腎疾患,高血圧症の電解質(Na,Cl)クリアランスに関する臨床的研究 : 水利尿,滲透圧性利尿に関連して

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C_<Na, Cl> was determined in 108 patients with various renal diseases and hypertension, simultaneously with tests for water dilution, standard renal clearance, T_<mPAH> and T_<mG>, to study renal function in these patients. The following observations were made: 1. Plasma concentration of the electrolytes measured in normal subjects were: 141.87±6.75 mEq/L for Na and 104.85±9.65 mEq/L for Cl. The values found in these patients tended to be characteristic of each disease. 2. C_<Na, Cl> was determined in persons, who had been fed on a diet containing only 5g of sodium chloride for over a week, 1 hour after administration of 1 liter of water on a fasting stomach, early in the morning. The values found in normal subjects were 0.61 cc/min for Na and 1.39 cc/min for Cl, while they tended to be lowered in patients with chronic nephritis, nephrotic syndrome and nephritis at the terminal stage. 3. In persons with renal diseases, the values of C_<Na> and C_<H_2O> were within a certain range in maximal water diuresis, the former being less than 1.0 cc/min and the latter being not more than 15.0 cc/min. 4. Following administration of 1 liter of water, C_<Na, Cl> was determined, in comparison with urine volume, every 30 minutes for 4 hours. In normal subjects, the values of C_<Na> followed a curve with two peaks which was typical of Na, and those of C_<Na> showed fluctuations corresponding to fluctuations in urine volume. On the other hand, the values found in patients with nephritis at the terminal stage indicated isosthenuria. 5. The following observations were made in osmotic diuresis (in determining C_<Thio>, C_<PAH>, T_<mPAH> and T_<mG>): (1) C_<Na, Cl> paralleled urine volume. (2) TRF_<Na, Cl> nearly paralleled TRF_<H_2O>. (3) C_<Na, Cl> nearly paralleled GFR, and an increase in C_<Na, Cl> concomitant to an increase in the amount of the electrolytes administered was marked in cases where GFR was within a normal range or slightly decreased (more than 61 cc/min), while the increase was slight in cases where GFR was greatly decreased (less than 30 cc/min). (4) In cases where GFR was more than 61 cc/min, C_<Na, Cl> rose and TRF_<Na> and TRF_<Cl> were reduced, though not to over 90|per cent of the glomerular filtrate, following administration of osmotic solution. In cases where GFR was less than 30 cc/min, on the other hand, the increase of C_<Na, Cl> was slight but the decrease of TRF_<Na> and TRF_<Cl> was marked, seemingly indicating lowered reabsorption capacity of the renal tubules. This phenomenon, however, appears to represent a mechanism in renal insufficiency to cope with the reduction of Na in the filtrate resulting from a decrease in the number of functioning nephrons. (5) C_<Na, Cl> showed an increase concomitant to an increase in the amount of the electrolytes administered, until RPF was greatly reduced to less than 200 cc/min. (6) C_<Na, Cl> paralleled T_<mPAH> and T_<mG>. TRF_<Na>, TRF_<Cl>, T_<mPAH> and T_<mG> remained well within 90 per cent of the glomerular filtrate until the renal tubules came to show a high degree of hypofunction (till T_<mPAH> and T_<mG> became less than 30 mg/min and 100 mg/min, respectively). 6. There was no relation of any kind between C_<Na, Cl> and various phases of body fluids. There was, however, an inverse correlation between ECF_<Na>/bodyweight and C_<Na, Cl>, following administration of a hypertonic solution.
千葉大学の論文

腎疾患,高血圧症の電解質(Na,Cl)クリアランスに関する臨床的研究 : 水利尿,滲透圧性利尿に関連して

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