Division of Nephrology and Hypertension, Department of Medicine, Georgetown University, Washington, DC, USA.
Curr Opin Nephrol Hypertens. 2018 Sep;27(5):379-383. doi: 10.1097/MNH.0000000000000441.
Renal ion transport undergoes dramatic changes during the course of gestation. These adaptations are necessary to meet the dynamic requirements of pregnancy and support fetal development. Pregnancy is characterized by a high demand for both sodium and potassium. Recently there has been work in the field profiling the modifications of the renal tubules in pregnancy to meet these demands. The purpose of this review is to summarize these findings.
The work to date suggests an important role for the distal nephron in both the renal sodium and potassium reabsorption during pregnancy. There is strong evidence that renal sodium reabsorption is mediated by the epithelial sodium channel (ENaC). Whereas renal potassium reabsorption is mediated by upregulation of potassium retaining transporters (HKA2) and downregulation of potassium secreting channels (ROMK, BK).
Fetal growth restriction and hypertensive disorders of pregnancy including preeclampsia are marked by suboptimal maternal plasma volume expansion, which is determined by renal electrolyte handling. Therefore, understanding the physiologic demand for sodium and potassium in pregnancy and the adaptations required to support these needs is necessary for the effective treatment of diseased states of pregnancy.
在妊娠过程中，肾脏离子转运发生显著变化。这些适应性变化是满足妊娠期间动态需求并支持胎儿发育所必需的。妊娠的特点是对钠和钾的需求量都很高。最近，人们对满足这些需求的肾脏小管在妊娠过程中的变化进行了研究。本文的目的是总结这些发现。
迄今为止的研究工作表明，远曲小管在妊娠期间的肾脏钠和钾重吸收中起着重要作用。有强有力的证据表明，肾脏钠重吸收是由上皮钠通道（ENaC）介导的。而肾脏钾重吸收是通过上调钾保留转运体（HKA2）和下调钾分泌通道（ROMK、BK）来实现的。
胎儿生长受限和妊娠高血压疾病，包括子痫前期，其特征是母体血浆容量扩张不足，这取决于肾脏电解质的处理。因此，了解妊娠期间对钠和钾的生理需求以及支持这些需求所需的适应性变化，对于治疗妊娠疾病状态是必要的。
