Relationship between structure and function in distal tubule and collecting duct.

The relationship between structure and function in the distal tubule and collecting duct has been studied with morphologic and physiologic techniques, including morphometric analysis, to identify functionally distinct cell populations. The distal tubule, including the thick ascending limb (TAL) and the distal convoluted tubule (DCT), is involved in active reabsorption of sodium chloride. It is characterized by extensive invaginations of the basolateral plasma membrane, numerous mitochondria, and high Na-K-ATPase activity, features characteristic for an epithelium involved in active transport. Between the distal tubule and the collecting duct is a transition region, the connecting segment or the connecting tubule (CNT), which exhibits species differences with respect to both structure and function. The collecting duct includes the cortical (CCD), the outer medullary (OMCD), and the inner medullary (IMCD) collecting ducts. Principal cells are present throughout the collecting duct, whereas intercalated cells are located mainly in the CCD and OMCD. Morphometric analysis combined with micropuncture and microperfusion studies has provided evidence that the CNT and principal cells are responsible for potassium secretion in the connecting segment and the CCD. The OMCD is a main site of hydrogen ion secretion, and morphometric studies have provided evidence that the intercalated cells in this segment secrete hydrogen ion at least in the rat. Two configurations of intercalated cells exist in the CCD--a type A and a type B. The A cells are similar in ultrastructure to the intercalated cells in the OMCD and are believed to be involved in hydrogen ion secretion. The function of the B cells remains to be established. The inner two-thirds of the IMCD corresponds to the papillary collecting duct, which has a high permeability to urea. The relationship between structure and function in the IMCD has not been studied in detail. This review emphasizes the role of morphometric analysis in establishing the relationship between structure and function in the distal nephron.