腎静脈カテーテル法による利尿剤および降圧剤の腎循環と代謝におよぼす影響にかんする研究
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To investigate the effects of diuretics and hypotensive drugs on renal circulation and metabolism, renal venous catheterization was performed in 6 normal subjects and 21 patients with hypertension and renal diseases, and renal oxygen consumption (O2 Cons.), renal glucose (US.G), lactate (US.L) and pyruvate usage (US.P), renal excretion of electrolytes (sodium and potassium) and renal venous pressure (RVP) as well as renal blood flow (RBF) and glomerular filtration rate (GFR) were observed before and after the administration of theophylline, mercurial diuretic, carbonic anhydrase inhibitor, hydralazine, ganglionic blocker and reserpine.The results were as follows.(1) After the intravenous administration of Neophyllin (theophylline ethylenediamine) RBF and GFR were slightly increased, tubular reabsorption of water (TRW) was decreased and RVP was found to be lowered. O2 Cons. and US.G were observed to have a tendency to increase.It is presumed that the diuretic effect of theophylline is consequent to both the improvement of renal circulation and the direct action on renal tubules, and that the latter mechanism is referable to the increase of O2 Cons. and US.G.(2) During diuresis after the administration of Igrosin (a mercurial diuretic) RBF and GFR were slightly decreased, TRW lowered, and renal arterio-venous oxygen difference and O2 Cons. were found to be increased remarkably.It would seem that the mercurial diuresis is due to the direct action on renal tubules and is associated with the increase of oxygen consumption.(3) In marked diuresis after Diamox RBF and GFR were observed to have a tendency to decrease, O2 Cons. to decrease, US.L to increase and excretion of sodium and potassium to increase markedly.It is considered that the diuretic effect of carbonic anhydrase inhibitor is the result of increased renal excretion of sodium and potassium, and is not accompanied by increased oxygen consumption.(4) No consistent correlations were found between the diuretic effects of studied diuretics and O2 Cons., US.G, US.L and US.P. This is considered to be due to differences in the action on renal circulation and renal tubular enzymatic systems.(5) During reduction of blood pressure due to Apersoline, RBF was increased remarkably, filtration fraction and renal vascular resistance (RVR) lowered, and RVP was found to rise. These data suggest that Apresoline acts directly on renal vascular system. GFR, TRW, urine volume, renal extraction of PAH, O2 Cons., US.L and US.P did not change markedly, in spite of increase of RBF.(6) During reduced blood pressure due to Ansolysen RVP was found to fall, and RBF, urine volume, sodium excretion and O2 Cons. decreased.(7) During lowered blood pressure induced by Serpasil RBF, GFR and urine volume did not change significantly, RVR fell slightly, and O2 Cons. and US.G were observed to have a tendency to increase.(8) No consistent tendencies were found under the effects of hypotensive drugs studied here on renal circulation and metabolism. It is suggested, however, that the reactions of kidney to Apresoline and Serpasil are in the direction of reducing the influence of lowered blood pressure. On the other hand, the action of ganglionic blocker seems to block such an autonomic mechanism of kidney.
- 社団法人 日本内科学会の論文