PRESENCE OF A NATRIURETIC FACTOR IN URINE OF PATIENTS WITH CHRONIC UREMIA - ABSENCE OF FACTOR IN NEPHROTIC UREMIC PATIENTS
PRESENCE OF A NATRIURETIC FACTOR IN URINE OF PATIENTS WITH CHRONIC UREMIA - ABSENCE OF FACTOR IN NEPHROTIC UREMIC PATIENTS
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DOI：
10.1172/jci107706
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发表时间：
1974-01-01
影响因子：
15.9
通讯作者：
BRICKER, NS
中科院分区：
文献类型：
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作者：
BOURGOIGNIE, JJ;HWANG, KH;BRICKER, NS
来自慢性尿毒症患者的血清的凝胶过滤部分先前已被证明在大鼠中产生钠尿。在目前的研究中，尿毒症患者和正常人尿液中相同的组份进行了利钠活性的研究。尿样取自17例慢性尿毒症患者(平均肾小球滤过率8.7ml/min；平均钠排泄率5.7%)和14例正常人。尿毒症患者组分的绝对钠排泄量(UNaV)和FENA显著增加；正常人的组分对UNaV和FENA均无统计学意义；尿毒症组分与正常组分对钠排泄的两个参数的反应差异均非常显著。当给予尿毒症患者更集中的尿液部分时，观察到显著的利钠作用，FEN值上升到12%的水平。研究对象还包括8名患有慢性肾功能不全和肾病综合征的晚期患者。对每一位患者的血清分数和三位患者的尿分数进行了研究。给药后大鼠的UNaV值下降0.87eq/μ，FENA值下降1.35%。这些结果与无肾病综合征的慢性尿毒症患者显著不同。这些数据与以下观点一致，即慢性尿毒症患者血清中钠尿素活性的增加不是由于排泄失败；相反，它与产生率增加和/或降解率下降有关。数据还显示，当FENais增加时，该抑制物可被检测到，但当尿毒症与钠保留状态相关时，则不能检测到。
A gel filtration fraction of serum from chronically uremic patients has been shown previously to produce natriuresis in the rat. In the present studies, the same fraction from urine of uremic patients and normal subjects was studied for its natriuretic activity. Urine samples were obtained from 17 chronically uremic patients (mean glomerular filtration rate [GFR], 8.7 ml/min; mean fractional sodium excretion [FENa], 5.7%), and 14 normal subjects. The fraction from the uremic patients produced a significant increase in absolute sodium excretion (UNaV) and FENa; the fraction from normal subjects had no statistically significant effect on either UNaV or FENa; and the difference between the response to the uremic vs. normal fractions was highly significant for both parameters of sodium excretion. When a more concentrated urine fraction from uremic patients was administered, a striking natriuresis was observed with values for FENarising to levels as high as 12%. Studies also were performed on eight patients with far advanced chronic renal insufficiency and the nephrotic syndrome. The serum fraction was studied in each of these patients and the urine fraction in three. For the group, UNaV in the assay rats decreased by 0.87 μeq/min and FENadecreased by 1.35% after infusion of the serum fraction. These results differ significantly from those of patients with chronic uremia without the nephrotic syndrome. The data are consistent with the view that the increased activity of the natriuretic factor in the serum of chronically uremic patients is not due to failure of excretion; rather it relates either to an increased rate of production and/or a decreased rate of degradation. The data also show that the inhibitor is detectable when FENais increased, but not when uremia is associated with a sodium-retaining state.