Buser S, Hagmaier V, Locher J T, Mihatsch M, Rist M, Rutishauser G, Scheidegger A M, Städtler K, Schoenenberger G A
Curr Probl Clin Biochem. 1979(9):44-55.
Previously reported experiments with animals suggested that reduced renal arterial flow might be the actual cause for the pathogenicity of nephroptosis. Clinical studies now give evidence that measurements of urinary LDH may be a criterion equal to the isotope nephrogram (ING) in considering this disease. Patients with a "mobile" kidney verified by i.v. pyelography were examined by an ING and a 1-day test for urinary LDH. In accordance with periodic kidney displacement total urinary LDH activities were measured in a 8-h urine volume in the supine position and a 8-h urine volume in the erect position of the patients. Evaluations were all expressed as percentage increase of LDH activity of the patient in the erect versus supine position and correlated with his ING-pattern. Among 45 nephroptotic individuals 34 showed, in accordance with a pathological ING, a mean LDH increase of more than a 100%. Eleven individuals had normal INGs and less than 20% increase equal to a group of 16 normal controls. We postulated a 30% increase as the upper limit between normal and pathological urinary LDH. The percentage distribution of isoenzymes was also altered within the pathological LDH range: LDH-I, which increases in normal controls, now decreased in nephroptotic patients. LDH-IV and V, which decrease in controls, now increased. Homomeric isoenzymes obviously show reciprocal behavior. The degree of kidney descent in cm does not correlate with percentage increase of urinary LDH, i.e. it is not a criterion for pathogenicity. Biopsies taken during nephropexy revealed that from an anamnestic duration of 50 weeks onwards the kidney is significantly affected and tissue damages become evident. If patients were re-investigated after nephropexy they showed normal i.v. pyelograms and normal LDH and no longer had clinical symptoms.
先前报道的动物实验表明，肾动脉血流减少可能是肾下垂致病性的实际原因。临床研究现提供证据表明，在考虑这种疾病时，尿乳酸脱氢酶（LDH）的测量可能是与同位素肾图（ING）相当的一项标准。通过静脉肾盂造影证实有“可移动”肾脏的患者接受了ING检查和为期1天的尿LDH检测。根据肾脏的周期性移位，测量患者仰卧位8小时尿量和站立位8小时尿量中的总尿LDH活性。评估结果均表示为患者站立位与仰卧位LDH活性的百分比增加，并与他的ING模式相关。在45例肾下垂患者中，34例根据病理性ING显示，LDH平均增加超过100%。11例患者的ING正常，增加不到20%，与16例正常对照组成的一组相当。我们假定30%的增加为正常与病理性尿LDH之间的上限。在病理性LDH范围内，同工酶的百分比分布也发生了改变：在正常对照中增加的LDH-I，在肾下垂患者中现在减少了。在对照中减少的LDH-IV和LDH-V，现在增加了。同聚体同工酶显然表现出相反的行为。肾脏下降的厘米数与尿LDH的百分比增加无关，即它不是致病性的标准。肾固定术中获取的活检显示，从有症状的50周起，肾脏受到明显影响，组织损伤变得明显。如果患者在肾固定术后再次接受检查，他们的静脉肾盂造影正常，LDH正常，并且不再有临床症状。
