慢性腎不全に伴う酸排泄障害の多様性

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The manifestations of metabolic acidosis do not relate in parallel to renal function, suggesting that various factors may be involved in the basic disorder of acid secretion in chronic renal failure (CRF). Neutral phosphate loading is one of the functional assessments of the handling of the hydrogen in the distal nephron. In this test, the ability to elevate the urinary Pco_2 above that of the arterial blood (U-B Pco_2) was employed as an estimate of hydrogen ion excretion. We have investigated a variety of the mechanisms underlying the acidifying disorder in patients with renal dysfunction due to chronic glomerulonephritis. Although CRF patients (creatinine clearance; less than 30 ml/min) tended to show decreased acid excretion, the ratio of acid excretion to Ccr increased, which might reflect compensation in the residual nephron. U-B Pco_2 was significantly lower in these patients (25.6 vs 45.4 mmHg), though a sufficient increase in U-B Pco_2 was also observed in some of these patients, indicating there were several subtypes of the hydrogen secretory failure in CRF. Neutral phosphate infusion was carried out in polycystic kidney disease with renal dysfunction, resulting in disordered urinary acidification and a discrepancy of results between neutral phosphate infusion and sodium bicarbonate loading. In conclusion, U-B Pco_2 in the neutral phosphate test is an apparently useful index of distal tubular acid excretion in patients with renal dysfunction. Heterogenous mechanisms of hydrogen ion secretory failure are involved in CRF status.
東京女子医科大学の論文
1996-10-25

慢性腎不全に伴う酸排泄障害の多様性

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