Sitprija V, Kashemsant U, Sriratanaban A, Arthachinta S, Poshyachinda V
Department of Medicine, Chulalongkorn University Hospital, Bangkok, Thailand.
Kidney Int. 1990 Nov;38(5):948-55. doi: 10.1038/ki.1990.296.
Renal function with respect to water clearance and renal hemodynamics was studied in 15 patients with obstructive jaundice due to cholangiocarcinoma. The results were compared with those of the control normal subjects. There was no change in renal function in the patients with mild to moderate jaundice, with total serum bilirubin from 8.0 to 15.1 mg/dl. Increased urinary sodium excretion and decreased free water and negative water clearances were observed in the patients with severe jaundice with total serum bilirubin from 27.0 to 40.4 mg/dl and normal serum albumin. Renal blood flow was normal, but creatinine clearance was decreased. In severely jaundiced patients with serum bilirubin from 30.5 to 40.1 mg/dl and hypoalbuminemia urinary sodium excretion, free water clearance, negative water clearance, renal blood flow and creatinine clearance were decreased. There was salt and water retention in this group. The findings suggest that in severe jaundice there is inhibition of sodium chloride reabsorption in the thick ascending limb of Henle's loop. ADH and increased hydraulic conductivity of the collecting tubules possibly contribute to decreased free water clearance. In severely jaundiced patients with hypoalbuminemia this salt losing effect is converted to salt retention by increased proximal tubular reabsorption of sodium.
对15例胆管癌所致梗阻性黄疸患者的肾功能进行了关于水清除和肾血流动力学方面的研究。将结果与对照正常受试者的结果进行了比较。血清总胆红素为8.0至15.1mg/dl的轻度至中度黄疸患者的肾功能无变化。血清总胆红素为27.0至40.4mg/dl且血清白蛋白正常的重度黄疸患者，观察到尿钠排泄增加，自由水清除率和负水清除率降低。肾血流量正常，但肌酐清除率降低。血清胆红素为30.5至40.1mg/dl且有低白蛋白血症的重度黄疸患者，尿钠排泄、自由水清除率、负水清除率、肾血流量和肌酐清除率均降低。该组存在盐和水潴留。研究结果表明，在重度黄疸中，亨氏袢升支粗段的氯化钠重吸收受到抑制。抗利尿激素和集合管水通透性增加可能导致自由水清除率降低。在有低白蛋白血症的重度黄疸患者中，这种失盐作用因近端小管钠重吸收增加而转变为盐潴留。
