of urea to loops of Henle in the outer medulla greatly enhances the medullary accumulation of urea, whereas, net addition of urea to loops within the inner medulla tends to defeat such accumulation and hence the urinary concentrating process. This general principle applies also to an alternate model of the countercurrent system, in which electrolyte reabsorption from thin ascending limbs of Henle is passive.