Yarger W E, Aynedjian H S, Bank N
J Clin Invest. 1972 Mar;51(3):625-37. doi: 10.1172/JCI106852.
In order to investigate the syndrome of postobstructive diuresis, clearance and micropuncture studies were carried out in rats after relief of 24 hr of bilateral (BUL) or unilateral (UUL) ureteral ligation. In rats with BUL, a striking diuresis and natriuresis occurred when the obstruction to one kidney (the experimental kidney) was relieved. The results were not influenced by administration of vasopressin or d-aldosterone. Whole kidney clearances of inulin and p-aminohippuric acid (PAH) in the experimental kidney were reduced to 10% and 20% of normal, respectively. Superficial nephron inulin and PAH clearances were also reduced, but only to 40% and 45%, respectively. These findings suggest a heterogeneity of nephron function in which deep nephrons were functioning poorly or not at all. To investigate the site of impaired tubular reabsorption in the surface nephrons, absolute and fractional water reabsorption was measured. Absolute reabsorption was found to be decreased all along the nephron. Fractional reabsorption in proximal tubules was normal, as indicated by an average endproximal tubular fluid per plasma inulin (TF/P(In)) of 2.16 vs. 2.30 in controls. TF/P(In) was markedly decreased in distal tubules (2.91 vs. 8.02) and final urine (5.56 vs. 263). These observations indicate that the major sites of impaired sodium reabsorption leading to the diuresis were beyond the proximal tubule.Rats with 24 hr of UUL did not demonstrate a comparable natriuresis or diuresis either spontaneously when the obstruction was relieved or after i.v. infusion of urea. A major difference between the BUL and UUL rats was that prerelease intrarenal hydrostatic pressure was markedly elevated (30.1 mm Hg) in the former but was below normal free-flow values (9.2 mm Hg) in the latter. Thus, elevation of intrarenal pressure during the period of obstruction may be causally related to the natriuresis and diuresis which occurs after the obstruction is relieved.
为了研究梗阻后利尿综合征,在双侧(BUL)或单侧(UUL)输尿管结扎24小时后解除梗阻的大鼠中进行了清除率和微穿刺研究。在BUL大鼠中,当一侧肾脏(实验肾)的梗阻解除时,出现了显著的利尿和利钠现象。这些结果不受血管加压素或d-醛固酮给药的影响。实验肾中菊粉和对氨基马尿酸(PAH)的全肾清除率分别降至正常的10%和20%。浅表肾单位菊粉和PAH清除率也降低,但仅分别降至40%和45%。这些发现提示肾单位功能存在异质性,其中深部肾单位功能不良或完全无功能。为了研究浅表肾单位中肾小管重吸收受损的部位,测量了绝对和分数水重吸收。发现沿肾单位的绝对重吸收均降低。近端小管的分数重吸收正常,对照组近端小管终末管液与血浆菊粉的平均比值(TF/P(In))为2.16,而实验组为2.30。远端小管(2.91对8.02)和终尿(5.56对263)中的TF/P(In)显著降低。这些观察结果表明,导致利尿的钠重吸收受损的主要部位在近端小管之外。UUL 24小时的大鼠在梗阻解除后或静脉输注尿素后,无论是自发的还是诱导的,都没有表现出类似的利钠或利尿现象。BUL和UUL大鼠之间的一个主要区别是,前者梗阻前肾内静水压力显著升高(30.1 mmHg),而后者低于正常自由流值(9.2 mmHg)。因此,梗阻期间肾内压力的升高可能与梗阻解除后发生的利钠和利尿有因果关系。