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The renal medulla (Latin: medulla renis 'marrow of the kidney') is the innermost part of the kidney. The renal medulla is split up into a number of sections, known as the renal pyramids. Blood enters into the kidney via the renal artery, which then splits up to form the segmental arteries which then branch to form interlobar arteries.
The collecting duct system of the kidney consists of a series of tubules and ducts that physically connect nephrons to a minor calyx or directly to the renal pelvis.The collecting duct participates in electrolyte and fluid balance through reabsorption and excretion, processes regulated by the hormones aldosterone and vasopressin (antidiuretic hormone).
The medulla in mammals is divided into outer and inner regions. The outer region consists of short loops of Henle and collecting ducts, while the inner region consists of long loops and collecting ducts. [78] The outer region is also subdivided into outer [79] (lying directly under the cortex) [80] and inner stripes. [79]
It contains the renal corpuscles and the renal tubules except for parts of the loop of Henle which descend into the renal medulla. It also contains blood vessels and cortical collecting ducts. The renal cortex is the part of the kidney where ultrafiltration occurs. [2] Erythropoietin is produced in the renal cortex. [3]
The collecting duct system begins in the renal cortex and extends deep into the medulla. As the urine travels down the collecting duct system, it passes by the medullary interstitium which has a high sodium concentration as a result of the loop of Henle's countercurrent multiplier system. [1]: 67
Peritubular capillaries surround the cortical parts of the proximal and distal tubules, while the vasa recta go into the medulla to approach the loop of Henle. [1] [2] About one-fifth of the blood plasma is filtered into Bowman's capsule as the blood passes through the glomerular capillaries; four-fifths continues into the peritubular capillaries.
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At this location, in the wall of the last portion of distal straight tubule, there is a modified region of tubular epithelium called the macula densa.(Fig. 5 in Kumaran and Hanukoglu 2020) [5] Cells in the macula densa respond to changes in the sodium chloride levels in the distal tubule of the nephron via the tubuloglomerular feedback (TGF) loop.