Wambach G, Bönner G, Kleinpass H, Dopatka A, Kaufmann W
Medizinische Klinik II der Universität Köln, Krankenanstalten Köln-Merheim Fed. Rep. of Germany.
Arzneimittelforschung. 1989 Mar;39(3):387-90.
An early diagnosis of renal dysfunction is particularly important in patients with chronic abuse of analgesics. First morphological changes in cases of analgesic nephropathy are found in the renal medulla. Therefore, urinary osmolarity as well as the urinary excretion of cyclic adenosine monophosphate (AMP) and kallikrein were measured after application of desamino-D-arginine vasopressin (DDAVP) as parameters of the renal tubular function in 21 patients with normal creatinine clearance and a regular, excessive use of analgesics. The results were compared with those of 17 healthy volunteers and 8 patients with chronic renal insufficiency after analgesic nephropathy. In patients with analgesic nephropathy the urine osmolarity after 12 h of thirst was 367 +/- 28 mOsm/kg and did not increase after DDAVP. The results obtained from healthy volunteers were 781 +/- 39 mOsm/kg. Half of the patients with chronic misuse of analgesics had lower values of urine osmolarity after thirst and DDAVP compared to the reference area of healthy subjects. Similar results were found when the effect of DDAVP under conditions of water-loading was tested. The excretion of cyclic AMP as a second messenger of DDAVP and of kallikrein did not differ between patients with chronic abuse of analgesics and healthy volunteers. The excretion of kallikrein in patients with manifest analgesic nephropathy, however, was decreased. Thus the renal concentration test with DDAVP proved to be useful in early diagnosis of renal dysfunction caused by analgesics.
对于长期滥用镇痛药的患者而言，肾功能障碍的早期诊断尤为重要。镇痛药肾病患者最早出现的形态学变化见于肾髓质。因此，我们对21名肌酐清除率正常且长期过量使用镇痛药的患者应用去氨基-D-精氨酸加压素（DDAVP）后，检测了尿渗透压以及环磷酸腺苷（AMP）和激肽释放酶的尿排泄量，以此作为肾小管功能的指标。将结果与17名健康志愿者以及8名镇痛药肾病后慢性肾功能不全患者的结果进行了比较。在镇痛药肾病患者中，禁水12小时后的尿渗透压为367±28mOsm/kg，应用DDAVP后未升高。健康志愿者的结果为781±39mOsm/kg。与健康受试者的参考范围相比，半数长期滥用镇痛药的患者在禁水和应用DDAVP后的尿渗透压值较低。在水负荷条件下检测DDAVP的作用时也发现了类似结果。慢性滥用镇痛药的患者与健康志愿者之间，作为DDAVP第二信使的环磷酸腺苷和激肽释放酶的排泄量并无差异。然而，在有明显镇痛药肾病的患者中，激肽释放酶的排泄量减少。因此，DDAVP肾浓缩试验被证明对早期诊断镇痛药所致肾功能障碍有用。
