Raimann Jochen G, Kitzler Thomas M, Levin Nathan W
Contrib Nephrol. 2012;178:150-156. doi: 10.1159/000337836. Epub 2012 May 25.
Many physiological processes relate to two aspects of kidney function: (1) excretory and secretory (excretion of electrolytes and water, elimination of metabolic end products and uremic toxins, regulation of the acid-base status), and (2) endocrine functions (regulating bone and mineral metabolism and red blood cell production). Decreases in renal functions are known to be associated with shortened survival. The exact mechanisms for this are still to be elucidated but evidence in the literature suggests mechanisms such as adverse effects of accumulation of uremic toxins, fluid overload, inflammation and possibly loss of antioxidant functions. Knowledge of factors affecting decrease of residual renal function is currently based on observational data only. Possible strategies to preserve residual renal function have been suggested but require confirmation in adequately powered prospective trials to test their effectiveness.
（1）排泄和分泌功能（电解质和水的排泄、代谢终产物和尿毒症毒素的清除、酸碱平衡的调节），以及（2）内分泌功能（调节骨和矿物质代谢以及红细胞生成）。肾功能下降已知与生存期缩短有关。其确切机制仍有待阐明，但文献中的证据表明，诸如尿毒症毒素蓄积的不良影响、液体超负荷、炎症以及可能的抗氧化功能丧失等机制与之相关。目前关于影响残余肾功能下降的因素的认识仅基于观察性数据。已经提出了保留残余肾功能的可能策略，但需要在有足够效力的前瞻性试验中加以证实，以检验其有效性。
