Winetz J A, Robertson C R, Golbetz H V, Carrie B J, Salyer W R, Myers B D
Am J Kidney Dis. 1981 Sep;1(2):91-8. doi: 10.1016/s0272-6386(81)80035-2.
Glomerular barrier function was evaluated in 12 healthy human volunteers and in 16 proteinuric patients in whom the nephrotic syndrome was associated with alteration of glomerular epithelial cells alone (minimal change nephropathy [MCN]) or in combination with focal glomerular sclerosis (FGS). We determined the glomerular sieving coefficient for each of nine narrow dextran fractions (Einstein Stoke radius [ESR] = 30 to 46 A), and directly measured, or indirectly estimated, values for the determinants of glomerular ultrafiltration. These quantities were then subjected to analysis based on an hydrodynamic theory of solute transport through an isoporous membrane. The results indicate that relative to normal subjects, effective pore radius is reduced from 59 to 55 and 53 A in McN and FGS, respectively; while the ratio, pore area to pore length (a measure of pore density) is correspondingly reduced from 21.7 X 10(6) to 10.1 X 10(6) and 4.7 X 10(6) cm. respectively, We suggest that collapse of the anionic glomerular membrane matrix in these proteinuric disorders may lead to pore shrinkage and reduced pore density, but that reduced electrostatic repulsion of anionic albumin (ESR = 36 A) facilitates its permeation into Bowman's space. The qualitatively similar disorder of glomerular barrier function in MCN and FGS is consistent with a unitary pathogenesis, but may represent a nonspecific response to depletion of glomerular polyanion.
在12名健康人类志愿者以及16名蛋白尿患者中评估了肾小球屏障功能，这些蛋白尿患者的肾病综合征单独与肾小球上皮细胞改变相关（微小病变肾病[MCN]），或与局灶性肾小球硬化（FGS）合并出现。我们测定了9种窄分子量葡聚糖组分（爱因斯坦斯托克斯半径[ESR]=30至46埃）中每种组分的肾小球滤过系数，并直接测量或间接估算了肾小球超滤决定因素的值。然后根据溶质通过等孔膜传输的流体动力学理论对这些量进行分析。结果表明，相对于正常受试者，MCN和FGS中有效孔径分别从59埃减小至55埃和53埃；而孔面积与孔长度之比（孔隙密度的一种度量）相应地分别从21.7×10⁶减小至10.1×10⁶和4.7×10⁶厘米。我们认为，这些蛋白尿性疾病中阴离子性肾小球膜基质的塌陷可能导致孔收缩和孔隙密度降低，但阴离子白蛋白（ESR = 36埃）静电排斥力的降低促进了其渗透进入鲍曼间隙。MCN和FGS中肾小球屏障功能在性质上相似的紊乱与单一发病机制一致，但可能代表对肾小球多阴离子耗竭的非特异性反应。
