EFFECT OF INSULIN ON RENAL HANDLING OF SODIUM, POTASSIUM, CALCIUM, AND PHOSPHATE IN MAN
EFFECT OF INSULIN ON RENAL HANDLING OF SODIUM, POTASSIUM, CALCIUM, AND PHOSPHATE IN MAN
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DOI：
10.1172/jci107996
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发表时间：
1975-01-01
影响因子：
15.9
通讯作者：
DAVIS, PJ
中科院分区：
文献类型：
--
作者：
DEFRONZO, RA;COOKE, CR;DAVIS, PJ
研究了胰岛素对肾脏处理钠、钾、钙和磷酸盐的影响，同时通过可变葡萄糖输注的负反馈伺服控制将血糖浓度维持在空腹水平。在对处于稳定利尿状态的6名水负荷正常受试者的研究中，静脉注射胰岛素以将血浆胰岛素浓度提高到98和193 μ U/ml之间，并以每分钟2 mU/kg体重的恒定速率输注，总时间为120分钟。血糖浓度没有显著改变，过滤后的葡萄糖负荷也没有变化;肾小球滤过率（CIN）和肾血浆流量（CPAH）无变化。在胰岛素给药期间，尿钠排泄量（UNaV）从401 ± 46（SEM）降至213 ± 18 μ eq/min，在30-60 min收集期内变化变得显著（P <0.02）。游离水清除率（CH 2 O）从10.6 ± 0.6增加到13 ± 0.5 ml/min（P <0.025）;渗透压清除率降低，尿流量不变。血浆醛固酮浓度无变化，在整个研究中均较低，血浆胰高血糖素浓度略有降低。在胰岛素给药期间，尿钾（UKV）和磷酸盐（UPV）排泄量也均降低; UKV从66 ± 9降至21 ± 1 μ eq/min（P <0.005），Tupv从504 ± 93降至230 ± 43 μ g/min（P <0.01）。UKV的变化与血浆钾浓度的显著降低相关。血浆磷酸盐浓度也有统计学显著性但较小的降低，认为这不足以单独解释UPV的大幅降低。尿钙排泄量（UCaV）从126 ± 24 μ g/min增加到200 ± 17 μ g/min（P <0.01）。这些研究表明，在葡萄糖滤过负荷、肾小球滤过率、肾血流量和血浆醛固酮浓度无变化的情况下，胰岛素给药可降低UNaV。胰岛素对CH 2 O的影响表明胰岛素对钠排泄的影响是由于远端肾单位稀释段的钠重吸收增强。图片
The effects of insulin on the renal handling of sodium, potassium, calcium, and phosphate were studied in man while maintaining the blood glucose concentration at the fasting level by negative feedback servocontrol of a variable glucose infusion. In studies on six water-loaded normal subjects in a steady state of water diuresis, insulin was administered i.v. to raise the plasma insulin concentration to between 98 and 193 muU/ml and infused at a constant rate of 2 mU/kg body weight per min over a total period of 120 min. The blood glucose concentration was not significantly altered, and there was no change in the filtered load of glucose; glomerular filtration rate (CIN) and renal plasma flow (CPAH) were unchanged. Urinary sodium excretion (UNaV) decreased from 401 plus or minus 46 (SEM) to 213 plus or minus 18 mueq/min during insulin administration, the change becoming significant (P smaller than 0.02) within the 30-60 min collection period. Free water clearance (CH2O) increased from 10.6 plus or minus 0.6 to 13 plus or minus 0.5 ml/min (P smaller than 0.025); osmolar clearance decreased and urine flow was unchanged. There was no change in plasma aldosterone concentration, which was low throughout the studies, and a slight reduction was observed in plasma glucagon concentration. Urinary potassium (UKV) and phosphate (UPV) excretion were also both decreased during insulin administration; UKV decreased from 66 plus or minus 9 to 21 plus or minus 1 mueq/min (P smaller than 0.005), and tupv decreased from 504 plus or minus 93 to 230 plus or minus 43 mug/min (P smaller than 0.01). The change in UKV was associated with a significant reduction in plasma potassium concentration. There was also a statistically significant but small reduction in plasma phosphate concentration which was not considered sufficient alone to account for the large reduction in UPV. Urinary calcium excretion (UCaV) increased from 126 plus or minus 24 to 200 plus or minus 17 mug/min (P smaller than 0.01). These studies demonstrate a reduction in UNaV associated with insulin administration that occurs in the absence of changes in the filtered load of glucose, glomerular filtration rate, renal blood flow, and plasma aldosterone concentration. The effect of insulin on CH2O suggests that insulin's effect on sodium excretion is due to enhancement of sodium reabsorption in the diluting segment of the distal nephron.Images