腎疾患におけるカルシウムならびに無機燐代謝に関する臨床的研究
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概要
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This paper, which deals with the mechanism of calcium and inorganic phosphate (P) metabolism in the. kidneys, is based on the study of 50 patients with various kidney diseases. Clinical experiments were carried out in these patients to study the metabolism of these substances from the viewpoint of homeostasis, along with the metabolism of Na, Cl and K, in comparison with glomerular and tubular function. The following observations were made: 1. In patients with a GFR of below 50cc/min., plasma Ca concentration was lower, and plasma P concentration was higher, than normal levels. This tendency was especially marked in patients with a GFR of below 20cc/min., in whom the behavior of plasma K concentration was similar to that of plasma P concentration. 2. Tests on the renal clearance of Ca, P, Na, Cl and K, conducted simultaneously with titration of glucose and PAH, showed that the clearance of these substances marked the highest levels when TmPAH and TmG were achieved. The clearance of these substances explicitly reflected kidney function. 3. After glucose and PAH overloading, fluctuations in Ca clearance paralleled those in GFR. Fluctuations in P clearance, which nearly paralleled those in GFR after PAH over-loading, were found to have no relation at all with those in GFR after glucose overloding. This observation seems to indicate that there would be some mechanism specifically responsible for P metabolism in the tubules. 4. After the overloading of either glucose or PAH, it was not until GFR, TmG, TmPAH and RPF showed a marked decrease that tubular reabsorption fraction of Ca (TRF Ca) was reduced to less than 90 per cent. On the other hand, TRFp fell progressively with the lowering of kidney function, the result of test being negative in 7 out of 60 cases. 5. Generally speaking, there was a similarity between Ca and Na and Cl, and between P and K, in their metabolism in the kidneys. 6. Tests were conducted after glucose overloading to study the effect of parathyroid hormone on P metabolism in the tubules. TRFp fell definitely in persons with normal kidney function, but this was not the case with persons with a high degree of disturbance of kidney function. 7. In persons with a slight degree of disturbance of kidney function, there was a rise in TRFp after Ca loading. 8. After phosphate loading, there was an increase in the amount of P eliminated by the kidneys, concomitant to the amount given. The amount of P eliminated by the kidneys was far greater in persons with normal kidney function than in those with a high degree of disturbance of kidney function.
- 千葉大学の論文
- 1959-09-28