Phelps Kenneth R, Gosmanova Elvira O
Clin Nephrol. 2020 Jul;94(1):43-49. doi: 10.5414/CN110056.
The purpose of this NephEd contribution is to introduce a generic method for analyzing plasma concentrations ([]). The method is applicable to substances that are filtered by glomeruli, reabsorbed or secreted by tubules, and excreted in urine. The equality from which the method follows states that the filtration rate of substance is the sum of excretion and net reabsorption rates of (F = E + TR). If is completely ultrafilterable, F = GFR[], and [] = E/GFR + TR/GFR. If creatinine clearance (C) is substituted for GFR, E/C simplifies to [][cr]/[cr], which can be calculated from measurements in simultaneous aliquots of serum and urine. TR/C is then deduced as [] - E/C. The ratios E/C and TR/C - the of [] - quantify the amounts of excreted and reabsorbed per volume of filtrate. If [] is abnormal, the generic method identifies which of the determinants is creating the abnormality. If [] is normal despite disruptive circumstances, e.g., a reduced GFR, the method elucidates the preservation of normalcy. Herein, we develop these concepts and illustrate their practical utility.
本NephEd文稿的目的是介绍一种分析血浆浓度([])的通用方法。该方法适用于经肾小球滤过、肾小管重吸收或分泌并经尿液排泄的物质。该方法所依据的等式表明,物质的滤过率等于其排泄率与净重吸收率之和(F = E + TR)。如果物质可完全超滤,则F = GFR[],且[] = E/GFR + TR/GFR。若用肌酐清除率(C)代替GFR,则E/C简化为[][cr]/[cr],可通过同时测定血清和尿液等分试样来计算。然后可推导出TR/C为[] - E/C。E/C和TR/C比值(即[]的排泄分数和重吸收分数)可量化每单位滤液中排泄和重吸收的物质量。如果[]异常,该通用方法可确定是哪个决定因素导致了异常。如果在诸如GFR降低等干扰情况下[]仍正常,该方法可阐明维持正常的机制。在此,我们阐述这些概念并说明其实际应用。