Hené R J, Koomans H A, Boer P, Dorhout Mees E J
Am J Nephrol. 1987;7(1):33-7. doi: 10.1159/000167426.
We investigated the effect of aldosterone infusion (0.5 mg/h for 6 h) on electrolyte excretion in 11 patients with severe renal insufficiency (creatinine clearance 6-20 ml/min), with normal or elevated serum potassium levels and a wide range of plasma aldosterone levels, and compared the data with those obtained in 7 healthy subjects. The studies were done under conditions of fixed sodium and potassium intake. In the normal subjects, aldosterone infusion caused a significant rise in potassium excretion and a significant fall in sodium and chloride excretion (p less than 0.01). In 1 patient with a high plasma aldosterone, virtually no response occurred to the aldosterone infusion. In the others, the increase in potassium excretion and reduction in chloride excretion were not different from the changes observed in the normals, but the fall in sodium excretion was less due to a higher urinary sodium before infusion in the normals (p less than 0.05). Fractional electrolyte excretions as well as the changes in fractional excretion by aldosterone were larger in the patients (p less than 0.05). Apparently, the renal tubules of patients with chronic renal failure are still responsive to maximal stimulation with aldosterone, in spite of their basically elevated fractional electrolyte output. These findings suggest that, with some exceptions, the hyperkalemia in patients with chronic renal failure is in part due to relative hypoaldosteronism.
我们研究了醛固酮输注（0.5毫克/小时，共6小时）对11例严重肾功能不全患者（肌酐清除率6 - 20毫升/分钟）电解质排泄的影响，这些患者血清钾水平正常或升高，血浆醛固酮水平范围较广，并将数据与7名健康受试者的数据进行比较。研究在固定钠和钾摄入量的条件下进行。在正常受试者中，醛固酮输注导致钾排泄显著增加，钠和氯排泄显著减少（p小于0.01）。1例血浆醛固酮水平高的患者对醛固酮输注几乎无反应。在其他患者中，钾排泄的增加和氯排泄的减少与正常受试者观察到的变化无差异，但由于正常受试者输注前尿钠较高，钠排泄的减少较少（p小于0.05）。患者的电解质排泄分数以及醛固酮引起的排泄分数变化更大（p小于0.05）。显然，慢性肾功能衰竭患者的肾小管尽管其基本排泄分数升高，但仍对醛固酮的最大刺激有反应。这些发现表明，除了一些例外情况，慢性肾功能衰竭患者的高钾血症部分归因于相对醛固酮缺乏。
