University of California San Diego School of Medicine, San Diego, California, USA.
Curr Opin Nephrol Hypertens. 2018 Jan;27(1):23-29. doi: 10.1097/MNH.0000000000000380.
High protein intake and hyperfiltration have been a focus of major interest as potential mechanism(s) of progression of renal disease. This review will examine: the renal response to a protein meal or amino acid infusion and its use to test the renal functional reserve (RFR); new methods to evaluate RFR; the use of RFR in various pathophysiologic conditions.
The renal response to protein/amino acid infusion involves several mechanisms, including nitric oxide, insulin, glucagon, arginine vasopressin, urea, the renal N-Methyl-D-Aspartate Glutamate receptor and modulation of the activity of the tubuloglomerular feedback system. Dose-response studies to evaluate RFR suggest the presence of a potential ceiling. The utilization of a noninvasive technique such as Doppler ultrasonography is trying to simplify the measurement of RFR and to bring this test into different clinical settings. There is increased interest in the presence or absence of RFR in patients with acute kidney injury, hypertension, chronic kidney disease, and its potential long-term implication regarding renal function.
The renal response to protein may help us understand the relationship between hyperfiltration, progression of renal disease, and other conditions (overall mortality, cardiovascular complications, and so on) currently being explored.
高蛋白摄入和超滤一直是人们关注的焦点，因为它们可能是导致肾脏疾病进展的机制之一。这篇综述将探讨：蛋白质餐或氨基酸输注引起的肾脏反应及其用于测试肾脏功能储备（RFR）的用途；评估 RFR 的新方法；RFR 在各种病理生理状况下的应用。
蛋白质/氨基酸输注引起的肾脏反应涉及多种机制，包括一氧化氮、胰岛素、胰高血糖素、精氨酸加压素、尿素、肾脏 N-甲基-D-天冬氨酸谷氨酸受体和对管球反馈系统活性的调节。评估 RFR 的剂量反应研究表明，可能存在一个上限。人们试图利用超声多普勒等非侵入性技术来简化 RFR 的测量，并将该检测方法应用于不同的临床环境。人们对急性肾损伤、高血压、慢性肾脏病患者中 RFR 的存在或缺失以及其对肾功能的潜在长期影响越来越感兴趣。
蛋白质引起的肾脏反应可能有助于我们了解超滤、肾脏疾病进展和其他正在研究的情况（总体死亡率、心血管并发症等）之间的关系。
