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In this study, we have extended a mathematical model of microvascular exchange in the renal medulla to elucidate the mechanisms by which plasma proteins are transported between vasa recta and the interstitium. In contrast with other work, a distinction was made between the paracellular pathway and the transcellular route (i.e., water channels) in descending vasa recta (DVR). Our model first indicates that concentration polarization on the interstitial side of vasa recta has a negligible effect on medullary function. Our results also suggest that, whereas proteins are cleared from the interstitium by convection, both diffusion and convection play a role in carrying proteins to the interstitium. In those regions where transcapillary oncotic pressure gradients favor volume influx through the paracellular pathway in DVR, diffusion is the only means by which proteins can penetrate the interstitium. Whether the source of interstitial protein is DVR or ascending vasa recta depends on medullary depth, vasa recta permeability to proteins, and vasa recta reflection coefficients to small solutes and proteins. Finally, our model predicts significant axial protein gradients in the renal medullary interstitium.

Transport of plasma proteins across vasa recta in the renal medulla