The renal medulla 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 arcuate arterioles. The arcuate arterioles each in turn branch into interlobular arterioles, which finally reach the glomeruli. At the glomerulus the blood reaches a highly disfavourable pressure gradient and a large exchange surface area, which forces the serum portion of the blood out of the vessel and into the renal tubules. Flow continues through the renal tubules, including the proximal tubule, the Loop of Henle, through the distal tubule and finally leaves the kidney by means of the collecting duct, leading to the renal ureter.
The renal medulla (Latin renes medulla = kidney middle) contains the structures of the nephrons responsible for maintaining the salt and water balance of the blood. These structures include the vasa rectae (both spuria and vera), the venulae rectae, the medullary capillary plexus, the loop of Henle, and the collecting tubule. The renal medulla is hypertonic to the filtrate in the nephron and aids in the reabsorption of water.
Blood is filtered in the glomerulus by solute size. Ions such as sodium, chloride, potassium, and calcium are easily filtered, as is glucose. Proteins are not passed through the glomerular filter because of their large size, and do not appear in the filtrate or urine unless a disease process has affected the glomerular capsule or the proximal and distule tubules of the nephron.