Editorial review. Recent formulations of the urinary concentrating mechanism: a status report

The SLC6A18 Transporter Is Most Likely a Na-Dependent Glycine/Urea Antiporter Responsible for Urea Secretion in the Proximal Straight Tubule: Influence of This Urea Secretion on Glomerular Filtration Rate

BACKGROUND

Urea is the major end-product of protein metabolism in mammals. In carnivores and omnivores, a large load of urea is excreted daily in urine, with a concentration that is 30-100 times above that in plasma. This is important for the sake of water economy. Too little attention has been given to the existence of energy-dependent urea transport that plays an important role in this concentrating activity.

SUMMARY

This review first presents functional evidence for an energy-dependent urea secretion that occurs exclusively in the straight part of the proximal tubule (PST). Second, it proposes a candidate transmembrane transporter responsible for this urea secretion in the PST. SLC6A18 is expressed exclusively in the PST and has been identified as a glycine transporter, based on findings in SLC6A18 knockout mice. We propose that it is actually a glycine/urea antiport, secreting urea into the lumen in exchange for glycine and Na. Glycine is most likely recycled back into the cell via a transporter located in the brush border. Urea secretion in the PST modifies the composition of the tubular fluid in the thick ascending limb and, thus, contributes, indirectly, to influence the "signal" at the macula densa that plays a crucial role in the regulation of the glomerular filtration rate (GFR) by the tubulo-glomerular feedback.

KEY MESSAGES

Taking into account this secondary active secretion of urea in the mammalian kidney provides a new understanding of the influence of protein intake on GFR, of the regulation of urea excretion, and of the urine-concentrating mechanism.

Effects of the renal medullary pH and ionic environment on vasopressin binding and signaling

The kidney has a cortico-medullary interstitial gradient of decreasing pH and increasing concentrations of sodium chloride and urea, but the influence of these gradients on receptor signaling is largely unknown. Here, we measured G-protein coupled receptor function in LLC-PK1 cells acutely exposed to conditions mimicking different kidney regions. Signaling through the parathyroid hormone receptor, normally expressed in the cortex, was greatly reduced at an acidic pH similar to that of the inner medulla. Parathyroid hormone receptor, tagged with green fluorescent protein, showed no ligand-induced internalization. In contrast, under both acidic and hyperosmotic conditions, vasopressin increased intracellular cAMP, and upon binding to its type 2 receptor (V2R) was internalized and degraded. Dose-displacement binding assays with selective vasopressin/oxytocin receptor ligands under inner medullary conditions indicated a shift in the V2R pharmacological profile. Oxytocin did not bind to the V2R, as it does under normal conditions and the vasopressin type 1 receptor (V1R) had reduced affinity for vasopressin compared to the V2R in low pH and high osmolality. We suggest that the cortico-medullary gradient causes a receptor-specific selectivity in ligand binding that is of functional significance to the kidney. While the gradient is important for urinary concentration, it may also play a substantial role in fine-tuning of the vasopressin response through the V2R.

Cycles and separations in a model of the renal medulla

This study gives the first quantitative analysis of net steady-state transmural fluxes of water, urea, and NaCl in a numerical model of the rat renal medulla in antidiuresis, revealing the model's predictions of water, urea, and NaCl cycling patterns. These predictions are compared both to in vivo micropuncture data from the literature and to earlier qualitative proposals (e.g., K. V. Lemley and W. Kriz. Kidney Int. 31: 538-548, 1987) of cycling and exchange patterns based on medullary anatomy and available permeability and transport parameter measurements. The analysis is based on our most recent three-dimensional model [X. Wang, S. R. Thomas, and A. S. Wexler. Am. J. Physiol. 274 (Renal Physiol. 43): F413-F424, 1998]. In general agreement with earlier proposed patterns, this analysis predicts the following: 1) important water short-circuiting from descending structures to ascending vasa recta in most medullary regions, 2) massive urea recycling in the upper inner medulla, 3) a progressive increase of the ratio of urea to total osmoles along the corticopapillary axis, 4) urea dumped from the collecting ducts (CD) into the deep papilla is returned to the cortex essentially via outer medullary short vasa recta, bearing witness to a shift from the long descending limbs and vasa recta of the inner medulla (IM) to short structures in the outer medulla (OM). The analysis also shows that the known radial heterogeneity of the inner stripe (IS) implies unequal osmolalities in long descending limbs, vasa recta, and CDs entering the IM across the OM/IM border and explains the model's unorthodox osmolality profile along the CD. In conflict with micropuncture evidence of a doubling of urea flow in superficial Henle's loops (SHL) between the end proximal and early distal tubule (T. Armsen and H. W. Reinhardt. Pflügers Arch. 326: 270-280, 1971), the model predicts net urea loss from SHL due to the model's inclusion of nonneglible measured urea permeability of medullary thick ascending limbs [M. A. Knepper, Am. J. Physiol. 245 (Renal Fluid Electrolyte Physiol. 14): F634-F639, 1983]. We present a suite of adjusted model permeabilities that improves agreement with the micropuncture data on this point. In conclusion, this modeling analysis of solute and water recycling serves as a quantitative check on qualitative propositions in the literature and allows closer critical comparison of model behavior with published experimental results than was heretofore possible.

Concentration profiles of calcium and oxalate in urine, tubular fluid and renal tissue--some theoretical considerations

This paper analyzes some aspects of the pathophysiology of urolithiasis. It is emphasized that a better understanding of factors contributing to stone formation can only be gained when the primary nucleation site is identified. Three compartments are considered in which supersaturation as a precondition for stone formation could be present: urine in the urinary tract, tubular fluid from the glomerulus down to the duct of Bellini, and the interstitium of the medulla. From calculations based on micropuncture data it becomes apparent that the oxalate concentration in the tubular fluid at the bend of Henle's loop is 1 or 2 orders of magnitude lower than in the duct of Bellini and that the oxalate concentration maximum invariably must be located in the final urine. The calculation of a tubular concentration profile of oxalate shows, that the probability of intra luminal crystal formation is even less likely for plasma oxalate values of 2-3 microM as compared to 1.2 microM, which therefore should be the correct value. The time necessary for the growth of crystals up to a critical size which can obstruct tubules or ureter is not available in the urinary tract nor in the tubules. However, in the medullary interstitium, where solute concentration is highest, nearly unlimited time for crystal growth is available due to the fact, that in this compartment convective flow is very low. It is concluded that the interstitium of the inner medulla has the best chances to function as the primary nucleation site where particles can be formed of a size which subsequently can obstruct the urinary tract.

Disorders of urinary concentration and dilution

A new approach to the classification of disorders of urinary concentration and dilution is recommended based on recent studies of how the kidney elaborates a urine of widely varying osmolality. The capacity to concentrate urine depends on ft, the fractional reabsorption of solute delivered to the loop of Henle; fu, the excretion of solute relative to the sum of solute excretion and solute delivery to Henle's loop; fw, the fraction of solute loss by vascular outflow from the medulla relative to that reabsorbed by the loop; and finally, collecting duct response to antidiuretic hormone (ADH). A decrease in ft or in increased fu or fw will diminish urinary concentrating ability, as will resistance of the tubule to ADH. Conversely, urinary dilution depends on the delivery of sodium and water to the ascending limb; NaCl reabsorption by the ascending limb; and the absence of ADH. A decrease in sodium and water delivery to the ascending limb or in NaCl reabsorption by the ascending limb will impair urinary diluting ability, as will the presence of ADH. The consequences of disorders in urinary concentrating and diluting ability vary widely. In an alert patient with an intact thirst center, there may be no consequence; in a patient unable to communicate thirst or whose thirst center is deranged, the results may be catastrophic. Keeping in mind the kidney's few basic requirements for formation of concentrated or dilute urine may help the physician avoid these potentially serious dislocations of water balance.

Ultrastructural localization of Na+,K+-ATPase in rat and rabbit kidney medulla

Na+,K+-ATPase was localized at the ultrastructural level in rat and rabbit kidney medulla. The cytochemical method for the K+-dependent phosphatase component of the enzyme, using p-nitrophenylphosphate (NPP) as substrate, was employed to demonstrate the distribution of Na+, K+-ATPase in tissue-chopped sections from kidneys perfusion-fixed with 1% paraformaldehyde-0.25% glutaraldehyde. In other outer medulla of rat kidney, ascending thick limbs (MATL) were sites of intense K+-dependent NPPase (K+-NPPase) activity, whereas descending thick limbs and collecting tubules were barely reactive. Although descending thin limbs (DTL) of short loop nephrons were unstained, DTL from long loop nephrons in outer medulla were sites of moderate K+-NPPase activity. In rat inner medulla, DTL and ascending thin limbs (ATL) were unreactive for K+-NPPase. In rabbit medulla, only MATL were sites of significant K+-NPPase activity. The specificity of the cytochemical localization of Na+,K+-ATPase at reactive sites in rat and rabbit kidney medulla was demonstrated by K+-dependence of reaction product deposition, localization of reaction product (precipitated phosphate hydrolyzed from NPP) to the cytoplasmic side of basolateral plasma membranes, insensitivity of the reaction to inhibitors of nonspecific alkaline phosphatase, and, in the glycoside-sensitive rabbit kidney, substantial inhibition of staining by ouabain. The observed pattern of distribution of the sodium transport enzyme in kidney medulla is particularly relevant to current models for urine concentration. The presence of substantial Na+,K+-ATPase in MATL is consistent with the putative role of this segment as the driving force for the countercurrent multiplication system in the outer medulla. The absence of significant activity in inner medullary ATL and DTL, however, implies that interstitial solute accumulation in this region probably occurs by passive processes. The localization of significant Na+,K+-ATPase in outer medullary DTL of long loop nephrons in the rat suggests that solute addition in this segment may occur in part by an active salt secretory mechanism that could ultimately contribute to the generation of inner medullary interstitial hypertonicity and urine concentration.

Freeze-fracture studies on the thin limbs of Henle's loop in Psammomys obesus

The thin limbs of short and long loops of Henle of the desert rodent Psammomys obesus were studied by freeze-fracture techniques. Intercellular junctions and internal membrane characteristics of thin-limb epithelia are of interest with regard to the high urine-concentrating capacity of this animal. The epithelium of the descending thin limbs of short loops is remarkably undifferentiated and equipped with multistrand tight junctions. In the descending thin limb of long loops, two segments are to be distinguished. The upper parts are characterized by an extensive cellular interdigitation and single-strand tight junctions. Thus, the paracellular pathways are prominent from two aspects: the junctional belt is elongated by interdigitation, and its apico-basal depth is shallow. The transition from the upper to the lower part appears to be abrupt, as indicated by the change in intramembrane particle density. The lower parts are characterized by a noninterdigitating epithelium with junctions consisting of few, but always more than two, strands. In addition, this thin-limb segment is characterized by regularly distributed infoldings of the basal cell membrane. The ascending thin limbs are established by an interdigitation epithelium, with junctions generally consisting of one strand. Once again, the elongated junctional belt is shallow. This study presents further evidence that remarkable species difference occur among thin-limb epithelia, especially concerning the descending thin limbs of long loops. Those differences may well explain discrepant functional findings concerning the transport properties of this segment in various species.

Urea handling by the medullary collecting duct of the rat kidney during hydropenia and urea infusion

Previous micropuncture studies of distal tubule fluid and ureteral urine have indicated a varying degree of urea reabsorption in the collecting duct. In the present experiments the microcatheterization technique was used to directly determine urea, Na, K, total solute and fluid reabsorption along the length of the medullary collecting duct in anesthetized hydropenic rats and in rats given low dose urea infusion (Purea 18.9 mM/l). In hydropenic rats, the remaining fraction of filtered urea did not change significantly along the collecting duct, as indicated both by regression analysis of all samples and by comparison of paired samples from the corticomedullary junction and papillary tip. During low dose urea infusion, urine osmolality increased in proportion to the increase in urea concentration and again there was no net urea reabsorption between the beginning and end of the duct. However, during urea infusion, analysis of samples from the beginning, mid-zone, and end of the collecting duct indicated that urea entry occurred in the proximal portion of the duct (beginning to mid-zone, P less than 0.01) and that urea reabsorption occurred in the distal portion (mid-zone to end, P less than 0.01). The lack of significant net urea reabsorption along the duct despite the excretion of moderately concentrated urine, has despite the excretion of moderately concentrated urine, has implications for the concept of medullary urea recycling and for models of the urinary concentrating mechanism. The finding of functional heterogeneity with respect to urea handling in the collecting duct in vivo, with both reabsorption are secretion being demonstrated, raises the possibility that internal recycling of urea in the medullary collecting duct itself may contribute to maintenance of a high papillary interstitial urea concentration.

The ultrastructure of the thin limbs of Henle in Kidneys of the desert heteromyid (Perognathus penicillatus)

The thin limbs of both long- and short-looped nephrons in Perognathus kidneys were studied with transmission and scanning electron microscopy. The superficial nephrons have a short thin limb located in the vascular bundles of the outer medulla and are characterized by a simple, low-lying epithelium (0.4 +/- 0.1 mu thickness). In contrast, the first descending part of the thin limb of the majority of midcortical and juxtamedullary nephrons has a relatively thick epithelium (1.7 +/- 0.6 mu in thickness) with marked lateral and basal interdigitation and a dense surface covering of microvilli. The remaining part of the long descending thin limb is relatively simple with a low-lying epithelium (0.6 +/- 0.1 mu in thickness), decorated on its surface by sparse microplicae. The bend of the loop and the ascending limb are covered by a very simple low-lying epithelium (0.6 +/- 0.2 mu in thickness) with relatively little surface modification. The extreme urine-concentrating ability of Perognathus does not appear to be due to the development of a unique thin loop epithelium but rather to the extensive length of the inner and outer medulla.