Department of Anatomical Sciences and Neurobiology and Kentucky Spinal Cord Injury Research Center, University of Louisville , Louisville, Kentucky.
Am J Physiol Renal Physiol. 2018 Jan 1;314(1):F58-F66. doi: 10.1152/ajprenal.00229.2017. Epub 2017 Sep 6.
Urinary dysfunction is a common complaint following spinal cord injury (SCI) and is a leading issue for individuals with SCI that impacts their quality of life. One urinary complication that has received little attention is SCI-induced polyuria, even though individuals with SCI will significantly restrict their fluid intake to decrease urine production, leading to sequelae of medical complications. Understanding the mechanisms instigating the development of polyuria will allow us to target interventions that may alleviate polyuria symptoms, leading to significant improvements in the quality of life and urinary health of individuals with SCI. In a rat SCI contusion model, an increase in the amount of urine excreted over a 24-h period ( P ≤ 0.001) was found at 2 wk postinjury. The urine excreted was more dilute with decreased urinary creatinine and specific gravity ( P ≤ 0.001). Several factors important in fluid balance regulation, vasopressin (AVP), natriuretic peptides, and corticosterone (CORT), also changed significantly postinjury. AVP levels decreased ( P = 0.042), whereas atrial natriuretic peptide (ANP) and CORT increased ( P = 0.005 and P = 0.031, respectively) at 2 wk postinjury. There was also a positive correlation between the increase in ANP and urine volume postinjury ( P = 0.033). The changes in AVP, ANP, and CORT are conducive to producing polyuria, and the timing of these changes coincides with the development of SCI-induced polyuria. This study identifies several therapeutic targets that could be used to ameliorate polyuria symptoms and improve quality of life in individuals with SCI.
尿功能障碍是脊髓损伤(SCI)后的常见主诉,也是影响 SCI 患者生活质量的主要问题。尽管 SCI 患者会显著限制液体摄入以减少尿液产生,但 SCI 引起的多尿症是一种很少受到关注的尿并发症,导致医疗并发症的后遗症。了解引发多尿症发展的机制将使我们能够针对干预措施,这些措施可能减轻多尿症症状,从而显著改善 SCI 患者的生活质量和尿健康。在大鼠 SCI 挫伤模型中,发现损伤后 2 周,24 小时内排出的尿液量增加(P≤0.001)。尿液排出更稀释,尿肌酐和比重降低(P≤0.001)。在损伤后,几个对液体平衡调节很重要的因素,如血管加压素(AVP)、利钠肽和皮质酮(CORT),也发生了显著变化。AVP 水平下降(P=0.042),而心房利钠肽(ANP)和 CORT 增加(P=0.005 和 P=0.031,分别)。损伤后 ANP 与尿量的增加也呈正相关(P=0.033)。AVP、ANP 和 CORT 的变化有利于产生多尿症,这些变化的时间与 SCI 引起的多尿症的发展相吻合。这项研究确定了几个治疗靶点,可用于改善 SCI 患者的多尿症症状和提高生活质量。