Mihata M, Tanizawa T, Tomimoto Y, Nishioka M, Kawaguchi M, Hatori M, Wada H
Department of Pediatrics, Hyogo College of Medicine, Japan.
Nihon Jinzo Gakkai Shi. 1991 Nov;33(11):1039-44.
We described a transient low or non-selective proteinuria after forced lordosis as a characteristic of orthostatic proteinuria and the heteroporous theory and sieving function theory which might explain the mechanism of orthostatic proteinuria. The angiogenic action of the renin-angiotensin system played an important part in these theories. Angiotensin II was recognized as the key regulator of renal sodium excretion, because it reduced the urinary Na/K ratio. Since the purpose of this study is to investigate the influence of the renin-angiotensin system on the mechanism of orthostatic proteinuria, proteins and electrolytes in the urine were examined before and after lordosis in 9 healthy children (Group A) and in 6 children with orthostatic proteinuria (Group B). The urinary ratio of protein/creatinine (P/cre) in Group B was already significantly higher than that in Group A before lordosis and significantly increased after lordosis, while P/cre in group A did not increase after lordosis. The urinary Na/K ratio (Na/K) in Group B was already significantly lower than that in Group A before lordosis, and after forced lordosis, Na/K in Group A decrease with no difference between both groups observed. It is suggested that a significant increase on P/cre after lordosis was obtained only in Group A, whereas in both groups the renal vein may be compressed by forced lordosis and as a result angiotensin II may be stimulated. There might be a difference of the responsibility to angiotensin II in glomerular mesangium contraction between both groups.
我们描述了强迫脊柱前凸后出现的短暂性轻度或非选择性蛋白尿,这是直立性蛋白尿的一个特征,以及可能解释直立性蛋白尿机制的异孔理论和筛分功能理论。肾素-血管紧张素系统的血管生成作用在这些理论中起着重要作用。血管紧张素II被认为是肾钠排泄的关键调节因子,因为它降低了尿钠/钾比值。由于本研究的目的是探讨肾素-血管紧张素系统对直立性蛋白尿机制的影响,因此对9名健康儿童(A组)和6名直立性蛋白尿儿童(B组)在脊柱前凸前后的尿液中的蛋白质和电解质进行了检测。B组在脊柱前凸前尿蛋白/肌酐比值(P/cre)就已经显著高于A组,脊柱前凸后显著升高,而A组脊柱前凸后P/cre没有升高。B组尿钠/钾比值(Na/K)在脊柱前凸前就已经显著低于A组,强迫脊柱前凸后,A组Na/K降低,两组之间无差异。提示仅在B组脊柱前凸后P/cre显著升高,而两组中强迫脊柱前凸可能压迫肾静脉,从而刺激血管紧张素II。两组在肾小球系膜收缩对血管紧张素II的反应性上可能存在差异。