THE PATHOLOGIC PHYSIOLOGY OF CHRONIC BRIGHTS DISEASE - AN EXPOSITION OF THE INTACT NEPHRON HYPOTHESIS
THE PATHOLOGIC PHYSIOLOGY OF CHRONIC BRIGHTS DISEASE - AN EXPOSITION OF THE INTACT NEPHRON HYPOTHESIS
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DOI：
10.1016/0002-9343(60)90225-4
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发表时间：
1960-01-01
影响因子：
5.9
通讯作者：
KIME, SW
中科院分区：
文献类型：
--
作者：
BRICKER, NS;MORRIN, PAF;KIME, SW
与慢性病肾的存活肾单位的功能能力有关的临床和实验数据在很大程度上支持这样的论点，即这些肾单位保持其基本功能完整性，而不管慢性肾病的潜在形式的性质如何。在某些情况下，肾单位特定部位的病理改变与肾单位的特定功能改变相关，但这些似乎代表了例外情况，一般来说，疾病越严重，鉴别特征就越不明显。对患单侧肾脏疾病的狗的研究表明，患侧肾单位的功能与对侧正常肾单位的功能相似。这些数据倾向于排除潜在病理过程对功能肾单位的广泛内在损伤。从这些观察结果，以及从某些支持性的临床和实验观察结果，这表明，大多数存活的肾单位在双侧肾脏疾病的患者同样是功能完整的。基于“完整肾单位假说”，提出了肾脏病理生理学的概念。在这一假说的框架内，我们得出结论：（1）病肾由数目减少的肾单位组成，其中大多数保留基本正常的功能能力：（2）双侧肾脏病的某些明显的功能异常可能与肾单位数目减少和体液紊乱引起的适应性变化有关，而不是与肾单位的结构畸变有关;（3）随着组成肾单位数量的减少，患病肾脏的整体灵活性降低;但（4）所有物质的排泄都有一个有序和可预测的模式。
Clinical and experimental data relating to the functional capacity of the surviving nephrons of the chronically diseased kidney for the most part support the thesis that these nephrons retain their essential functional integrity regardless of the nature of the underlying form of chronic Bright''s disease. There are instances in which specific alterations of function correlate with pathologic involvement of a particular site of the nephron but these appear to represent the exceptions, and in general the more advanced the disease becomes, the less evident are the differentiating features. Studies on dogs with unilateral renal disease indicate that the functional capactiy of the nephrons of the diseased kidney parallels that of the nephrons of the contralateral normal kidney. These data tend to exclude widespread intrinsic damage to the functioning nephrons by the underlying pathologic processes. From these observations, as well as from certain supporting clinical and experimental observations, it is suggested that the majority of surviving nephrons in the patient with bilateral renal disease similarly are functionally intact. Concepts of the pathologic physiology of the kidney, based on the "intact nephron hypothesis," are presented. Within the framwork of this hypothesis it is concluded that (1) the diseased kidney consists of a diminished number of nephrons, most of which retain essentially normal functional abilities; (2) certain of the apparent abnormalities in function in bilateral renal disease may relate to adaptive changes imposed by the decreased nephron population and the attendant derangements in body fluids rather than to structural distortion of nephrons; (3) the over-all flexibility of the diseased kidney decreases as the number of constituent nephrons decreases; but (4) there is an orderly and predictable pattern of excretion for all substances.