Mathematical models of renal fluid and electrolyte transport: acknowledging our uncertainty.

Mathematical models of renal tubular function, with detail at the cellular level, have been developed for most nephron segments, and these have generally been successful at capturing the overall bookkeeping of solute and water transport. Nevertheless, considerable uncertainty remains about important transport events along the nephron. The examples presented include the role of proximal tubule tight junctions in water transport and in regulation of Na(+) transport, the mechanism by which axial flow in proximal tubule modulates solute reabsorption, the effect of formate on proximal Cl(-) transport, the assessment of potassium transport along collecting duct segments inaccessible to micropuncture, the assignment of pathways for peritubular Cl(-) exit in outer medullary collecting duct, and the interaction of carbonic anhydrase-sensitive and -insensitive pathways for base exit from inner medullary collecting duct. Some of these uncertainties have had intense experimental interest well before they were cast as modeling problems. Indeed, many of the renal tubular models have been developed based on data acquired over two or three decades. Nevertheless, some uncertainties have been delineated as the result of model exploration and represent communications from the modelers back to the experimental community that certain issues should not be considered closed. With respect to model refinement, incorporating more biophysical detail about individual transporters will certainly enhance model reliability, but ultimate confidence in tubular models will still be contingent on experimental development of critical information at the tubular level.