There are three normal urine-forming processes to remove metabolic waste, ie plasma

gromerulus filtration, tubular reabsorption and tubular secretion. The filtration of gromerulus
consists of three cell layers. The first layer is the capillary endothelium commonly called
lamina fenestra because there are pores with a diameter of 50-100 nm. The second layer is a
basement membrane consisting of fine fibril webbing embedded in a gel-like matrix and the
third layer is a podosit which is the visceral layer of the bowman capsule. Blood cells and
large molecules such as large proteins and negatively charged proteins such as albumin are
retained by size selection and load selection which is characteristic of the gromerular
filtration membrane barrier. While molecules of smaller size or with neutral or positive loads
such as water and crystalloids are instantly filtered.

The next process is resorption and tubular secretion. There are three classes of substances
filtered in gromerulus ie electrolyte, non electrolyte and water. Some of the most important
electrolytes are sodium (Na +), potassium (K +), calcium (Ca ++), magnesium (Mg ++),
bicarbonate (HCO3-), chloride (Cl-) and phosphate (HPO4-). While non-essential electrolytes
are glucose, amino acids and metabolites which are the final product of protein metabolism
processes such as urea, uric acid and creatinine

This process of reabsorption and secretion takes place through active and passive transport
mechanisms. Glucose and amino acids are reabsorbed completely along the proximal tubule
through active transport. K + and uric acid are almost entirely reabsorbed actively and both
are secreted into the distal tubule. At least two-thirds of the filtered Na + will be reabsorbed
in the proximal tubule which then progresses to the henle arch, the distal tubule and the
collecting ducts
Most of Ca2 + and HPO4 are reabsorbed in the proximal tubule actively while water, Cl- and
urea are reabsorbed passively. By switching most of the positively charged Na + ions, the
negatively charged Cl-ion must accompany to achieve a neutral condition. The exit of most of
the ions and non-electrolyte from the proximal tubular fluid causes the fluid to undergo
osmotic dilution and the water diffuses out of the tubule and enters the peritubular blood.
Urea then diffuses passively. The ratio of urea concentration increases along the tubules
because 50% of urea is reabsorbed. H + ions, organic acids such as para-amino-pituitary
(PAH), penicillin and creatinine are all actively discontinued into the proximal tubules

Approximately 90% of HCO3 is indirectly resorbed from the tubules proximal through Na +
- H + exchange. H + is secreted into the tubular lumen as the Na + exchanger will bind to
HCO3 - present in the gromerulus filtrate to form carbonic acid (H2CO3). H2CO3 will
dissociate into H2O and carbon dioxide (CO2). H2O and CO2 will diffuse out of the tubular
lumen, into the tubule cells. In the tubular cells, the carbonic anhydrase catalyzes the reaction
of H2O and CO2 by forming H2CO3 once again. The dissociation of H2CO3 produces
HCO3 and H +. H + re-secreted and HCO3- will enter peritubular blood with Na +. Besides
reabsorption and rescue of most HCO3-kidneys also remove excessive H +. This process
occurs within the nephron and is important in the concentration of the urine.

There are several hormones that regulate tubular reabsorption and secretion of solutes and
water. Reabsorption of water is influenced by the antidiuretic hormone (ADH), aldosterone
affects reabsorption of Na + and K + and parathyroid hormone (PTH) that regulates Ca ++
and HPO4 reabsorption along the tubules.

References :

Tanner GA, Kidney function. In: Roardes RA, David DR. Medical physiologyfor clinical
medicine. Ed.3. Baltimore: Lippincott Williams & Wilkins, 2008:391-419.
Price SA, Wilson LR. Patofisiologis: konsep klinik proses-proses penyakitAlihbahasa.
Brahm U. Jakarta: EGC, 2005: 873-9, 899-900, 913-8, 951.