Levy M, Wexler M J
J Lab Clin Med. 1978 Mar;91(3):520-36.
Renal handling of sodium was studied in five dogs where an end-to-side portacaval fistula was constructed prior to the induction of cirrhosis with DMN. Such a model permits the effects of cirrhosis to be studied separately from the consequences of portal hypertension. Three control animals without cirrhosis maintained normal liver and kidney function and remained in sodium balance for as long as 8 weeks following surgery. In the five cirrhotic dogs, urinary sodium retention preceded ascites formation and was independent of hyperaldosteronism, hypoalbuminemia, hepatic ischemia, or decreased renal perfusion. Portal venous pressure remained normal in all cirrhotic dogs, and the splanchnic area remained free of venous collaterals. Plasma volume expansion also preceded ascites formation, and this variable increased by 8.4% (p less than 0.05) following 6 days of sodium retention. These temporal relationships between sodium retention, expanded plasma volume, and ascites formation are similar to those observed in ordinary cirrhotic dogs previously studied in this laboratory. Total plasma volume increased by 13.2% (p less than 0.05) when measured during the ascitic phase of cirrhosis. However, when the splanchnic and nonsplanchnic ("effective") components of plasma volume were measured by an exclusion technique, the ratio of these components to total plasma volume was not different from that observed in normal dogs. Thus no preferential consignment of retained salt and water had occurred. We conclude that urinary sodium retention in cirrhotic dogs occurs independently of portal hypertension or augmented splanchnic vascular capacity and is associated with expansion of the effective plasma volume, even though ascites is present.
在五只狗身上研究了钠的肾脏处理情况,这些狗在用二甲基亚硝胺诱导肝硬化之前构建了端侧门腔静脉瘘。这样的模型允许将肝硬化的影响与门静脉高压的后果分开研究。三只无肝硬化的对照动物肝功能和肾功能正常,术后长达8周保持钠平衡。在五只肝硬化狗中,尿钠潴留先于腹水形成,且与醛固酮增多症、低白蛋白血症、肝缺血或肾灌注减少无关。所有肝硬化狗的门静脉压力均保持正常,内脏区域无静脉侧支循环。血浆容量扩张也先于腹水形成,在钠潴留6天后,这一变量增加了8.4%(p<0.05)。钠潴留、血浆容量扩张和腹水形成之间的这些时间关系与本实验室之前研究的普通肝硬化狗中观察到的相似。在肝硬化腹水期测量时,总血浆容量增加了13.2%(p<0.05)。然而,当通过排除技术测量血浆容量的内脏和非内脏(“有效”)成分时,这些成分与总血浆容量的比值与正常狗中观察到的无差异。因此,没有发生保留盐和水的优先分配。我们得出结论,肝硬化狗的尿钠潴留独立于门静脉高压或内脏血管容量增加而发生,并且与有效血浆容量扩张有关,即使存在腹水。