Tulassay T, Rascher W, Schärer K
Division of Pediatric Nephrology, Universitäts-Kinderklinik, Heidelberg, Federal Republic of Germany.
Pediatr Nephrol. 1989 Jan;3(1):92-100. doi: 10.1007/BF00859635.
The role of intra- and extrarenal factors in oedema formation in children with nephrotic syndrome is reviewed. Oedema reflects an abnormal accumulation of fluid within the interstitial tissue. At the capillary level oedema develops when increased lymph flow is no longer effective for the removal of interstitial fluid and the maintenance of intravascular volume. Alterations of intrarenal haemodynamics and tubular sodium reabsorption contribute to sodium retention. Recent studies suggest that during oedema formation reduced effective circulatory volume triggers changes in various hormonal systems, such as renin-angiotensin-aldosterone, noradrenaline, dopamine, vasopressin, prostaglandins and natriuretic factors, which contribute to sodium and water retention. It appears that the release of atrial natriuretic peptide following central volume expansion is responsible for the increased urine flow and natriuresis after intravenous administration of albumin.
本文综述了肾内和肾外因素在肾病综合征患儿水肿形成中的作用。水肿反映了间质组织内液体的异常蓄积。在毛细血管水平，当淋巴液流量增加不再能有效清除间质液和维持血管内容量时，水肿就会发生。肾内血流动力学和肾小管钠重吸收的改变会导致钠潴留。最近的研究表明，在水肿形成过程中，有效循环血量减少会触发各种激素系统的变化，如肾素-血管紧张素-醛固酮、去甲肾上腺素、多巴胺、血管加压素、前列腺素和利钠因子，这些都会导致钠和水潴留。静脉输注白蛋白后尿量增加和尿钠排泄增加似乎是由于中心血容量扩张后心房利钠肽的释放所致。
