Glomerular capillary wall function in human lupus nephritis.
Glomerular capillary wall function in human lupus nephritis.
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人狼疮性肾炎的肾小球毛细血管壁功能。
DOI：
10.1152/ajprenal.1984.246.5.f580
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发表时间：
1984
期刊：
影响因子：
--
通讯作者：
Myers,BD
中科院分区：
文献类型：
--
作者：
Friedman,S;Strober,S;Field,EH;Silverman,E;Myers,BD
应用微分溶质清除技术对18例狼疮性肾炎所致肾性蛋白尿患者进行了评价。肾血浆流量与17名健康志愿者对照组相似（506 +/- 75 vs 503 +/- 32 ml/min, P = NS），而肾小球前和肾小球后血浆的肿瘤压分别降低了9.2和17.3 mmHg。这些结果与净超滤压升高一致，提示肾小球过滤过低（51 +/- 9 vs 103 +/- 8 ml/min, P < 0.001）是由于肾小球超滤系数（Kf）降低所致。在狼疮性肾炎中，小右旋糖酐（半径小于50 A）的清除率降低，而大右旋糖酐（半径大于50 A）的清除率升高。溶质运输的孔隙模型，当应用于葡聚糖过滤数据时，揭示了狼疮肾炎中不存在的大蛋白质可渗透孔隙亚群。此外，在个别患者中，通过这些扩大毛孔的肾小球滤液的比例与各自的白蛋白（r = 0.71）和免疫球蛋白G （r = 0.75）的分数清除率直接相关。9例患者的免疫抑制与滤过率和滤过分数的增加有关。相反，蛋白质的分数清除率和被大孔隙占据的肾小球膜的面积分数降低。我们的结论是，人类免疫肾小球炎症表现为Kf减少和肾小球孔隙度增加，这些膜的改变是部分可逆的。
Eighteen patients with nephrotic-range proteinuria due to lupus nephritis were evaluated with a differential solute clearance technique. Renal plasma flow was similar to that in 17 healthy volunteer controls (506 +/- 75 vs. 503 +/- 32 ml/min, P = NS), while oncotic pressure in pre- and postglomerular plasma was depressed by 9.2 and 17.3 mmHg, respectively. These findings are consistent with elevation of net ultrafiltration pressure and suggest that glomerular hypofiltration (51 +/- 9 vs. 103 +/- 8 ml/min, P less than 0.001) was due to a lowered glomerular ultrafiltration coefficient (Kf). In lupus nephritis the fractional clearance of smaller dextrans (radii less than 50 A) was depressed, while that of larger dextrans (radii greater than 50 A) was elevated. A pore model of solute transport, when applied to the dextran filtration data, revealed a subpopulation of large protein-permeable pores in lupus nephritis not present in controls. Moreover, the fraction of glomerular filtrate permeating these enlarged pores correlated directly with the respective fractional clearances of albumin (r = 0.71) and immunoglobulin G (r = 0.75) in individual patients. Immunosuppression in nine patients was associated with an increase of the filtration rate and filtration fraction. Conversely, fractional protein clearances and the area fraction of the glomerular membrane occupied by large pores decreased. We conclude that human immune glomerular inflammation is manifested by a reduction of Kf and increased glomerular porosity and that these membrane alterations are partially reversible.