Gardiner BS, Smith DW, O'Connor PM, Evans RG. A mathematical model of diffusional shunting of oxygen from arteries to veins in the kidney. Am J Physiol Renal Physiol 300: F1339-F1352, 2011. First published March 2, 2011; doi: 10.1152/ajprenal. 00544.2010.-To understand how arterial-to-venous (AV) oxygen shunting influences kidney oxygenation, a mathematical model of oxygen transport in the renal cortex was created. The model consists of a multiscale hierarchy of 11 countercurrent systems representing the various branch levels of the cortical vasculature. At each level, equations describing the reactiveadvection- diffusion of oxygen are solved. Factors critical in renal oxygen transport incorporated into the model include the parallel geometry of arteries and veins and their respective sizes, variation in blood velocity in each vessel, oxygen transport (along the vessels, between the vessels and between vessel and parenchyma), nonlinear binding of oxygen to hemoglobin, and the consumption of oxygen by renal tissue. The model is calibrated using published measurements of cortical vascular geometry and microvascular Po-2. The model predicts that AV oxygen shunting is quantitatively significant and estimates how much kidney (V)over doto(2) must change, in the face of altered renal blood flow, to maintain cortical tissue Po-2 at a stable level. It is demonstrated that oxygen shunting increases as renal (V)over doto(2) or arterial Po-2 increases. Oxygen shunting also increases as renal blood flow is reduced within the physiological range or during mild hemodilution. In severe ischemia or anemia, or when kidney (V)over doto(2) increases, AV oxygen shunting in proximal vascular elements may reduce the oxygen content of blood destined for the medullary circulation, thereby exacerbating the development of tissue hypoxia. That is, cortical ischemia could cause medullary hypoxia even when medullary perfusion is maintained. Cortical AV oxygen shunting limits the change in oxygen delivery to cortical tissue and stabilizes tissue Po-2 when arterial Po-2 changes, but renders the cortex and perhaps also the medulla susceptible to hypoxia when oxygen delivery falls or consumption increases.