Colome M F, Boudailliez B, Renaud H, Makdassi R, el Esper N, Grégoire I, Piussan C, Fournier A
Service de Néphrologie-Médecine Interne, CHU Amiens.
Nephrologie. 1987;8(4):197-204.
After a protein load, the glomerular filtration increases to a maximum called maximal filtration capacity (MFC). The difference of this value with that observed in the fasting state defines the functional renal reserve (FRR). Fifty oral protein loads have been performed in 16 controls (13 adults and 3 children) and 31 patients with kidney disease or hypertension (22 adults, 9 children, 3 tests being performed twice). The load consisted in the adults of 80 g of various proteins. In the children the load consisted in the 100% of the protein intake recommended of the whole day. The urinary samples were made hourly during the 5 hours following the beginning of the meal. The MFC was not always observed during the 2 hours following the end of the meal. However the mean of the clearances measured during these 2 hours allowed an acceptable evaluation of the FRR in 42 out of 50 cases and had the advantage to reduce the errors linked to incomplete bladder voiding. In the adult controls the mean of hourly determined MFC is 156 +/- 27 ml/min, the mean of the clearances measured on the 2 hours following the meal is 136 +/- 21 ml/min and the fasting clearance 96 +/- 22 ml/min. The FRR is null in all patients with a nephropathy with a fasting clearance below 40 ml/min. It is modest or null in patients with acquired or congenital solitary kidney. Three out of five patients with proteinuria have MFC and FRR higher than the mean of the patients with comparable fasting clearances but without proteinuria suggesting that proteinuria is associated with a hyperfiltration state.
摄入蛋白质后，肾小球滤过率会增加至最大值，即最大滤过能力（MFC）。该值与空腹状态下观察到的值之差定义为功能性肾储备（FRR）。对16名对照者（13名成人和3名儿童）以及31名患有肾脏疾病或高血压的患者（22名成人，9名儿童，3次测试重复进行）进行了50次口服蛋白质负荷试验。成人的负荷量为80克各种蛋白质。儿童的负荷量为全天推荐蛋白质摄入量的100%。在进食开始后的5小时内，每小时采集尿液样本。在进食结束后的2小时内并非总能观察到MFC。然而，在这2小时内测得的清除率平均值在50例中有42例能够对FRR进行可接受的评估，其优点是减少了与膀胱排空不完全相关的误差。在成年对照组中，每小时测定的MFC平均值为156±27毫升/分钟，进食后2小时测得的清除率平均值为136±21毫升/分钟，空腹清除率为96±22毫升/分钟。所有空腹清除率低于40毫升/分钟的肾病患者的FRR均为零。在获得性或先天性孤立肾患者中，FRR适度或为零。五分之三的蛋白尿患者的MFC和FRR高于空腹清除率相当但无蛋白尿患者的平均值，这表明蛋白尿与高滤过状态有关。
