Wilcox C S
J Clin Invest. 1983 Mar;71(3):726-35. doi: 10.1172/jci110820.
Micropuncture studies have shown that glomerular filtration rate (GFR) falls in response to a rise in Na(+) or Cl(-) concentrations in the loop of Henle, whereas studies in isolated kidneys have shown that GFR falls in response to osmotic diuresis. To define the separate effects of an acute increase in plasma sodium (P(Na)), chloride (P(Cl)) or osmolality (P(osmol)), changes in renal blood flow (RBF) and GFR were measured during intrarenal infusions of hypertonic NaCl, NaHCO(3), Na acetate, dextrose, NH(4)Cl or NH(4)acetate to denervated kidneys. The infusions raised P(osmol) at the experimental kidney by 30-45 mosmol. RBF increased abruptly by 10-30% with all hypertonic infusions indicating that an acute increase in plasma tonicity causes renal vasodilatation. Renal vasodilatation persisted or increased further during infusion of dextrose, NaHCO(3) and Na acetate, but GFR was unchanged. In contrast, during infusion of the two Cl-containing solutions, vasodilatation was reversed after 1-5 min and RBF and GFR decreased (P < 0.01) below preinfusion levels. Prior salt depletion doubled the vasoconstriction seen with hypertonic NaCl infusions. Overall, changes in RBF were unrelated to changes in P(Na) or fractional Na or fluid reabsorption but correlated with changes in P(Cl) (r = -0.91) and fractional Cl(-) reabsorption (r = 0.94). The intrafemoral arterial infusion of the two Cl-containing solutions did not increase femoral vascular resistance. In conclusion, hyperchloremia produces a progressive renal vasoconstriction and fall in GFR that is independent of the renal nerves, is potentiated by prior salt depletion and is related to tubular Cl(-) reabsorption. Chloride-induced vasoconstriction appears specific for the renal vessels.
微穿刺研究表明,髓袢中Na⁺或Cl⁻浓度升高时,肾小球滤过率(GFR)会下降,而在离体肾脏中的研究表明,渗透性利尿时GFR也会下降。为了明确血浆钠(P(Na))、氯(P(Cl))或渗透压(P(osmol))急性升高的单独影响,在对去神经支配的肾脏进行肾内输注高渗NaCl、NaHCO₃、醋酸钠、葡萄糖、NH₄Cl或醋酸铵期间,测量了肾血流量(RBF)和GFR的变化。输注使实验肾脏的P(osmol)升高了30 - 45毫渗摩尔。所有高渗输注时RBF均突然增加10% - 30%,表明血浆张力急性升高会导致肾血管舒张。在输注葡萄糖、NaHCO₃和醋酸钠期间,肾血管舒张持续或进一步增强,但GFR未改变。相比之下,在输注两种含Cl⁻溶液期间,1 - 5分钟后血管舒张逆转,RBF和GFR下降(P < 0.01)至输注前水平以下。预先的盐缺失使高渗NaCl输注时的血管收缩加倍。总体而言,RBF的变化与P(Na)或钠分数或液体重吸收的变化无关,但与P(Cl)的变化相关(r = -0.91)以及Cl⁻分数重吸收的变化相关(r = 0.94)。股动脉内输注两种含Cl⁻溶液并未增加股血管阻力。总之,高氯血症会导致进行性肾血管收缩和GFR下降,这与肾神经无关,预先的盐缺失会增强这种作用,且与肾小管Cl⁻重吸收有关。氯离子诱导的血管收缩似乎对肾血管具有特异性。