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The Physiology of Water Homeostasis

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Core Concepts in the Disorders of Fluid, Electrolytes and Acid-Base Balance

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Abstract

Water is the most abundant constituent in the body. Vasopressin secretion, water ingestion, and the renal concentrating mechanism collaborate to maintain human body fluid osmolality nearly constant. Abnormalities in these processes cause hyponatremia, hypernatremia, and polyuria. The primary hormonal control of renal water excretion is by vasopressin (also named antidiuretic hormone). Thirst and vasopressin release from the posterior pituitary are under the control of osmoreceptive neurons in the central nervous system. The kidney maintains blood plasma osmolality and sodium concentration nearly constant by means of mechanisms that independently regulate water and sodium excretion. The renal medulla produces concentrated urine through the generation of an osmotic gradient extending from the cortico-medullary boundary to the inner medullary tip. This gradient is generated in the outer medulla by the countercurrent multiplication of a comparatively small transepithelial difference in osmotic pressure. This small difference, called a single effect, arises from active NaCl reabsorption from thick ascending limbs, which dilutes ascending limb flow relative to flow in vessels and other tubules. In the inner medulla, the gradient may also be generated by the countercurrent multiplication of a single effect, but the single effect has not been definitively identified. Continued experimental investigation and incorporation of the resulting information into mathematic simulations may help to more fully elucidate the inner medullary urine concentrating mechanism.

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Acknowledgments

This chapter is an expanded version of two articles published originally as Sands JM, Layton HE. The physiology of urinary concentration: an update. Semin Nephrol. 2009;29(3):178–95, copyright Elsevier Inc.; and Mount DB. The brain in hyponatremia: both culprit and victim. Semin Nephrol. 2009;29(3):196–215, copyright Elsevier Inc., 2009.

This work was supported by National Institutes of Health grants R01-DK41707 to J.M.S., R01-DK42091 to H.E.L., and PO1-DK070756 to D.B.M.

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Authors and Affiliations

  1. Department of Medicine, Renal Division, Emory University, 1639 Pierce Drive, NE, WMB Room 338, Atlanta, GA, 30322, USA

    Jeff M. Sands M.D.

  2. Renal Division, VA Boston Healthcare System, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    David B. Mount M.D.

  3. Department of Mathematics, Duke University, 90230, Durham, NC, 27708-0320, USA

    Harold E. Layton Ph.D.

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  1. Jeff M. Sands M.D.
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  1. Brigham and Women's Hospital, Harvard Medical School, VA Boston Healthcare System, Blackfan Circle 4, Boston, 02115, Massachusetts, USA

    David B. Mount

  2. Harvard Medical School, Renal Division, Brigham and Women's Hospital, Francis Street 75, Boston, 02115, Massachusetts, USA

    Mohamed H. Sayegh

  3. Harvard Medical School, Renal Division, Brigham and Women's Hospital, Francis Street 75, Boston, 02115, Massachusetts, USA

    Ajay K. Singh

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Sands, J.M., Mount, D.B., Layton, H.E. (2013). The Physiology of Water Homeostasis. In: Mount, D., Sayegh, M., Singh, A. (eds) Core Concepts in the Disorders of Fluid, Electrolytes and Acid-Base Balance. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-3770-3_1

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