Free water clearance

In the physiology of the kidney, free water clearance (CH2O) is the volume of blood plasma that is cleared of solute-free water per unit time. An example of its use is in the determination of an individual's state of hydration.

Overview
At its simplest, the kidney produces urine composed of solute and pure (solute-free) water. How rapidly the kidney clears the blood plasma of a substance (be it water or solute) is the renal clearance, which is related to the rate of urine production. The rate at which plasma is cleared of solute is the osmolal clearance; the rate at which plasma is cleared of solute-free water is the free water clearance.

Calculation
Since urine flow is determined by the rate at which plasma is cleared of solutes and water (as discussed above), urine flow (V) is given as the sum of osmolal (Cosm) and free water clearance (CH2O):


 * $$V = C_{osm} + C_{H_2O}$$

Rearranging yields CH2O


 * $$C_{H_2O} = V - C_{osm}$$

Since osmolal clearance is given as the product of urine flow rate and the ratio of urine to plasma osmolality, this is commonly represented as


 * $$C_{H_2O} = V - \frac{U_{osm}}{P_{osm}}V$$

For example, for an individual with a urine osmolality of 140 mOsm/L, plasma osmolality of 280 mOsm/L, and a urine production of 4 ml/min, the free water clearance is 2 ml/min, obtained from


 * $$C_{H_2O} = 4 \ \mbox{ml/min} - \frac{140 \ \mbox{mOsm/L}}{280 \ \mbox{mOsm/L}} \times 4 \ \mbox{ml/min}$$

Interpretation
Free water clearance can be used as an indicator of how the body is regulating water. A free water clearance of zero means the kidney is producing urine isosmotic with respect to the plasma. Values greater than zero imply that the kidney is producing dilute urine through the excretion of solute-free water. Values less than zero imply that the kidney is conserving water (likely under the influence of antidiuretic hormone, ADH), resulting in the production of concentrated urine.