Namba M, Kikuchi K, Komura H, Suzuki S, Satoh N, Ohtomo T, Takada T, Marusaki S, Iimura O
Second Department of Internal Medicine, Sapporo Medical College, Japan.
Nihon Naibunpi Gakkai Zasshi. 1992 Jan 20;68(1):51-61. doi: 10.1507/endocrine1927.68.1_51.
This study was conducted to elucidate renal uric acid metabolism in patients with primary aldosteronism (PA;16 cases) as compared with normotensive subjects (NT;25 cases) and essential hypertensives (EHT;51 cases). All subjects were hospitalized and received a regular diet(Na;120 mEq,K;75 mEq,daily) for more than two weeks, after which renal clearance tests were performed, and serum uric acid(SUA), fractional excretions of uric acid(FEUA), sodium(FENa), and inorganic phosphorus(FEP) were evaluated. Plasma aldosterone concentration(PAC) was measured in 16 patients with PA before treatment and in 8 patients after adrenalectomy. SUA was lower in PA than in either NT or EHT, and this lowering was more obvious in male subjects. In NT, PA and EHT, FEUA, an index of renal excretion of uric acid, correlated negatively with SUA and positively with FENa and FEP, which reflected sodium reabsorption at the renal total tubules and proximal tubules, respectively. Although FENa was nearly the same in all the three groups, FEUA and FEP were significantly higher in PA than in EHT or NT. However, no significant correlation was found between PAC and SUA or FEUA in PA. In PA a significant increase of SUA, and decreases of FEUA and FEP were observed after the removal of adenoma compared to before the surgery. These results suggest that uric acid transport might be closely related to sodium transport in the renal tubules, particularly at the proximal site, and also lead to the conclusion that the lower SUA in PA resulted from the suppression of reabsorption and/or an enhancement of secretion of uric acid in the proximal tubules, being related to the so-called escape phenomenon.
本研究旨在阐明原发性醛固酮增多症（PA；16例）患者的肾脏尿酸代谢情况，并与血压正常者（NT；25例）和原发性高血压患者（EHT；51例）进行比较。所有受试者均住院并接受超过两周的常规饮食（钠120 mEq，钾75 mEq，每日），之后进行肾脏清除率测试，并评估血清尿酸（SUA）、尿酸排泄分数（FEUA）、钠排泄分数（FENa）和无机磷排泄分数（FEP）。在16例PA患者治疗前及8例患者肾上腺切除术后测量血浆醛固酮浓度（PAC）。PA患者的SUA低于NT或EHT患者，且这种降低在男性受试者中更为明显。在NT、PA和EHT中，尿酸排泄分数（FEUA）作为肾脏尿酸排泄指标，与SUA呈负相关，与FENa和FEP呈正相关，分别反映肾全段小管和近端小管的钠重吸收情况。尽管三组的FENa几乎相同，但PA组的FEUA和FEP显著高于EHT或NT组。然而，PA组中PAC与SUA或FEUA之间未发现显著相关性。与手术前相比，PA患者切除腺瘤后SUA显著升高，FEUA和FEP降低。这些结果表明，尿酸转运可能与肾小管中的钠转运密切相关，尤其是在近端部位，也得出结论，PA患者SUA降低是由于近端小管尿酸重吸收受抑制和/或分泌增强，这与所谓的逃逸现象有关。
