腎血行と腎外血行の相関性にかんする臨床的研究
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概要
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Using simultaneously our modification of Wezler's circulatory analysis, tbiosulphate-, PAH-clearance and Gomez' estimation of renal resistance, the correlation between systemic and renal circulation was studied in disease and health. These observations were made in 14 normal subjects, 79 patients with essential or renal hypertension (116 estimations), 12 with hypertensive cardiac disease (30 estimations), 27 with valvular disorders, 8 with coronary sclerosis and 22 with miscellaneous diseases including various sorts of metabolic or endocrine disorders, before and after treatments. 1. In essential hypertension, as a rule, renal clearance tended to decrease, renal resistance to increase in proportion to the advance of age, especially this could be seen distinctly in senile hypertension beyond 60 years old. Juvenile hypertension of Keith-Wagener's 1st type showed quite normal values. GFR of middle aged hypertensives were found mostly within the normal range or in its lower border, while nearly all of RBF beneath the normal limits. Both GFR and RBF of senile hypertension were estimated subnormally. From the viewpoint of Keith-Wagener's classification, it takes for granted that in the 1st type the renal clearance was found normal or rather supernormal; this tendency could be also recognized even in senile hypertension of the 1st type. As the advance from the 1st type to the 2nd or the 3rd, the renal clearance gradually decreased, especially the reduction of RBF was more marked than that of GFR. Total renal resistance and R_A also decreased, especially in the 2nd the 3rd type of middle age. Re and Vr showed not so much striking changes. In the cases with RBF less than 400 cc per minute, there began to appear various kinds of pathological electrocardiographic patterns and urinary findings. In the 4th type, the renal clearance was Nextremely reduced; all cases proved fatal during this observation. In proportion to the elevation of systolic blood pressure, the renal clearance decreased in its amount; especially in the cases with systolic pressure higher than 200mmHg, this diminution was observed very abruptly. The correlation between renal clearance and diastolic pressure was less closely found than that between renal clearance and systolic pressure; however the higher both systolic and diastolic pressure were elevated, the more both R_T ahd R_A were augmented showing the intimate correlation between these values. But in senile hypertension, despite of the lack of byperpiecies, the renal clearance was very commonly reduced to moderate extent. R_T increased among nearly all the cases, depending chiefly upon the augmentation of R_A, R_E' was found within normal range. Rv increased slightly. While there could not be seen any so definite relationship between Vm and GFR or Vm and RBF, renal resistance and W or E' showed the significant correlation, moreover, by means of treatments increased W or E' was reduced in proportion to the diminution of R_T or R_A, having a tendency to be normalized; yet they remained beyond the normal range. In the 4th type of Keith-Wagener's classification so-called malignant hypertension, there could be dominantly observed the marked W type, but during the progressive course of the extreme renal impairment, M type was often seen; it is safe to say that this was meant by the final cardiac compensation for the failing renal function. At last when the cardiac reserve became exhausted, the death was used to come within several weeks or months. The combined therapy with hydrazinophthalazine and reserpine sometimes improved both renal clearance and resistance. However so far as results of longtermed observations were concerned, the effectiveness of the therapy proved utterly unsteady; the improvement of GFR was usually a little, whereas that of RBF was apt to be largely improved showing pretty marked fluctuation. The effect of hydrazinophthalazine upon systemic and renal circulation showed the positive correlation between each other; Vm was augmented in proportion to both increase in RBF and decrease in W or E'; R_T and R_A were also lessen, although GFR remained almost unchanged. 2. In nephritis and renal hypertension, the extent of decrease in GFR was more marked than that in RBF, whereas in the reconvalescense of nephritis these values were not rarely found normal or rather supernormal. The renal resistance was augmented, but not so much as in essential hypertension. According to Wezler-Boeger's classification, there prevailed W+E' type among renal hypertension. Even if some treatments in essential hypertension not seldom improved the clearance values and reduced the renal resistance, and thus showed a tensency to normalize impaired data, still there existed usually a certain limitation of such effectiveness. However in the less severe nephritis or lower nephron nephrosis there could be seen the recovery of disturbed clearance nearly up to the normal range. In one case suffered from subacute nephritis, by the use of hydrazinophthalazine there could be observed the positive correlation between systemic and renal circulatory dynamics. 3. In valvular heart diseases, as the advance of decompensation, the renal clearance was apt to be reduced. Under this circumstance the extent of the decrease in RBF was more remarkable than that in GFR. By means of successful treatments, reduced GFR and RBF with low or high output tended to increase up to the normal limits, however the improvement of each dynamical value remained not always same in its manner and its degree. Immediately after the effective digitalisation, renal clearance and resistance were used to be transitorily improved, but in the maintenance stage, despite of the disappearance of congestive cardiac symptoms, the'renal clearance tended to go backward the former range, and the renal resistance to increase slightly again, showing the superiority of R_A to R_E'. Although Rv was pretty augmented, there could not be any definite relationship to the height of venous pressure. Some treatments not seldom reduced the renal resistance even down to the normal range. 4. In coronary sclerosis and hypertensive cardiac disease, the renal clearance was usually found small, but not so rarely within normal limits. Notwithstanding various sorts of treatments, both circulatory dynamics and renal clearance remained almost unchanged. The intravenous injection of Lakarnol "forte" hardly showed the significant influence upon the renal circulatory dynamics, differently from the effectiveness upon coronary circulatory dynamics which was assured by our collaborators with the use of coronary catherization. 5. In hyperthyrosis there could be found frequently high output as well as supernormal clearance which tended to be normalized by means of suitable treatments.
- 千葉大学の論文
- 1958-09-28