Macula densa

In the kidney, the macula densa is an area of closely packed specialized cells lining the wall of the distal tubule at the point of return of the nephron to the vascular pole of its parent glomerulus, (glomerular vascular pole).

The cells of the macula densa are sensitive to the concentration of sodium chloride in the distal convoluted tubule. A decrease in sodium chloride concentration initiates a signal from the macula densa that has two effects: (1) it decreases resistance to blood flow in the afferent arterioles, which increases glomerular hydrostatic pressure and helps return glomerulus filtration rate (GFR) toward normal, and (2) it increases renin release from the juxtaglomerular cells of the afferent and efferent arterioles, which are the major storage sites for renin.

The release of renin is an essential component of the renin-angiotensin-aldosterone system (RAAS), which regulates blood pressure and volume.

Histology
The cells of the macula densa are taller and have more prominent nuclei than surrounding cells of the distal straight tubule (cortical thick ascending limb).

The close proximity and prominence of the nuclei cause this segment of the distal tubule wall to appear darker in microscopic preparations, hence the name macula densa.

Function
A decrease in blood pressure causes a decrease in the GFR (glomerular filtration rate) which causes more reabsorption, resulting in a decreased concentration of sodium and chloride ions in the filtrate and/or decreased filtrate flow rate that the macula densa can sense and then trigger an autoregulatory response to increase reabsorption of ions and water in order to return blood pressure to normal. Reduced blood pressure means decreased venous pressure and hence a decreased peritubular capillary pressure. This causes a smaller capillary hydrostatic pressure which causes an increased absorption of sodium ions into the vasa recta at the proximal tubule. Because of this increased absorption, less NaCl is present at the distal tubule which is where the macula densa is located. The macula densa senses this drop in salt concentration and responds through two mechanisms: first, it triggers dilation of the renal afferent arteriole, decreasing afferent arteriole resistance and thus offsetting the decrease in glomerular hydrostatic pressure caused by the drop in blood pressure. Second, macula densa cells release prostaglandins, which triggers granular juxtaglomerular cells lining the afferent arterioles to release renin into the bloodstream. (The juxtaglomerular cells can also release renin independently of the macula densa, as they are also triggered by baroreceptors lining the arterioles, and release renin if a fall in blood pressure in the arterioles is detected.) Furthermore, activation of the sympathetic nervous system stimulates renin release through activation of beta-1 receptors.

The process triggered by the Macula densa helps keep the glomerular filtration rate (GFR) fairly steady in response to varying artery pressure, due to dilation of the afferent arterioles and the action of Renin, which triggers constriction of the efferent arterioles, both of which increase hydrostatic pressure in the glomerulus.