Variation in urine composition in the human urinary tract: Evidence of urothelial function in situ?

Purpose: An increased awareness of the concept that the urothelium has a significant transport function led us to question whether urine composition changes as it passes along the human lower urinary tract. Materials and Methods: Urine samples from the bladder and renal pelvis were collected from 30 adults who underwent percutaneous nephrolithotomy (27) or ureteral stent insertion before lithotripsy (3). Urine was obtained from the 2 renal pelves (operative and contralateral sides) in 6 patients (24%). Urine pH was measured using an ultra-thin glass pH electrode. Urinary osmolality, Na and K were measured by micro-osmometry and flame photometry, respectively. Comparison of data sets was achieved using conventional nonparametric statistical methods. Results: Median bladder urine pH in 30 patients, osmolality in 16, Na in 16 and K in 15 were significantly higher than in the renal pelvis at 6.76 (IQR 6.23 to 6.99), 469 mOsm. kg.(1) (IQR 349 to 553), 132 (IQR 100 to 154) and 45 mM. (IQR 30 to 64) versus 6.08 (IQR 5.84 to 6.89), 308 mOsm. kg.(1) (IQR 248 to 465), 90 (IQR 69 to 115) and 17 HIM. (IQR 10 to 47), respectively (p less than or equal to 0.05). There was no significant difference in these parameters in the urine of the paired renal pelves. Conclusions: Bladder urine pH, osmolality, Na and K significantly differ from values in the renal pelvis in moderately hydrated humans. Our data show that urine composition is modified in the lower urinary tract, supporting the concept of a dynamic urothelium. We propose that urothelial-urinary interactions and urinalysis need reappraisal, particularly in investigations of urinary stone formation and sensory bladder function.