Current concepts of sodium chloride and water transport by the mammalian nephron

Abstract

The decision of the editors to solicit a review for the Medical Progress series of this journal devoted to current concepts of the renal handling of salt and water is sound in that this important topic in kidney physiology has recently been the object of a number of new, exciting and, in some instances, quite unexpected insights into the mechanisms governing sodium excretion. These developments have come about largely as a consequence of the fact that segments of nephrons previously inaccessible to direct study are now readily accessible. Many of the findings to be discussed argue for extensive revision of a number of our current widely held views concerning the renal handling of sodium chloride and water. In the opinion of the authors, the strength of this argument rests in the fact that many of these new findings were obtained under circumstances that enabled workers to gain more direct access to the nephron than has been possible heretofore. This is not to say that areas of controversy and disagreement no longer exist. Wherever possible, these have been identified. In attempting to provide a comprehensive review of this topic, it has been necessary at times to overgeneralize and to disregard minor deficiencies in some of the studies cited. Finally, we wish to emphasize that a considerable portion of the information contained herein derives from work still under active investigation. Much of this contemporary work will undoubtedly withstand the rigors of future experimental scrutiny. It is inevitable, however, as William James so aptly noted in the quotation cited below, that some of our present ideas will need to be abandoned or revised in favor of newer, more convincing evidence. Seen in this light, the present effort is intended as nothing more than a timely survey of this active and fertile topic in renal physiology.