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Once the osmolality of the luminal fluid approaches that of the interstitial fluid, the cortical collecting duct then behaves analogously to the proximal tubule, reabsorbing approximately equal proportions of solute (mainly sodium chloride) and water The result is that the tubular fluid, which leaves the cortical collecting duct to enter the medullary collecting duct, is iso-osmotic compared with cortical plasma, and its volume is greatly reduced compared with the amount entering from the distal tubule In the medullary collecting duct, solute reabsorption continues but water reabsorption is proportionally even greater In other words, the tubular fluid becomes more and more hyperosmotic and reduced in volume in its passage through the medullary collecting ducts because the interstitial fluid of the medulla is very hyperosmotic, for reasons discussed later. 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How does ADH convert epithelial water permeability from very low to very high An alternative name for ADH is vasopressin, because the hormone can constrict arterioles and thus increase arterial blood pressure, but ADH s major renal effect is antidiuresis (ie, against a high urine volume ) In the absence of ADH, the water permeability of the cortical and outer medullary collecting duct is very low, and little if any water is reabsorbed from these segments, resulting in water diuresis On the other hand, in the presence of high plasma concentrations of ADH, the water permeability of all regions of the collecting ducts is great, and only a small volume of maximally hyperosmotic urine is excreted. 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