Shapiro M D, Nicholls K M, Groves B M, Schrier R W
Am J Kidney Dis. 1986 Aug;8(2):81-7. doi: 10.1016/s0272-6386(86)80117-2.
Hemodynamic and hormonal factors were monitored in nine patients with nephrotic syndrome who were evaluated relative to their capacity to excrete a 20-mL/kg water load (normal greater than 80%). In five "nonexcretor" patients (37% of water load excreted in five hours), as compared to four normal excretors (105% of water load excreted in five hours; P less than .01 v nonexcretors), neither BP (131/88 v 119/79 mm Hg), pulse (74 v 77 beats/min), cardiac index (3.7 v 3.1 L/min/m2), pulmonary wedge pressure (9.3 v 7.3 mm Hg), systemic vascular resistance (1537 v 1254 dynes-sec-cm-5), nor plasma volume (41.3 v 40.1 mL/kg) were different. Similarly, plasma renin activity (2.6 v 3.7 ng/mL/h), plasma aldosterone (12 v 10.9 ng/dL), and plasma norepinephrine (403 v 312 pg/mL) were not different between nonexcretor v excretor patients with nephrotic syndrome. Plasma vasopressin concentrations were also similar both before (3.1 +/- 0.8 v 2.4 +/- 1.2 pg/mL) and during the water load (0.9 +/- 0.3 v 1.0 +/- 0.4 pg/mL). Inulin clearances, however, were lower in the nonexcretor v the excretor nephrotic patients (37 v 78 mL/min/1.73 m2; P less than .02) and correlated with water excretion (r = .68; P less than .05). Head-out water immersion increased sodium (40 to 110 microEq/min; P less than .01) and water excretion (37% to 82%; P less than .025) in the nonexcretors; the improvement correlated with the increase in inulin clearance during immersion (r = .70; P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)
对9名肾病综合征患者的血流动力学和激素因素进行了监测，根据他们排泄20毫升/千克水负荷的能力进行评估（正常情况下大于80%）。在5名“无排泄者”患者中（5小时内排泄的水负荷为37%），与4名正常排泄者（5小时内排泄的水负荷为105%；与无排泄者相比P<0.01）相比，血压（131/88对119/79毫米汞柱）、脉搏（74对77次/分钟）、心脏指数（3.7对3.1升/分钟/平方米）、肺楔压（9.3对7.3毫米汞柱）、全身血管阻力（1537对1254达因-秒-厘米⁻⁵）以及血浆容量（41.3对40.1毫升/千克）均无差异。同样，肾病综合征的无排泄者与排泄者患者之间，血浆肾素活性（2.6对3.7纳克/毫升/小时）、血浆醛固酮（12对10.9纳克/分升）和血浆去甲肾上腺素（403对312皮克/毫升）也没有差异。水负荷前（3.1±0.8对2.4±1.2皮克/毫升）和水负荷期间（0.9±0.3对1.0±0.4皮克/毫升）血浆血管加压素浓度也相似。然而，无排泄者肾病患者的菊粉清除率低于排泄者肾病患者（37对78毫升/分钟/1.73平方米；P<0.02），且与水排泄相关（r=0.68；P<0.05）。头低位水浸使无排泄者的钠排泄增加（40至110微当量/分钟；P<0.01）和水排泄增加（37%至82%；P<0.025）；这种改善与浸浴期间菊粉清除率的增加相关（r=0.70；P<0.05）。（摘要截短至250字）
