THE PROXIMAL TUBULE REABSORBS essentially all the filtered organic solutes, most of the filtered phosphate, 80% of the filtered bicarbonate, and 60% of the filtered sodium chloride. Approximately 70% of the filtered water is also reabsorbed by this segment. Despite these very high rates of proximal tubule solute transport, the osmolality of the luminal fluid decreases by only 5 mosmol/kgH2O from Bowman’s space to the end of the proximal tubule accessible by micropuncture (3). Furthermore, the luminal osmolality was found to be 7.5 mosmol/kgH2O lower than that in the peritubular plasma in Munich-Wistar rats (3). This luminal hypotonicity provides the driving force for water reabsorption in the proximal tubule. The fact that there is only a very small decrease in luminal osmolality is consistent with a very high diffusional water permeability in this nephron segment (10).

Despite much debate, physiological studies showed that the vast majority of water is transported across the proximal tubular cell and not across the paracellular pathway (1, 8, 10). The mechanism for this high rate of transcellular water flow was elusive until the cloning of aquaporin-1 (9), which was found to be expressed in high abundance on the apical and basolateral membranes of the proximal tubule and also in the thin descending limb (7). Since these seminal observations, a family of aquaporins has been cloned. At least seven aquaporin isoforms are expressed in the kidney, and each different nephron segment has a unique aquaporin isoform expression (6). In addition to aquaporin-1, aquaporin-7 is also expressed on the proximal tubule but only on the apical membrane of the distal portion of the proximal straight tubule, the S3 segment. The role of aquaporin-1 in mediating proximal tubule water transport has been delineated by elegant studies by Schnermann, Verkman, and co-workers (11). Aquaporin-1 null mice have an 50% lower rate of proximal tubule volume absorption measured in vivo and in vitro than do wild-type mice (11). These data indicate that water permeability can be a limiting factor in proximal tubule solute transport. These mice also have a lower brush-border membrane vesicle osmotic water permeability compared with wild-type mice (4). In addition, aquaporin-1 null mice had an 80% reduction in transepithelial water permeability consistent with most of water movement occurring transcellularly via aquaporin-1 (11). Aquaporin-1 null mice generate a higher proximal tubule transepithelial osmotic gradient despite the lower rates of volume reabsorption, indicating that the nearly isotonic reabsorption of proximal tubular fluid is largely due to water movement through aquaporin-1 (13).