Obstetric Nephrology: Renal Hernodynamic and Metabolic Physiology in Normal Pregnancy
Obstetric Nephrology: Renal Hernodynamic and Metabolic Physiology in Normal Pregnancy
复制标题
DOI：
10.2215/cjn.00470112
复制
发表时间：
2012-12-01
影响因子：
9.8
通讯作者：
Hladunewich, Michelle
中科院分区：
文献类型：
--
作者：
Odutayo, Ayodele;Hladunewich, Michelle
肾小球过度滤过、肾小管功能改变和电解质液体平衡的变化是健康妊娠的标志性肾脏生理变化。这些调整不仅对母体和胎儿的健康至关重要，而且还为识别妊娠肾功能和电解质成分异常提供了临床背景。全身血管舒张是妊娠早期的特征，导致肾血浆流量和肾小球滤过率（GFR）增加，后者一直维持到产后期。此外，肾小管的变化允许胎儿生长所需的营养物质和电解质的积累，从而限制了怀孕期间尿液中蛋白质、葡萄糖和氨基酸的浪费，并且在整个妊娠期间体内电解质的总量储存增加。可以从现有的动物和人类文献中收集对这些复杂调整背后机制的大量见解，但我们在许多领域的理解仍然不完整。本文回顾了有关肾脏适应正常妊娠的现有文献，包括肾功能、肾小管功能和电解质液体平衡，以及这些调整的临床影响、现有文献的局限性以及对未来研究的建议。 Clin J Am Soc Nephrol 7：2073-2080，2012。doi：10.2215/CJN.00470112
Glomerular hyperfiltration, altered tubular function, and shifts in electrolyte-fluid balance are among the hallmark renal physiologic changes that characterize a healthy pregnancy. These adjustments are not only critical to maternal and fetal well being, but also provide the clinical context for identifying gestational aberrations in renal function and electrolyte composition. Systemic vasodilation characterizes early gestation and produces increments in renal plasma flow and GFR, the latter of which is maintained into the postpartum period. In addition, renal tubular changes allow for the accumulation of nutrients and electrolytes necessary for fetal growth such that wasting of proteins, glucose, and amino acids in urine is limited in pregnancy and total body stores of electrolytes increase throughout gestation. Substantial insight into the mechanisms underlying these complex adjustments can be gleaned from the available animal and human literature, but our understanding in many areas remains incomplete. This article reviews the available literature on renal adaptation to normal pregnancy, including renal function, tubular function, and electrolyte-fluid balance, along with the clinical ramifications of these adjustments, the limitations of the existing literature, and suggestions for future studies. Clin J Am Soc Nephrol 7: 2073-2080, 2012. doi: 10.2215/CJN.00470112