Urinary Concentration Ability: Time to Bring the Tubules to the Table.
Urinary Concentration Ability: Time to Bring the Tubules to the Table.
复制标题
尿液浓缩能力：将小管带到餐桌上的时间。
DOI：
10.1053/j.ajkd.2019.01.019
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Kestenbaum,Bryan
中科院分区：
文献类型：
--
作者：
Wang,Ke;Kestenbaum,Bryan
作为一个中枢体内平衡器官，肾脏除了肾小球滤过外，还具有多种生理功能，包括重要激素的合成、蛋白质结合有机溶质的分泌以及盐和水平衡的维持。完整肾元假说假设在整个慢性肾脏疾病（CKD）谱系中肾脏功能的进行性和比例性下降。然而，一些证据表明，在病变状态下，肾小管和肾小球的功能存在差异。例如，肾活检的小管间质损伤程度是糖尿病和其他肾小球疾病进展的最强决定因素之一，然而这种病理病变通常与肾小球滤过率（GFR）分离。2,3此外，代谢并发症和尿毒症症状的存在和严重程度在GFR水平相似的人群中有所不同。因此，有理由怀疑不同疾病和具有潜在重要临床意义的个体的不同肾脏功能的不均匀下降。在这一期的《美国肾脏疾病杂志》上，Tabibzadeh和他的同事报道了最大尿浓缩能力的临床意义，这是一种内在的肾小管功能。作者在多中心肾试验队列中收集了1796名CKD患者的晨尿样本，测量了尿渗透压（Uosm）。通过51Cr-EDTA清除率测定，研究组的平均GFR为40.2 ml/min/1.73 m2。参与者被要求在收集尿液的前一天晚上8点以后不要吃东西或喝水。正如预期的那样，大多数参与者能够将尿液浓缩到高于预期的血浆渗透压：空腹Uosm值的中位数（四分位数范围）为482 mOsm/kgH2O （402-591 mOsm/kgH2O）。然而，研究个体的尿浓缩能力存在相当大的差异。在对测量的GFR和其他协变量进行调整后，禁食Uosm的最低分位数与进展为终末期肾病（ESKD）的风险增加约两倍相关：风险比为2.0 （95% CI 1.3至3.1）。与eskd前死亡的关联没有达到统计学意义：风险比0.99 （95% CI 0.68 ~ 1.44）。随着时间的推移，较低的空腹Uosm水平也与GFR测量值的较大下降有关。这些发现提示尿浓缩能力受损可能反映肾小球滤过未捕获的肾小管损伤。
As a central homeostatic organ, the kidneys perform diverse physiologic functions beyond glomerular filtration, including the synthesis of vital hormones, secretion of protein-bound organic solutes, and maintenance of salt and water balance. The intact nephron hypothesis postulates a progressive and proportionate decline of kidney functions across the spectrum of chronic kidney disease (CKD). 1 However, several lines of evidence suggest contrasts between tubular and glomerular functions in the diseased state. For example, the degree of tubulointerstitial injury on kidney biopsy is among the strongest determinants of disease progression in diabetes and other glomerular disorders, yet this pathological lesion is often dissociated from glomerular filtration rate (GFR). 2, 3 Furthermore, the presence and severity of metabolic complications and uremic symptoms vary across people with similar levels of GFR. Therefore, there is reason to suspect non-uniform declines in distinct kidney functions across diseases and individuals with potentially important clinical implications.In this issue of the American Journal of Kidney Disease, Tabibzadeh and colleagues report on the clinical significance of the maximum urinary concentrating ability, an intrinsic kidney tubular function. The authors measured urine osmolality (Uosm) in spot morning samples collected from 1,796 persons with CKD in the multi-center NephroTest cohort. The mean GFR of the study group, determined by 51Cr-EDTA clearance, was 40.2 ml/min/1.73 m2. Participants were instructed not to eat or drink after 8 PM on the night prior to the urine collection. As expected, most participants were able to concentrate their urine above the expected osmolality of plasma: the median (interquartile range) of fasting Uosm values was 482 mOsm/kgH2O (402–591 mOsm/kgH2O). Yet, there was considerable variability in urinary concentrating ability across study individuals. After adjustment for measured GFR and other covariates, the lowest tertile of fasting Uosm was associated with an approximate two-times higher risk of progression to end stage kidney disease (ESKD): hazard ratio 2.0 (95% CI 1.3 to 3.1). The association with pre-ESKD death did not reach statistical significance: hazard ratio 0.99 (95% CI 0.68 to 1.44). Lower fasting Uosm levels were also associated with a greater decline in measured GFR over time. These findings suggest that impaired urinary concentrating ability may reflect kidney tubular damage that is not captured by glomerular filtration.
论尿毒症的发病机制——权衡假说的阐述.
DOI：
--
发表时间：
1972
期刊：
Nihon Jinzo Gakkai shi
影响因子：
--
作者：
N. Bricker
通讯作者：
N. Bricker
影响因子：
13.6
作者：
Hsu, Chi-yuan;Propert, Kathleen;Feldman, Harold
通讯作者：
Feldman, Harold