The medullary microcirculation

Kidney International
B L ZimmerhacklR L Jamison

Abstract

Like other regional circulations, the medullary circulation supplies oxygen and other primary substrates to the medulla and removes carbon dioxide and other waste metabolites. It also acts as a countercurrent exchanger and simultaneously removes water reabsorbed from the renal tubule to preserve mass balance. Our present understanding of how the medulla serves both these functions at the same time is illustrated in Figure 3. Blood leaves the efferent arteriole with an elevated plasma protein concentration as a consequence of glomerular filtration, and flows down descending vasa recta within a vascular bundle. The increased interstitial osmotic-concentration coupled with a finite capillary reflection coefficient for small solutes causes additional water to be extracted so that at the termination of descending vasa recta, the plasma protein concentration exceeds that in the systemic circulation by approximately twofold. Solute, urea more than sodium chloride, also enters descending vasa recta. As blood flows through the interconnecting capillary plexus and up ascending vasa recta, transcapillary oncotic and osmotic pressure differences combine to cause capillary uptake of fluid. There is also simultaneous loss of urea such that t...Continue Reading

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Citations

Apr 16, 2010·American Journal of Physiology. Renal Physiology·Julie Kim, Thomas L Pannabecker
Nov 20, 2013·Annual Review of Physiology·Jeff M Sands, Harold E Layton
Apr 5, 2001·International Anesthesiology Clinics·A D Friedrich
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Jun 16, 2009·Seminars in Nephrology·Jeff M Sands, Harold E Layton
Jul 15, 2015·The New England Journal of Medicine·Mark A KnepperSoren Nielsen
Mar 1, 2001·Journal of the Renin-angiotensin-aldosterone System : JRAAS·L Gabriel NavarAkira Nishiyama
Sep 27, 2018·American Journal of Physiology. Renal Physiology·Chang-Joon LeeDavid W Smith
Nov 3, 2005·American Journal of Physiology. Renal Physiology·Michael L PucciVictor L Schuster
Dec 17, 2002·American Journal of Physiology. Regulatory, Integrative and Comparative Physiology·David L Mattson
Jul 15, 2015·The New England Journal of Medicine·Johann MorelleOlivier Devuyst
Jun 3, 2021·Cells·Katerina ApeltTon J Rabelink

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