Plasma concentrations fall within a fixed range

Urine concentrations will change depending on homeostatic needs of any given moment

NORMAL PLASMA CONCENTRATIONS

Sodium 140 mEq/L

Potassium 4-5 mEq/L

Chloride 104 mEq/L

Bicarbonate 24 mEq/L

BUN 10 mg/dL

Creatinine 1 mg/dL

Calcium 9-10 mg/dL

Phosphorus 4-5 mg/dL

Albumin 4-4.5 g/dL

Osmolality 290 mOsm/kg H2O

pH 7.4 —

CO2 40 mmHg

Bicarbonate 24 mEq/L

URINARY EXCRETION RATES

TIMES OF CONSERVATION TIMES OF EXCRETION
Concentrated urine Dilute urine

WATER OsmolalityUrine > OsmolalityPlasma OsmolalityUrine < OsmolalityPlasma

Max: 1000–1200 mOsm/kg H2O Min: 50–100 mOsm/kg H2O

[Na]Urine > 20 mEq/L
[Na]Urine < 20 mEq/L
SODIUM The kidney can excrete several hundred mEq of sodium daily.
The additional sodium/solute excretion will obligate water
Max: < 10 mEq/L excretion (osmotic diuresis) such that the highest urine sodium
concentration will typically be < plasma sodium concentration.
[Cl]Urine > 20 mEq/L
[Cl]Urine < 20 mEq/L
Chloride excretion typically parallels sodium excretion. The
CHLORIDE kidney can excrete several hundred mEq of chloride daily. The
Max: < 10 mEq/L additional solute excretion (NaCl) will obligate water excretion
(osmotic diuresis) such that the highest urine chloride
concentration will typically be < plasma chloride concentration.
Potassium cannot be conserved as avidly as sodium and
chloride. However, urinary potassium excretion can be
reduced to ~20 mEq/day. Urine potassium concentration [Cl]Urine > 20 mEq/L
will depend on how much water as being excreted.
POTASSIUM
Over time, the kidney can increase excretion to several
hundred mEq of potassium daily.
Max: ≤ 20 mEq/L
Assumes typical urinary output of ≥ 1L/day

Measurements and assessment of urinary solute concentrations and urine osmolality can be performed to determine whether or not the kidney is performing the appropriate homeostatic function
• Volume deficiency à ↓[Na]Urine and ↑OsmolalityUrine
• Vomiting à Metabolic alkalosis + Chlorine loss à ↓[Cl]Urine
• Loop/Thiazide diuretics à Metabolic alkalosis + Chlorine loss à [Cl]Urine cannot be low due to diuretic effects on renal tubules
o If the above changes are not occurring, there is a problem with kidney function