The renal concentrating mechanism: fundamental theoretical concepts.

Five theoretical principles that follow from qualitative consideration of renal architecture and tubular permeabilities are proposed to explain the concentration of urine in the mammalian kidney. These are: 1) The medullary loop of the doubly folded S-shaped configuration of the nephron permits solute supplied by ascending Henle's limb (AHL) to extract water from descending Henle's limb (DHL) and collecting duct (CD). 2) The cortical loop allows the diluted AHL fluid to return to isotonicity with cortical plasma before returning to the medulla. 3) The folded vasa recta and surrounding interstitium (the central core) provide an expansion chamber for the performance of osmotic work and a mixing chamber for salt and urea. This mixing induces passive salt transport out of AHL. 4) Overall, the system acts as a solute cycling multiplier from the AHL to vascular core and the osmotically equilibrated DHL and CD. 5) The short-looped nephrons provide urea to drive salt transport out of AHL of long nephrons in the inner medulla.