溶質處理の面より見た尿細管機能の研究
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概要
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Glomerular filtration rate (GFR), Cosm, C_<H_2O> and T^C_<H_2O> were measured in water diuresis and also in antidiuresis to investigate the homeostatic mechanism of renal tubules in the diseased kidney.The term Cosm/GFR (×100) indicates the amount of osmolar water in the urine per 100 ml of GFR. In the recovery stage of acute nephritis slightly low value for Cosm/GFR was noted, suggesting that glomerular impairment exceeds tubular impairment. Conversely, below 50cc/min of GFR an ever-increasing volume of Cosm/GFR was brought about in chronic nephritis and a marked increase was noted in chronic renal failure. Urine flow during antidiuresis also increased in both of these conditions.These facts suggest that so-called osmotic diuresis has occurred because of the fact that an ever-decreasing number of functioning nephrons continue to excrete an essentially constant amount of solute, although little change in the total amount of solute in urine in advanced renal disease was noted.The significant correlation was found between C_<H_2O> and GFR and between T^C_<H_2O> and GFR, while C_<H_2O>/GFR was within the normal range in acute and chronic nephritis, even in renal failure it was not markedly decreased. T^C_<H_2O>/GFR, however, did not indicate constant value.The concentrating mechanism seems to be impaired before the diluting mechanism. Though C_<H_2O>/GFR and T^C_<H_2O>/GFR were not markedly decreased in chronic renl failure, urine osmolarity in both hydration and dehydration was almost equal to serum osmolarity, because of the marked increase of osmolar water per 100 ml of glomerular filtration.In nephrotic syndrome Cosm and T^C_<H_2O> were almost equal to those of chronic nephritis, but C_<H_2O> was decreased.Serum osmolarity in the early stage of acute nephritis was slightly elevated but was normal in the recovery stage.In chronic renal failure serum osmolarity was elevated as NPN rose. In some cases with nephrotic syndrome, serum osmolarity was also slightly elevated in spite of the fact that electrolyte and NPN were within normal range.
- 社団法人日本循環器学会の論文
- 1959-10-20