Corrigan G, Ramaswamy D, Kwon O, Sommer F G, Alfrey E J, Dafoe D C, Olshen R A, Scandling J D, Myers B D
Department of Medicine, Division of Nephrology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California 94305, USA.
Am J Physiol. 1999 Aug;277(2):F312-8. doi: 10.1152/ajprenal.1999.277.2.F312.
We determined the effect of postischemic injury to the human renal allograft on p-aminohippurate (PAH) extraction (E(PAH)) and renal blood flow. We evaluated renal function in 44 allograft recipients on two occasions: 1-3 h after reperfusion (day 0) and again on postoperative day 7. On day 0 subsets underwent intraoperative determination of renal blood flow (n = 35) by Doppler flow meter and E(PAH) (n = 25) by renal venous assay. Blood flow was also determined in another subset of 16 recipients on postoperative day 7 by phase contrast-cine-magnetic resonance imaging, and E(PAH) was computed from the simultaneous PAH clearance. Glomerular filtration rate (GFR) on day 7 was used to divide subjects into recovering (n = 23) and sustained (n = 21) acute renal failure (ARF) groups, respectively. Despite profound depression of GFR in the sustained ARF group, renal plasma flow was only slightly depressed, averaging 296 +/- 162 ml. min(-1). 1.73 m(-2) on day 0 and 202 +/- 72 ml. min(-1). 1.73 m(-2) on day 7, respectively. These values did not differ from corresponding values in the recovering ARF group: 252 +/- 133 and 280 +/- 109 ml. min(-1). 1.73 m(-2), respectively. E(PAH) was profoundly depressed on day 0, averaging 18 +/- 14 and 10 +/- 7% in recovering and sustained ARF groups, respectively, vs. 86 +/- 6% in normal controls (P < 0.001). Corresponding values on day 7 remained significantly depressed at 65 +/- 20 and 11 +/- 22%, respectively. We conclude that postischemic injury to the renal allograft results in profound impairment of E(PAH) that persists for at least 7 days, even after the onset of recovery. An ensuing reduction in urinary PAH clearance results in a gross underestimate of renal plasma flow, which is close to the normal range in the initiation, maintenance, and recovery stages of this injury.
我们确定了人类肾移植术后缺血性损伤对对氨基马尿酸（PAH）提取率（E(PAH)）和肾血流量的影响。我们在两个时间点评估了44例移植受者的肾功能：再灌注后1 - 3小时（第0天）以及术后第7天。在第0天，部分患者通过多普勒流量计术中测定肾血流量（n = 35），通过肾静脉检测法测定E(PAH)（n = 25）。另外16例受者在术后第7天通过相位对比电影磁共振成像测定血流量，并根据同时测定的PAH清除率计算E(PAH)。根据第7天的肾小球滤过率（GFR）将受试者分别分为恢复性急性肾衰竭（ARF）组（n = 23）和持续性急性肾衰竭组（n = 21）。尽管持续性ARF组的GFR显著降低，但肾血浆流量仅略有降低，第0天平均为296 ± 162 ml·min⁻¹·1.73 m⁻²，第7天为202 ± 72 ml·min⁻¹·1.73 m⁻²。这些值与恢复性ARF组的相应值无差异：分别为252 ± 133和280 ± 109 ml·min⁻¹·1.73 m⁻²。第0天E(PAH)显著降低，恢复性ARF组和持续性ARF组平均分别为18 ± 14%和10 ± 7%，而正常对照组为86 ± 6%（P < 0.001）。第7天的相应值仍显著降低，分别为65 ± 20%和11 ± 22%。我们得出结论，肾移植术后缺血性损伤导致E(PAH)严重受损，这种损伤至少持续7天，即使在恢复开始后也是如此。随后尿PAH清除率的降低导致对肾血浆流量的严重低估，在这种损伤的起始、维持和恢复阶段，肾血浆流量接近正常范围。
