RENAL FUNCTION AS A FACTOR IN FLUID RETENTION IN PATIENTS WITH CIRRHOSIS OF THE LIVER
RENAL FUNCTION AS A FACTOR IN FLUID RETENTION IN PATIENTS WITH CIRRHOSIS OF THE LIVER
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DOI：
10.1172/jci102539
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发表时间：
1951-01-01
影响因子：
15.9
通讯作者：
RALLI, EP
中科院分区：
文献类型：
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作者：
LESLIE, SH;JOHNSTON, B;RALLI, EP
本文对17例肝硬化患者在不同病期进行了32次肾功能测定。所做的测量是滤过率（菊粉清除率）、有效肾血浆流量（对氨基马尿酸清除率）和对氨基马尿酸的最大肾小管排泄。将患者分为3组（随着患者病情改善，并在这些时间重复清除，其数据被纳入指定组）：第I组包括6例从未出现腹水或从未严重到需要穿刺的患者。11次清除。在这个组里。第II组包括6名患者，他们在治疗过程中均需要穿刺，但在清除研究时，由于治疗，腹水不严重到需要进一步穿刺。该组进行了10次清除。第三组包括7例腹水迅速再积聚的患者，因此需要每隔7 ~ 16天进行一次穿刺。在该组中测量了11个间隙。在穿刺后1或2天进行清除，以避免腹内压升高的因素。探讨腹主动脉瘤对腹内压的影响。对于腹水，在几个患者中，当腹部因液体而严重膨胀时，以及当腹部液体少得多时，在穿刺后的短时间间隔内，进行了清除。安全检查。在7名患者中重复一次以上，在2名受试者中，在疾病过程中间隔12-15个月重复清除，直到腹水得到控制。在组I的患者中，清除率测量值均未降低。在n组患者中，2例患者的滤过率低于平均正常值，其他值均在正常范围内。在第三组的患者中，腹水迅速积聚，需要反复穿刺，所有的清除率测量值均降低。一旦腹水得到控制，因此不需要进一步的穿刺，肾功能测量变得正常。进行清除率研究时腹腔内存在的腹水量对已经降低的清除率值没有显著影响。研究表明，肝硬化患者在腹水明显的疾病阶段存在肾功能抑制。显然，肾功能紊乱是可逆的，如果患者通过治疗改善，肾功能将恢复正常。重建正常功能的肾脏与利尿有关，利尿可控制腹水。
32 renal functional measurements were done on 17 patients with cirrhosis of the liver at different stages of the disease. The measurements done were the filtration rate (inulin clearance), effective renal plasma flow (p-aminohippuric acid clearance) and maximal tubular excretion of p-aminohippuric acid. The patients were divided into 3 groups (as the patients improved and the clearances were repeated at such times, their data was included in the indicated group): Group I consisted of 6 patients in whom ascites had either never been present or in whom it was never sufficiently severe to require paracentesis. Eleven clearances were detd. in this group. Group II consisted of 6 patients who had all required paracentesis during the course of therapy but at the time of the clearance studies, as a result of therapy, ascites was not severe enough to require further taps. Ten clearances were done in this group. Group III consisted of 7 patients in whom ascitic fluid rapidly reaccumulating, so that taps were required at intervals of from 7 to 16 days. Eleven clearances were measured in this group. The clearances were done 1 or 2 days following the tap in order to avoid the factor of increased intra-abdominal pressure. To evaluate the effect of the intra-abdominal pressure resulting from the presence in the absomen of large amts. of ascitic fluid, clearances were done in several patients at times when the abdomen was grossly distended with fluid and at short intervals after a tap, when there was much less fluid in the abdomen. Clearance detns. were repeated more than once in 7 patients and in 2 subjects the clearances were repeated at intervals during the course of the disease, a period of 12-15 months, until ascites was controlled. In the patients in Group I none of the clearance measurements was depressed. In the patients in Group n, the filtration rates were below the mean normal value in 2 cases and the values otherwise were within normal limits. In the patients in Group III, in whom ascitic fluid accumulated rapidly and who required repeated taps, all of the clearance measurements were depressed. Once ascites was controlled, so that further paracenteses were not required, the renal functional measurements became normal. The amount of ascitic fluid present in the abdomen at the time the clearance studies were done did not significantly affect the already depressed clearance values. The studies demonstrate that there is a functional depression of the kidney in patients with cirrhosis of the liver during the phase of the disease when ascites is pronounced. Apparently, the disturbance in kidney function is reversible and if the patient improves with therapy, kidney function will return to normal. The reestablishment of a normally functioning kidney is associated with diuresis, which results in the control of ascites.