Sodium balance is not just a renal affair.
Sodium balance is not just a renal affair.
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DOI：
10.1097/01.mnh.0000441151.55320.c3
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发表时间：
2014-03
影响因子：
3.2
通讯作者：
Titze J
中科院分区：
文献类型：
--
作者：
Titze J
细胞外体液的平衡理论与钠 (Na+) 代谢密切相关。人们普遍接受的观点是，随着盐摄入量的变化，肾脏排钠将防止间质 Na+ 含量和浓度发生任何变化。这篇综述总结了最近在盐和水稳态方面的异常发现，这些发现与当前的假设不一致。最近对实验动物的化学分析研究以及对患者进行的无创定量 Na+ MRI (Na-MRI) 研究表明，大量的 Na+ 储存在肌肉和皮肤中，而没有相应的保水性。此外，一项针对人类的超长期 Na+ 平衡研究表明，存在内源性时钟，可产生每周和每月的 Na+ 存储的次红外节律，与盐摄入量无关。动物实验表明，与血浆相比，皮肤间质中的液体是高渗的，间质渗透压会诱导局部肾外免疫细胞和毛细淋巴管驱动机制，以清除电解质和维持内部环境。最近的定量证据挑战了当前关于盐和水稳态的观点，并表明如果没有额外的迄今为止未被重视的肾外调节机制，Na + 稳态就无法维持。
The equilibration theory of extracellular body fluids is tightly linked to sodium (Na+) metabolism. Accepted is the notion that with changes in salt intake, renal sodium elimination will prevent any change in interstitial Na+ content and concentration. This review summarizes recent anomalous findings in salt and water homeostasis that are inconsistent with current assumptions. Recent findings from chemical analysis studies of laboratory animals, as well as noninvasive quantitative Na+ MRI (Na-MRI) studies in patients, have shown that remarkable amounts of Na+ are stored in muscle and in skin without commensurate water retention. Furthermore, an ultra-long Na+ balance study in humans suggests the presence of endogenous clocks that generate weekly and monthly infradian rhythmicity of Na+ storage independent of salt intake. Animal experiments suggest that fluids in the skin interstitium are hypertonic compared with plasma and that interstitial osmotic stress induces local extrarenal immune cell and lymph–capillary driven mechanisms for electrolyte clearance and maintenance of the internal environment. Recent quantitative evidence challenges current ideas on salt-and-water homeostasis and suggests that Na+ homeostasis cannot be maintained without additional hitherto unappreciated extrarenal regulatory mechanisms.