高血壓症と腎機能(第1報) : 緒論並びに腎機能測定法 : 特に腎クリアランス法に依る腎血行力學的研究の方法

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• In the introduction, the general theory of the cause of hypertension, especially relationship between hypertension and the kidney has been stated ; but the true cause of hypertension has not yet been discovered. Arterial hypertension has long been suspected to be of renal origin, and many pressor substances have been described-renin(Tigerstedt and Bergman, Page and Braun-Menendez), pherentasin (Schroeder), VEM (Schorr) etc., but the precise mechanism by which the blood pressure rises has not yet entirely elucidated.According to Prof. MAEKAWA, neurogenic, renal and endocrine factors or their correlations are merely the conditions whereby the hypertension develops, the "true cause" of hypertension is considered to be the disturbance of ATP-ATPase system and this disturbance seems to occur most markedly in kidneys, especially in the course of ischemia of kidneys and the renal ischemia is considered to lead to the liberation of its ATPase into the blood stream which is reponsible for development of hypertension.These studies were attempted to clarify the relationship between renal functions and hypertension (experimental and clinical) and to discuss the cause of hypertension.For the renal functional measurements, renal clearance techniques were used. Effective renal plasma flow was measured by sodium para-aminohippurate clearance, and glomerural filtration rate by sodium thiosulphate clearance. For tubular function tests, tubular reabsorptive capacity was measured by glucose (TmG), and excretory capacity by PAH (Tm_<PAH>).Moreover, urea clearance, phenolsulphonphthalein excretion test and blood non-protein nitrogen concentration were measured.Here, normal clearance values were indicated : [table]And with percentage to mean normal value, renal functional damage was shown ; for instance, for RPF 70〜50%^<・・・>slight decrease, 50〜30%^<・・・>moderate decrease, 30〜0%^<・・・>markedly decrease.The largest proportion of the phenolsulphonphthalein is removed from the blood plasma by tubular excretion and a comparavively monor fraction by glomerular filtration. Consequently the 15 minute excretion of PSP paralleled with RPF.It was notable that PSP and PAH were excreted by the liver in renal insufficiency.Non-Protein nitrogen retention in blood occured, when GFR was below 30 cc/min (25%).In dogs, renal vein catheterization was performed and extraction ratio of PAH and of thiosulphate were measured. Extractio ratio of PAH was ca. 85%, and that of thiosulphate ca. 35% and under normal condition, glomerular plasma flow(GPF) was equal to tubular plasma flow (TPF).By above mentioned techniques, the following investigations, experimental and clinical, were performed.

• 1958-01-20

著者

• 高木 秀夫

  京都大學醫學部内科學第3講座

• 高木 秀夫

  大阪医大 鷹津内科

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