Zager R A, Baltes L A
J Lab Clin Med. 1984 Apr;103(4):511-23.
The purpose of this study was to determine whether progressive renal insufficiency alters the resistance of residual nephrons to ischemic acute renal failure. Normal rats were subjected to either sham nephrectomy (2K rats; n = 7); right nephrectomy (1K rats; n = 7); or right nephrectomy plus variable degrees of ablation (one third to three fourths) of the left kidney (less than 1K rats; n = 10). Nine additional 1K rats received varying doses of nephrotoxic antiserum (NTX rats). One week later, glomerular filtration rate was determined and then ischemic acute renal failure was induced in all remaining renal tissues (25-minute renal artery occlusion). After ischemia, glomerular filtration rate was measured for 160 minutes, renal blood flow was determined, and the kidneys were fixed by in vivo perfusion. The 2K and non-NTX 1K rats had comparable percent recoveries of glomerular filtration rate (22% +/- 5%; 23% +/- 5%) despite a 64% higher renal blood flow for the 1K group. The less than 1K rats had a significantly higher percent recovery of glomerular filtration rate (53% +/- 11%; p less than 0.01), their absolute postischemic glomerular filtration rates were comparable to those of the 2K rats, and they showed significantly less morphologic evidence of ischemic renal injury (p less than 0.01). Both NTX and non-NTX rats with renal ablation showed a strong inverse correlation between baseline glomerular filtration rate and log percent filtration rate recovery (r = -0.75, p less than 0.02; r = -0.83, p less than 0.001, respectively). The less than 1K rats (n = 6) subjected to ischemia 1 day (rather than 1 week) after renal ablation were not protected against acute renal failure (18 +/- 5%) filtration rate recovery) despite renal blood flow comparable with that in other less than 1K rats. In conclusion, progressive renal insufficiency can confer increasing protection on residual nephrons against ischemic acute renal failure once a threshold reduction in functioning renal mass is achieved (greater than 1K). The present data suggest that this protection is not a result of compensatory renal hypertrophy, increased blood flow, or increased solute excretion per nephron, but probably arises as a delayed consequence of renal insufficiency-induced alterations of the internal milieu.
本研究的目的是确定进行性肾功能不全是否会改变残余肾单位对缺血性急性肾衰竭的抵抗力。将正常大鼠分为三组:假手术切除组(2K大鼠;n = 7);右肾切除组(1K大鼠;n = 7);或右肾切除加左肾不同程度切除(三分之一至四分之三)组(小于1K大鼠;n = 10)。另外9只1K大鼠接受不同剂量的肾毒性抗血清(NTX大鼠)。一周后,测定肾小球滤过率,然后对所有剩余肾组织诱导缺血性急性肾衰竭(肾动脉阻断25分钟)。缺血后,测量肾小球滤过率160分钟,测定肾血流量,并通过体内灌注固定肾脏。2K和非NTX 1K大鼠的肾小球滤过率恢复百分比相当(22%±5%;23%±5%),尽管1K组的肾血流量高64%。小于1K大鼠的肾小球滤过率恢复百分比显著更高(53%±11%;p<0.01),它们缺血后的绝对肾小球滤过率与2K大鼠相当,且缺血性肾损伤的形态学证据显著更少(p<0.01)。肾切除的NTX和非NTX大鼠的基线肾小球滤过率与滤过率恢复对数百分比之间均呈强负相关(r = -0.75,p<0.02;r = -0.83,p<0.001)。肾切除后1天(而非1周)进行缺血的小于1K大鼠(n = 6)尽管肾血流量与其他小于1K大鼠相当,但未受到急性肾衰竭的保护(滤过率恢复为18±5%)。总之,一旦功能性肾质量达到阈值降低(大于1K),进行性肾功能不全可对残余肾单位提供越来越强的保护,使其免受缺血性急性肾衰竭。目前的数据表明,这种保护不是肾代偿性肥大、血流量增加或单个肾单位溶质排泄增加的结果,而是肾功能不全引起的内环境改变的延迟后果。