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Collecting duct system
Scheme of renal tubule and its vascular supply.
Latin	tubulus renalis colligens
Gray's	subject #253 1223
MeSH	Kidney+Collecting+Ducts
Dorlands/Elsevier	t_22/12830107

The collecting duct system of the kidney consists of a series of tubules and ducts that connect the nephrons to the ureter. It participates in electrolyte and fluid balance through reabsorption and excretion, processes regulated by the hormones aldosterone and antidiuretic hormone.

Anatomically, there are several components of the collecting duct system, including the connecting tubules, cortical collecting ducts, and medullary collecting ducts.

Contents 1 Function 2 Anatomy 2.1 Connecting tubule 2.2 Initial collecting tubule 2.3 Cortical collecting duct 2.4 Medullary collecting duct 2.4.1 Outer segment 2.4.2 Inner segment 2.5 Papillary duct 3 Cell types 3.1 Principal cells 3.2 Intercalated cells 4 Additional images 5 References 6 External links

The collecting duct system is the last component of the kidney to influence the body's electrolyte and fluid balance. In humans, the system accounts for 4-5% of the kidney's reabsorption of sodium and 5% of the kidney's reabsorption of water. At times of extreme dehydration, over 24% of the filtered water may be reabsorbed in the collecting duct system.

The wide variation in water reabsorption levels for the collecting duct system reflects its dependence on hormonal activation. The collecting ducts, particularly the outer medullary and cortical collecting ducts, are largely impermeable to water without the presence of antidiuretic hormone (ADH, or vasopressin).

• In the absence of ADH, water in the renal filtrate is left alone to enter the urine, promoting diuresis.
• When ADH is present, aquaporins allow for the reabsorption of this water, thereby inhibiting diuresis.

The collecting duct system participates in the regulation of other electrolytes, including chloride, potassium, hydrogen ions, and bicarbonate.

The segments of the system are as follows:

Segment	Description
connecting tubule
initial collecting tubule	Before convergence of nephrons
cortical collecting ducts
medullary collecting ducts
papillary ducts, also known as duct of Bellini

Main article: Connecting tubule

With respect to the renal corpuscle, the "connecting tubule" is the most proximal part of the collecting duct system. It is adjacent to the distal convoluted tubule, the most distal segment of the renal tubule. Connecting tubules from several adjacent nephrons merge to form cortical collecting tubules, and these may join to form cortical collecting ducts. Connecting tubules of some juxtamedullary nephrons may arch upward, forming an arcade.

The connecting tubule derives from the metanephric blastema, but the rest of the system derives from the ureteric bud. Because of this, some sources group the connecting tubule as part of the nephron, rather than grouping it with the collecting duct system.

The initial collecting tubule is a segment with a constitution similar as the collecting duct, but before the convergence with other tubules.^[1]

The "cortical collecting ducts" receive filtrate from multiple initial collecting tubules and descend into the renal medulla to form medullary collecting ducts.

"Medullary collecting ducts" are divided into outer and inner segments, the latter reaching more deeply into the medulla. The variable reabsorption of water and, depending on fluid balances and hormonal influences, the reabsorption or secretion of sodium, potassium, hydrogen and bicarbonate ion continues here.

The outer segment of the medullary collecting duct follows the cortical collecting duct. It reaches the level of the renal medulla where the thick ascending limb of loop of Henle borders with the [[thin ascending limb of loop of Henle^[2]

The inner segment is the part of the collecting duct system between the outer segment and the papillary ducts.

Main article: Papillary duct

The terminal portions of the medullary collecting ducts are the "papillary ducts", which end at the renal papilla and empty into a minor calyx.

Each component of the collecting duct system contains two cell types, intercalated cells and a segment-specific cell type:

• For the connecting tubules, this specific cell type is the connecting tubule cell
• For the collecting ducts, it is the principal cell. The inner medullary collecting ducts contain an additional cell type, called the inner medullary collecting duct cell.

The principal cell mediates the collecting duct's influence on sodium and potassium balance via sodium channels and potassium channels located on the cell's apical membrane. Aldosterone determines if the sodium channels transport ions.^[3]

Intercalated cells come in α and β varieties and participate in acid-base homeostasis.

Type of cell	Secretes	Reabsorbs
α-intercalated cells[4]	acid (via an apical H+-ATPase and H+/K+ exchanger) in the form of hydrogen ions	bicarbonate (via band 3, a basolateral Cl-/HCO3- exchanger)
β-intercalated cells	bicarbonate (via pendrin a specialised apical Cl-/HCO3-)	acid (via a basal H+-ATPase)

For their contribution to acid-base homeostasis, the intercalated cells play important roles in the kidney's response to acidosis and alkalosis. Damage to the α-intercalated cell's ability to secrete acid can result in distal renal tubular acidosis (RTA type I, classical RTA).

Transverse section of pyramidal substance of kidney of pig, the bloodvessels of which are injected.

Alpha intercalated cell cartoon

1. ^ Walter F., PhD. Boron. Medical Physiology: A Cellular And Molecular Approaoch. Elsevier/Saunders. ISBN 1-4160-2328-3. 
2. ^ Walter F., PhD. Boron. Medical Physiology: A Cellular And Molecular Approaoch. Elsevier/Saunders. ISBN 1-4160-2328-3.  Page 837
3. ^ Physiology at MCG 7/7ch03/7ch03p19 - "The Nephron: Collecting Duct"
4. ^ Physiology at MCG 7/7ch07/7ch07p17 - "Intercalated Cells"

• Eaton, Douglas C., Pooler, John P. (2004). Vander's Renal Physiology, 6, Lange Medical Books/McGraw-Hill. ISBN 0-07-135728-9. 

• Histology at KUMC epithel-epith04 "Collecting Duct (Kidney)"
• Histology at BU 15803loa - "Urinary System: kidney, medulla, collecting duct and ascending tubule"
• Histology at BU 16013loa - "Urinary System: kidney, H&E, collecting duct and ascending tubule"

v • d • e Urinary system - Kidney
Layers	Renal fascia • Renal capsule • Renal cortex  (Renal column) • Renal medulla (Renal sinus, Renal pyramids) • Renal lobe • Cortical lobule • Medullary ray • Nephron
Afferent circulation	Renal artery → Segmental arteries → Interlobar arteries → Arcuate arteries → Cortical radial arteries → Afferent arterioles → Renal corpuscle (Glomerulus, Bowman's capsule)
Renal tubule	Proximal tubule → Loop of Henle (Descending, Thin ascending, Thick ascending) → Distal convoluted tubule → Connecting tubule → Collecting ducts → Duct of Bellini → Renal papilla → Minor calyx → Major calyx → Renal pelvis → Ureter
Efferent circulation	Glomerulus → Efferent arterioles → Peritubular capillaries/Vasa recta → Arcuate vein → Interlobar veins → Renal vein
Juxtaglomerular apparatus	Macula densa • Juxtaglomerular cells • Extraglomerular mesangial cell
Filtration	Glomerular basement membrane • Podocyte • Filtration slits • Intraglomerular mesangial cell • Tubular fluid
Renal physiology	Acid base physiology • Fluid balance