Futrakul P, Yenrudi S, Futrakul N, Sensirivatana R, Kingwatanakul P, Jungthirapanich J, Cherdkiadtikul T, Laohapaibul A, Watana D, Singkhwa V, Futrakul S, Pongsin P
Departments of Pediatrics, Pathology, and Medicine, The King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Am J Kidney Dis. 1999 May;33(5):886-91. doi: 10.1016/s0272-6386(99)70421-x.
Tubular transport determined by the fractional excretion (FE) of filtered solutes was studied in 129 nephrotic patients; 72 patients with mesangial proliferation (MesP-NS) and intact tubulointerstitium (group 1), 13 patients with MesP-NS and superimposed tubulointerstitial fibrosis (TIF; group 2), 27 patients with mild focal segmental glomerulosclerosis (FSGS; group 3), and 17 patients with severe FSGS (group 4). In the 72 nephrotic patients with MesP-NS and normal tubulointerstitium (no TIF), tubular transport was intact (FE of sodium [FENa], 0.5 +/- 0.5; FE of calcium [FECa], 0.3 +/- 0.3; FE of phosphate [FEPO4], 14 +/- 13; FE of uric acid [FEUA], 9.8 +/- 5; FE of magnesium [FEMg], 1.3 +/- 0.5). In the 13 nephrotic patients with MesP-NS and superimposed TIF (4.9% +/- 2%), there was no difference in FE solutes from those in group 1 except for FEMg (3.3 +/- 0.9; P < 0.001). In the 27 nephrotic patients with mild FSGS (TIF, 28% +/- 9%), four of five variables of FE solutes (FENa, 1.2 +/- 0.7; P < 0.001; FECa, 0.9 +/- 0.8; P < 0.001; FEPO4, 17 +/- 12; P, not significant; FEUA, 16.5 +/- 8; P < 0.001; FEMg, 4. 1 +/-1; P < 0.001) were significantly different from those of patients with MesP-NS without TIF, and two of five variables (FECa, FEMg) were statistically different from those of patients with MesP-NS with TIF. In the severe category of FSGS (TIF, 69% +/-19%), all FE solutes were statistically different from the other groups (FENa, 4.8 +/- 3; FECa, 2 +/- 1; FEPO4, 47 +/- 24; FEUA, 37 +/- 18; FEMg, 12 +/- 6). Thus, the results imply that (1) normal tubular transport reflects an underlying intact tubulointerstitial structure, whereas tubular dysfunction indicates an underlying tubulointerstitial disease, and (2) FEMg is the most sensitive index to detect an early abnormality of tubular structure and function.
在129例肾病患者中研究了由滤过溶质分数排泄（FE）所决定的肾小管转运情况；72例系膜增生性肾病（MesP-NS）且肾小管间质完整的患者（第1组），13例MesP-NS且合并肾小管间质纤维化（TIF）的患者（第2组），27例轻度局灶节段性肾小球硬化（FSGS）的患者（第3组），以及17例重度FSGS的患者（第4组）。在72例MesP-NS且肾小管间质正常（无TIF）的肾病患者中，肾小管转运正常（钠的FE [FENa]，0.5±0.5；钙的FE [FECa]，0.3±0.3；磷酸盐的FE [FEPO4]，14±13；尿酸的FE [FEUA]，9.8±5；镁的FE [FEMg]，1.3±0.5）。在13例MesP-NS且合并TIF（4.9%±2%）的肾病患者中，除FEMg外（3.3±0.9；P<0.001），FE溶质与第1组患者无差异。在27例轻度FSGS的肾病患者中（TIF，28%±9%），FE溶质的五个变量中有四个（FENa，1.2±0.7；P<0.001；FECa，0.9±0.8；P<0.001；FEPO4，17±12；P无显著性差异；FEUA，16.5±8；P<0.001；FEMg，4.1±1；P<0.001）与无TIF的MesP-NS患者有显著差异，五个变量中有两个（FECa，FEMg）与合并TIF的MesP-NS患者有统计学差异。在重度FSGS组（TIF，69%±19%）中，所有FE溶质与其他组均有统计学差异（FENa，4.8±3；FECa，2±1；FEPO4，47±24；FEUA，37±18；FEMg，12±6）。因此，结果表明：（1）正常的肾小管转运反映了潜在的完整肾小管间质结构，而肾小管功能障碍提示潜在的肾小管间质疾病；（2）FEMg是检测肾小管结构和功能早期异常的最敏感指标。
