Mannitol therapy revisited (1940-1997)
Mannitol therapy revisited (1940-1997)
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DOI：
10.1038/ki.1997.409
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发表时间：
1997-10-01
影响因子：
19.6
通讯作者：
Knochel, JP
中科院分区：
文献类型：
--
作者：
Better, OS;Rubinstein, I;Knochel, JP
本文的目的是回顾甘露醇对正常肾功能的影响及其在预防 ARF 和保护挤压伤后骨骼肌功能方面的临床治疗潜力。渗透性利尿剂是可自由过滤的低分子量物质，由于其有限的重吸收和小尺寸，在管状液体中产生渗透力，足以延缓液体和溶质（特别是氯化钠）沿肾单位的重吸收。因此，渗透性利尿导致尿中水、钠、钾和二价阳离子的损失。甘露醇是一种六碳不可代谢多元醇，分子量为 182，可能是最古老且使用最广泛的渗透性利尿剂 [21。在生理和病理生理条件下对实验动物和人类进行的大量研究极大地促进了我们对其肾脏和肾外作用的理解。具有类似作用的化合物是山梨醇。当葡萄糖以足够高的浓度存在于肾小球滤液中以超过近端肾单位的重吸收能力时，葡萄糖同样可以充当“内源性”渗透利尿剂。其他部分或难再吸收的药物，如尿素和硫酸盐，过去被归入渗透性利尿剂类别，因为当血浆中高浓度存在时，它们可能会增加尿流量，部分机制类似于甘露醇[4]。除了作为利尿剂的作用外，在过去的五年里，甘露醇还被许多肾脏生理学家用作研究肾小管和细胞水平的盐和水转运机制的重要工具。作为一种生理探针，甘露醇有助于我们了解这些转运过程。
The purpose of the present communication is to review the effect of mannitol on normal kidney function as well as its clinical therapeutic potential in the prevention of ARF and protection of skeletal muscle function following crush injury. Osmotic diuretics are freely filterable, low molecular weight substances that due to their limited reabsorption and small size create an osmotic force in the tubular fluid sufficient to retard the reabsorption of fluids and solutes (notably NaCI) along the nephron. Thus, osmotic diuresis results in urinary loss of water, sodium, potassium and divalent cations. Mannitol, a six-carbon nonmetabolizable polyacohol with a molecular weight of 182, is perhaps the oldest and most widely employed osmotic diuretic agent [21. Numerous studies in experimental animals and humans, under both physiologic and pathophysiologic conditions, have contributed significantly to our understanding of its renal and extrarenal actions. A compound with similar effects is sorhitol. Glucose may likewise act as an" endog-enous" osmotic diuretic agent when present at sufficiently high concentrations in the glomerular filtrate, to exceed the reabsorp-tion capacity of the proximal nephron. Other partially or poorly reabsorbable agents, such as urea and sulfates, were included in the past in the category of osmotic diuretics, because, when present in high concentrations in plasma, they may increase urine flow rate, in part by a mechanism similar to that of mannitol [4]. Beyond its action as a diuretic agent, mannitol has been used by many renal physiologists, over the past five decades, as an important tool in the study of the mechanisms of salt and water transport at the tubular and cellular level. As a physiologic probe, mannitol has contributed to our understanding of these transport processes.