Myers B D, Hilberman M, Spencer R J, Jamison R L
Am J Med. 1982 Apr;72(4):642-9. doi: 10.1016/0002-9343(82)90475-2.
Glomerular and tubular function were evaluated in 30 non-oliguric patients with increasing azotemia following open heart surgery. Fractional clearances (theta) of test solutes relative to that of inulin were determined. In 16 patients, theta dextran (radius 22 to 30 A) exceeded unity, a finding attributed to inulin backleak through necrotic tubules. These patients were classified as having acute renal failure; 14 subsequently required dialysis. In the remaining patients (N = 14), theta dextran was normal. These patients were considered to have prerenal failure; all recovered spontaneously. clearance of inulin (Cin) was lower in acute renal failure than in prerenal failure (12 +/- 2 versus 18 +/- 2 ml/min/1.73 m2; p less than 0.025). The apparent difference in glomerular filtration rate when Cin is used as an index was abolished, however, when Cin in acute renal failure was corrected for tubule backleak of inulin. In acute renal failure, fractional clearance of p-aminohippurate (theta PAH) was 7.1 +/- 1.0, and fractional excretion of potassium (FEk) was 160 +/- 18 percent. These findings strongly suggest that secretory ability in both proximal and terminal tubule augments, respectively, is preserved in acute renal failure. Compared with prerenal failure, the urine-to-plasma inulin ratio was lower (U/Pin = 10 +/- 1 versus 25 +/- 4; p less than 0.005) and FENa was higher (FENa = 5.1 +/- 1.5 versus 0.5 +/- 1.0 percent; p less than 0.01) in acute renal failure.
对30例心脏直视手术后氮质血症逐渐加重的非少尿患者的肾小球和肾小管功能进行了评估。测定了试验溶质相对于菊粉的分数清除率（θ）。16例患者的θ右旋糖酐（半径22至30埃）超过1，这一发现归因于菊粉通过坏死肾小管的反流。这些患者被归类为急性肾衰竭；其中14例随后需要透析。其余患者（N = 14）的θ右旋糖酐正常。这些患者被认为有肾前性肾衰竭；所有患者均自发康复。急性肾衰竭患者的菊粉清除率（Cin）低于肾前性肾衰竭患者（12±2对18±2 ml/min/1.73 m2；p＜0.025）。然而，当对急性肾衰竭患者的Cin进行菊粉肾小管反流校正后，以Cin作为指标时肾小球滤过率的明显差异消失。在急性肾衰竭患者中，对氨基马尿酸的分数清除率（θPAH）为7.1±1.0，钾的分数排泄率（FEk）为160±18%。这些发现强烈提示急性肾衰竭时近端和远端肾小管的分泌能力分别得以保留。与肾前性肾衰竭相比，急性肾衰竭患者的尿/血浆菊粉比值较低（U/Pin = 10±1对25±4；p＜0.005），钠分数排泄率较高（FENa = 5.1±1.5对0.5±1.0%；p＜0.01）。
