There are considerable experimental results that indicate that arginine vasopressin (AVP)-independent factors are involved in urinary concentration. This study examined the role of hyperosmolality in vivo to modulate aquaporin 2 (AQP2) and Na-K-2Cl co-transporter (NKCC2), pivotal factors in urinary concentration, in AVP-deficient Brattleboro (BB) rats. Hyperglycemia with associated hyperosmolality occurred in diabetic BB rats (BBDM). Protein abundance of AQP2 increased and was reversed by insulin in the inner medulla (IM; control 100 ؎ 5%; BBDM 146 ؎ 8%; BBDM؉Ins 122 ؎ 9%; P < 0.001) and inner stripe of outer medulla (ISOM; control 100 ؎ 4%; BBDM 123 ؎ 8%; BBDM؉Ins 93 ؎ 6%; P < 0.05). These results were confirmed by immunohistochemistry studies. NKCC2 rose in the ISOM but was not reversed with insulin treatment. For investigation of the role of hyperosmolality in the absence of hyperglycemia on the regulation of the expression of renal AQP and NKCC2, studies were performed with hyperosmolality that was induced by 0.5% NaCl in drinking water in BB rats. Hyperosmolality that was induced by NaCl increased significantly the protein abundance of IM AQP2 (121 ؎ 2 versus 100 ؎ 5%; P < 0.01), ISOM AQP2 (135 ؎ 6 versus 100 ؎ 5%; P < 0.001), cortex plus outer stripe of outer medulla AQP2 (121 ؎ 4 versus 100 ؎ 1%; P < 0.001), ISOM NKCC2 (133 ؎ 1 versus 100 ؎ 4%; P < 0.05), and cortex plus outer stripe of outer medulla NKCC2 (142 ؎ 16 versus 100 ؎ 9%; P < 0.05). In conclusion, hyperosmolality, secondary to either glucose or NaCl, upregulated renal AQP2 and NKCC2 in vivo in BB rats.J Am Soc Nephrol 17: 1657 -1664, 2006 . doi: 10.1681 R enal water excretion is regulated by arginine vasopressin (AVP), which increases the water permeability in the collecting duct (CD) (1,2). Recently, the water channel aquaporin 2 (AQP2) that mediates the water transport in the CD in response to vasopressin was identified (3). It is widely known that AQP2 is the main target for the action of vasopressin to regulate CD water reabsorption and hence body water balance via the V 2 receptor and cAMP pathway (4).There is, however, some in vitro evidence for vasopressinindependent effects on the regulation of water channels. For example, it has been demonstrated that hypertonicity enhances the expression and the stability of AQP1 in the absence of AVP in cultured murine renal medullary cells (5). Hyperosmolality also increased the expression of AQP3 in vitro (6). In recent in vitro studies, a long-term (24 h) increase of extracellular tonicity by addition of NaCl or sucrose increased AQP2 expression via stimulation of AQP2 gene transcription (7). In mouse inner medullary CD mIMCD3 cell lines that were transfected with AQP2 cDNA, hyperosmolality with supplemented NaCl increased the expression of nonglycosylated AQP2 and enhanced the apical membrane insertion of nonglycosylated AQP2 in the absence of AVP. These results indicate that hyperosmolality may play a critical role in the regulation of AQP2 in the CD (8). Taken together, these in vitro studies s...