Myers B D, Miller D C, Mehigan J T, Olcott C O, Golbetz H, Robertson C R, Derby G, Spencer R, Friedman S
J Clin Invest. 1984 Feb;73(2):329-41. doi: 10.1172/JCI111217.
The effects of total renal ischemia (TRI) of 15-87 min duration due to suprarenal clamping of the aorta were studied in 15 mannitol-treated patients undergoing abdominal aortic surgery. 15 patients undergoing similar surgery but requiring only infrarenal clamping served as controls. 1-2 h following TRI, GFR was reduced to only 39% of that in controls, 23 +/- 5 vs. 59 +/- 7 ml/min (P less than 0.001). This could not be ascribed to impaired renal plasma flow (RPF), which was mildly reduced to 331 +/- 71 and was not different from the value in controls, 407 +/- 66 ml/min. However, impaired PAH extraction (43 +/- 7%) and isosthenuria, not present in controls, suggest a primary role for tubular injury in lowering GFR at this time. 24 h following TRI, the GFR remained depressed below controls, 45 +/- 8 vs. 84 +/- 8 ml/min (P less than 0.005), while the transglomerular sieving of neutral dextrans was significantly enhanced (radius interval, 24-40 A). A theoretical analysis of transcapillary solute exchange revealed that these findings could be largely explained by a selective reduction of either RPF (-61%) or of transmembrane hydraulic pressure difference (-18%) below control values. Alternately, a combination of these two factors with changes of smaller magnitude could explain the findings. In contrast, a selective increase in oncotic pressure or decrease of the glomerular ultrafiltration coefficient could be excluded as a cause of hypofiltration 24 h after TRI. These observations lead us to suggest that the transient azotemia observed following TRI is due to a self-limited injury to the nephron that is identical to that seen in overt and sustained forms of acute renal failure.
对15例接受腹部主动脉手术且用甘露醇治疗的患者，研究了因主动脉肾上腺上方钳夹导致的持续15 - 87分钟的完全性肾缺血（TRI）的影响。15例接受类似手术但仅需肾下钳夹的患者作为对照。TRI后1 - 2小时，肾小球滤过率（GFR）降至对照组的39%，分别为23±5与59±7 ml/分钟（P＜0.001）。这不能归因于肾血浆流量（RPF）受损，其轻度降至331±71，与对照组的值407±66 ml/分钟无差异。然而，对氨基马尿酸（PAH）摄取受损（43±7%）以及对照组不存在的等渗尿，提示此时肾小管损伤在降低GFR中起主要作用。TRI后24小时，GFR仍低于对照组，分别为45±8与84±8 ml/分钟（P＜0.005），而中性葡聚糖的跨肾小球筛分显著增强（半径区间，24 - 40 Å）。对跨毛细血管溶质交换的理论分析表明，这些发现很大程度上可由RPF（-61%）或跨膜液压差（-18%）选择性降至对照值以下来解释。或者，这两个因素与较小幅度变化的组合也可解释这些发现。相反，可排除TRI后24小时滤过减少的原因是胶体渗透压选择性增加或肾小球超滤系数降低。这些观察结果使我们认为，TRI后观察到的短暂性氮质血症是由于肾单位的自限性损伤，这与明显和持续性急性肾衰竭中所见的损伤相同。
