Kurnik B R, Weisberg L S, Kurnik P B
Department of Medicine, Cooper Hospital/University Medical Center, Camden, NJ.
J Am Soc Nephrol. 1992 May;2(11):1617-26. doi: 10.1681/ASN.V2111617.
Systemic and renal oxygen consumption and hemodynamics were studied in patients with normal renal function (NI; serum creatinine concentration (Screat), 1.0 +/- 0.04 mg/dL) and those with moderate chronic renal failure with diabetes mellitus Screat, 2.7 +/- 0.2 mg/dL) or without diabetes mellitus (Screat, 2.4 +/- 0.1 mg/dL). Patients with chronic renal failure were anemic and had normal systemic oxygen consumption (NI, 10,564 +/- 277; chronic renal failure, 9,669 +/- 362 mumol of O2/min) and elevated systemic oxygen extraction (NI, 22.9 +/- 1; chronic renal failure, 30.9 +/- 1.2%) (P less than 0.02). Cardiac output and index and arterial oxygen saturation were equivalent in normal patients and in patients with chronic renal failure. Patients with chronic renal failure had higher renal oxygen extraction (NI, 7.3 +/- 0.8; chronic renal failure, 13.9 +/- 1%), lower RBF (NI, 572 +/- 146; chronic renal failure, 197 +/- 20 mL/min/kidney), and lower renal oxygen consumption per kidney (NI, 391 +/- 101; chronic renal failure, 177 +/- 20 mumol of O2/min/kidney) than did normal patients (P less than 0.02). There was a linear relationship between hemoglobin and RBF (r = 0.47, P less than 0.02). Patients with chronic renal failure and diabetes had lower RBF (diabetes mellitus, 146 +/- 23; without diabetes, 242 +/- 28 mL/min/kidney) and renal oxygen consumption per kidney (diabetes mellitus, 131 +/- 21; without diabetes, 218 +/- 29 mumol of O2/min/kidney (P less than 0.03) but equivalent renal oxygen extraction when compared with patients without diabetes. Patients with chronic renal failure without diabetes mellitus had higher renal oxygen consumption when expressed per 100 mL of creatinine clearance (diabetes mellitus, 1,016 +/- 150; without diabetes mellitus, 1,453 +/- 175 mumol of O2/min/100 mL of creatinine clearance; P less than 0.03). There was a significant linear relationship (P less than 0.005, r = 0.38) between calculated creatinine clearance and renal oxygen consumption with a y intercept representing basal renal oxygen consumption (115 mumol of O2/min/kidney) and a slope of 2.3 mumol of O2/mL. Patients with moderate chronic renal failure have normal systemic oxygen consumption but reduced RBF and renal oxygen consumption. The latter parameters are even lower in patients with chronic renal failure and diabetes. Renal hypermetabolism is more likely to exist in nondiabetic than diabetic renal disease. Basic human renal physiology and pathophysiology are described by the relationships between renal oxygen consumption, blood flow, oxygen extraction, and creatinine clearance in patients with normal and abnormal renal function of varied cause.
对肾功能正常的患者（NI；血清肌酐浓度（Screat），1.0±0.04mg/dL）以及患有中度慢性肾衰竭且伴有糖尿病（Screat，2.7±0.2mg/dL）或不伴有糖尿病（Screat，2.4±0.1mg/dL）的患者的全身和肾脏氧消耗及血流动力学进行了研究。慢性肾衰竭患者存在贫血，其全身氧消耗正常（NI组为10564±277；慢性肾衰竭组为9669±362μmol O₂/min），全身氧摄取增加（NI组为22.9±1；慢性肾衰竭组为30.9±1.2%）（P<0.02）。正常患者和慢性肾衰竭患者的心输出量、心指数和动脉血氧饱和度相当。慢性肾衰竭患者的肾脏氧摄取更高（NI组为7.3±0.8；慢性肾衰竭组为13.9±1%），肾血流量更低（NI组为572±146；慢性肾衰竭组为197±20mL/min/肾），每侧肾脏的氧消耗更低（NI组为391±101；慢性肾衰竭组为177±20μmol O₂/min/肾），与正常患者相比差异有统计学意义（P<0.02）。血红蛋白与肾血流量之间存在线性关系（r=0.47，P<0.02）。患有慢性肾衰竭且伴有糖尿病的患者肾血流量更低（糖尿病组为146±23；无糖尿病组为242±28mL/min/肾），每侧肾脏的氧消耗更低（糖尿病组为131±21；无糖尿病组为218±29μmol O₂/min/肾）（P<0.03），但与无糖尿病患者相比，肾脏氧摄取相当。不伴有糖尿病的慢性肾衰竭患者按每100mL肌酐清除率计算的肾脏氧消耗更高（糖尿病组为1016±150；无糖尿病组为1453±175μmol O₂/min/100mL肌酐清除率；P<0.03）。计算得到的肌酐清除率与肾脏氧消耗之间存在显著的线性关系（P<0.005，r=0.38），y轴截距代表基础肾脏氧消耗（115μmol O₂/min/肾），斜率为2.3μmol O₂/mL。中度慢性肾衰竭患者全身氧消耗正常，但肾血流量和肾脏氧消耗降低。在患有慢性肾衰竭且伴有糖尿病的患者中，后两个参数更低。非糖尿病性肾病比糖尿病性肾病更易出现肾脏高代谢。不同病因导致的肾功能正常和异常患者的肾脏氧消耗、血流量、氧摄取和肌酐清除率之间的关系描述了人体肾脏的基本生理和病理生理情况。
