Auguste L J, Stone A M, Wise L
Ann Surg. 1980 Jul;192(1):65-8. doi: 10.1097/00000658-198007000-00011.
The renal response to sepsis results in increased renal blood flow, decreased renal vascular resistance, polyuric renal failure and a change in intracortical renal blood distribution. Prior reports used whole animal preparations, where the effects of sepsis on other organs may have led to systemic vasoactive changes altering the experimental model. To elucidate the direct effect of gram negative bacteremia on the kidney, intracortical hemodynamics and urinary flow were investigated using isolated canine kidneys perfused with a nonpulsatile pump oxygenator primed with modified dog plasma. Bacteremia was produced by 2.5 x 10(11) live Escherichia coli organisms infused directly into the perfusate. Intracortical blood flow distribution was measured by radioactive microsphere trapping using 15 microns diameter plastic radioactive microspheres. Urine flow increased 157% (p less than 0.05) following E. coli bacteremia while intracortical blood distribution was unchanged. The polyuric renal failure of sepsis is therefore, a direct result of bacteremia and not secondary to a change in intracortical flow as previously reported. The changes in intracortical blood distribution reported previously in sepsis using intact animal models probably reflect the renal response to release of vasoactive compounds originating in other organs rather than an intrinsic renal reaction to bacteremia.
肾脏对脓毒症的反应会导致肾血流量增加、肾血管阻力降低、多尿性肾衰竭以及肾皮质内血液分布改变。先前的报告使用的是完整动物模型，脓毒症对其他器官的影响可能导致全身血管活性变化，从而改变实验模型。为了阐明革兰氏阴性菌血症对肾脏的直接影响，我们使用非搏动性泵氧合器灌注经改良的犬血浆，对离体犬肾进行研究，观察其肾皮质内血流动力学和尿流情况。通过将2.5×10¹¹ 个活的大肠杆菌直接注入灌注液来制造菌血症。使用直径为15微米的塑料放射性微球通过放射性微球捕获法测量肾皮质内血流分布。大肠杆菌菌血症后尿流增加了157%（p<0.05），而肾皮质内血液分布未改变。因此，脓毒症的多尿性肾衰竭是菌血症的直接结果，而非如先前报道的那样继发于肾皮质血流的改变。先前在完整动物模型中报道的脓毒症时肾皮质内血液分布的变化，可能反映了肾脏对源自其他器官的血管活性化合物释放的反应，而非肾脏对菌血症的内在反应。
