Location AMC, Department of Internal Medicine, Section Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK.
Pediatr Nephrol. 2020 Aug;35(8):1373-1380. doi: 10.1007/s00467-019-04305-8. Epub 2019 Jul 30.
In recent times, the traditional nephrocentric, two-compartment model of body sodium has been challenged by long-term sodium balance studies and experimental work on the dermal interstitium and endothelial surface layer. In the new paradigm, sodium can be stored without commensurate water retention in the interstitium and endothelial surface layer, forming a dynamic third compartment for sodium. This has important implications for sodium homeostasis, osmoregulation and the hemodynamic response to salt intake. Sodium storage in the skin and endothelial surface layer may function as a buffer during periods of dietary depletion and excess, representing an extra-renal mechanism regulating body sodium and water. Interstitial sodium storage may also serve as a biomarker for sodium sensitivity and cardiovascular risk, as well as a target for hypertension treatment. Furthermore, sodium storage may explain the limitations of traditional techniques used to quantify sodium intake and determine infusion strategies for dysnatraemias. This review is aimed at outlining these new insights into sodium homeostasis, exploring their implications for clinical practice and potential areas for further research for paediatric and adult populations.
近年来，传统的以肾脏为中心的、两室模型的体钠模式受到长期钠平衡研究和皮肤间质及内皮表面层实验工作的挑战。在新的模式中，钠可以在间质和内皮表面层没有相应的水潴留的情况下储存，形成一个动态的第三个钠储存室。这对钠稳态、渗透压调节和盐摄入的血液动力学反应有重要影响。皮肤和内皮表面层的钠储存可能在饮食不足和过量的时期作为缓冲，代表一种调节体内钠和水的肾外机制。间质钠储存也可以作为钠敏感性和心血管风险的生物标志物，以及高血压治疗的靶点。此外，钠储存可以解释传统技术在量化钠摄入和确定电解质紊乱输注策略方面的局限性。本综述旨在概述这些对钠稳态的新见解，探讨其对临床实践的影响以及儿科和成人人群进一步研究的潜在领域。
