Albumin turnover in renal disease.
Albumin turnover in renal disease.
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肾脏疾病中的白蛋白周转。
DOI：
10.1159/000057351
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发表时间：
1998
期刊：
影响因子：
--
通讯作者：
Kaysen,GA
中科院分区：
文献类型：
--
作者：
Kaysen,GA
低白蛋白血症见于接受连续不卧床腹膜透析 (CAPD) 或血液透析治疗的肾病综合征和终末期肾病 (ESRD) 患者。在肾病患者中，低白蛋白血症的主要原因是尿白蛋白损失、白蛋白分解代谢率（FCR）的不适当增加以及白蛋白合成率的增加不足以弥补这些损失。尽管如此，白蛋白合成率却显着增加。在接受 CAPD 的患者中，白蛋白流失到尿液中并穿过腹膜，导致低白蛋白血症。与肾病患者相比，白蛋白FCR随着血清白蛋白下降而降低，并且血清白蛋白水平显着高于具有相同外部白蛋白损失的肾病患者。 CAPD患者与肾功能正常的肾病患者一样，可以增加白蛋白合成以补充损失。因此 ESRD 不直接抑制白蛋白合成。相反，血液透析患者的低白蛋白血症是由于白蛋白合成减少所致。白蛋白合成减少的原因是炎症反应（急性期反应）和（较小程度上）营养不足的综合作用。没有证据表明白蛋白转移到血管外空间或通过容量扩张稀释血浆在导致 ESRD 或肾病患者的低白蛋白血症中发挥任何作用。
Hypoalbuminemia is found in patients both with the nephrotic syndrome and with end-stage renal disease (ESRD) treated either with continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis. In nephrotic patients the primary causes of hypoalbuminemia are urinary albumin losses, an inappropriate increase in the fractional catabolic rate (FCR) of albumin and an insufficient increase in the rate of albumin synthesis to replace these losses. Nevertheless, the albumin synthetic rate is increased significantly. In patients on CAPD, albumin losses into the urine and across the peritoneal membrane contribute significantly to hypoalbuminemia. In contrast to nephrotic patients, albumin FCR decreases as serum albumin falls and serum albumin levels are significantly greater than in nephrotic patients with the same external losses of albumin. CAPD patients, like nephrotic patients with normal renal function, can increase albumin synthesis to replace losses. Thus ESRD does not directly suppress albumin synthesis. In contrast, hypoalbuminemia in hemodialysis patients results from reduced albumin synthesis. The cause of decreased albumin synthesis is a combination of response to inflammation (acute-phase response) and, to a lesser extent, inadequate nutrition. There is no evidence that shifts of albumin to the extravascular space or that dilution of the plasma by volume expansion play any role in causing hypoalbuminemia in ESRD or nephrotic patients.