Pruszczynski W, Drieu L, Cabrol C, Rondeau E, Ardaillou R
INSERM Research Unit 64, Tenon Hospital, Paris, France.
Clin Nephrol. 1987 Aug;28(2):65-72.
The renal excretion of an intravenous sodium load by ten heart-transplant recipients with (five patients) or without (five patients) moderate renal failure was compared with the results obtained in two matched control groups of ten kidney-transplant recipients with similar renal function. All patients were treated with prednisone and cyclosporine except, for the latter treatment, the kidney-transplant recipients without renal failure. A supplementary control group of five healthy subjects who did not receive any treatment was also included in the study. Fractional sodium and osmolal clearances were greater in heart-transplant than in kidney-transplant recipients for both the patients with and the patients without renal failure. These two parameters were also greater in heart-transplant recipients without renal failure than in healthy subjects. Free water clearance was smaller in the heart-transplant recipients than in the corresponding control patients. Fractional potassium clearance was not different from group to group. These results demonstrate that heart-transplant recipients excrete a greater fraction of the filtered sodium load than their controls. This increased fractional excretion of sodium cannot be attributed to the cyclosporine treatment or the moderate chronic renal failure which both have been taken into account in the comparisons. The unchanged blood pressure during the saline load and the high or normal plasma renin activity levels in the heart-transplant recipients make it also unlikely that the exaggerated natriuresis was the consequence of the higher blood pressure observed in these patients. The chronic cardiac denervation which is the consequence of surgery in these patients could play a role in the mechanism of the saline diuresis.
将十名心脏移植受者（其中五名患者有中度肾衰竭，另外五名患者无肾衰竭）静脉注射钠负荷后的肾脏排泄情况，与两组各十名肾功能相似的匹配肾脏移植受者对照组的结果进行了比较。除了无肾衰竭的肾脏移植受者不进行环孢素治疗外，所有患者均接受泼尼松和环孢素治疗。该研究还纳入了一个由五名未接受任何治疗的健康受试者组成的补充对照组。有肾衰竭和无肾衰竭的心脏移植受者的钠分数清除率和渗透清除率均高于肾脏移植受者。无肾衰竭的心脏移植受者的这两个参数也高于健康受试者。心脏移植受者的自由水清除率低于相应的对照患者。钾分数清除率在各组之间没有差异。这些结果表明，心脏移植受者排出的滤过钠负荷比例高于其对照组。钠分数排泄增加不能归因于环孢素治疗或中度慢性肾衰竭，在比较中已考虑到这两个因素均存在。心脏移植受者在盐水负荷期间血压未改变，且血浆肾素活性水平高或正常，这也使得这些患者中观察到的钠利尿增加不太可能是血压升高的结果。这些患者手术导致的慢性心脏去神经支配可能在盐水利尿机制中起作用。
