Maintenance and recovery stages of postischemic acute renal failure in humans.
Maintenance and recovery stages of postischemic acute renal failure in humans.
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人类缺血后急性肾衰竭的维持和恢复阶段。
DOI：
10.1152/ajprenal.0068.2001
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发表时间：
2002
期刊：
影响因子：
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通讯作者：
Myers,BryanD
中科院分区：
文献类型：
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作者：
Ramaswamy,Deepa;Corrigan,Geraldine;Polhemus,Catherine;Boothroyd,Derek;Scandling,John;Sommer,FGraham;Alfrey,Edward;Higgins,John;Deen,WilliamM;Olshen,Richard;Myers,BryanD
Postischemic injury in 38 recipients of 7-day-old cadaveric renal allografts was classified into sustained (n= 15) or recovering (n= 23) acute renal failure (ARF) according to the prevailing inulin clearance. Recipients of long-standing allografts that functioned optimally (n= 16) and living transplant donors undergoing nephrectomy (n= 10) served as functional and structural controls, respectively. A combination of physiological and morphometric techniques were used to evaluate glomerular filtration rate and its determinants 1–3 h after reperfusion and again onday 7to elucidate the mechanism for persistent hypofiltration in ARF that is sustained. Glomerular filtration rate in the sustained ARF group onday 7was depressed by 90% (mean ± SD); the corresponding fall in renal plasma flow was proportionately less. Neither plasma oncotic pressure nor the single-nephron ultrafiltration coefficient differed between the sustained ARF and the control group, however. A model of glomerular ultrafiltration and a sensitivity analysis were used to compute the prevailing transcapillary hydraulic pressure gradient (ΔP), the only remaining determinant of ΔP. This revealed that ΔP varied between 27 and 28 mmHg in sustained ARF and 32–38 mmHg in recovering ARF onday 7vs. 47–54 mmHg in controls. Sustained ARF was associated with persistent tubular dilatation. We conclude that depression of ΔP, perhaps due partially to elevated tubule pressure, is the predominant cause of hypofiltration in the maintenance stage of ARF that is sustained for 7 days.
