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缺氧对肾脏水排泄的作用机制。

Mechanism of effect of hypoxia on renal water excretion.

作者信息

Anderson R J, Pluss R G, Berns A S, Jackson J T, Arnold P E, Schrier R W, McDonald K E

出版信息

J Clin Invest. 1978 Oct;62(4):769-77. doi: 10.1172/JCI109188.

Abstract

The effect of lowering the pressure of oxygen from 80 to 34 mm Hg was examined in anesthetized dogs that were undergoing a water diuresis. This degree of hypoxia was associated with an antidiuresis as urine osmolality (Uosm) increased from 107 to 316 mosmol/kg H(2)O (P < 0.001) and plasma arginine vasopressin increased from 0.06 to 7.5 muU/ml, (P < 0.05). However, hypoxia was not associated with significant changes in cardiac output (CO, from 4.2 to 4.7 liters/ min), mean arterial pressure (MAP, from 143 to 149 mm Hg), glomerular filtration rate (GFR, from 46 to 42 ml/min), solute excretion rate (SV, from 302 to 297 mosmol/min), or filtration fraction (from 0.26 to 0.27, NS). Hypoxia was associated with an increase in renal vascular resistance (from 0.49 to 0.58 mm Hg/ml per min, P < 0.01). The magnitude of hypoxia-induced antidiuresis was the same in innervated kidneys and denervated kidneys. To further examine the role of vasopressin in this antidiuresis, hypoxia was induced in hypophysectomized animals. The effect of hypoxia on CO, MAP, GFR, SV, and renal blood flow in hypophysectomized animals was the same as in intact animals. In contrast to intact animals, however, hypoxia did not induce a significant antidiuresis in hypophysectomized animals (Uosm from 72 to 82 mosmol/kg H(2)O). To delineate the afferent pathway for hypoxia-stimulated vasopressin release, hypoxia was induced in dogs with either chemo- or baroreceptor denervation. The effect of hypoxia on CO, MAP, GFR, SV, and renal blood flow in the denervated animals was the same as in nondenervated animals. Hypoxia resulted in an antidiuresis in chemoreceptor (Uosm from 113 to 357 mosmol/kg H(2)O, P < 0.001) but not in baroreceptor (Uosm from 116 to 138 mosmol/kg H(2)O, NS) denervated animals. To determine if hypoxia alters renal response to vasopressin, exogenous vasopressin was administered to normoxic and hypoxic groups of dogs. The antidiuretic effect of vasopressin was no different in these two groups. These results demonstrate that hypoxia induces an antidiuresis which is independent of alterations in CO, MAP, SV, filtration fraction, renal nerves, or renal response to vasopressin and occurs through baroreceptor-mediated vasopressin release. The nature of the baroreceptor stimulation remains to be elucidated.

摘要

在进行水利尿的麻醉犬中,研究了将氧分压从80毫米汞柱降至34毫米汞柱的效果。这种程度的低氧血症与抗利尿作用相关,因为尿渗透压(Uosm)从107毫摩尔/千克H₂O增加到316毫摩尔/千克H₂O(P < 0.001),血浆精氨酸血管加压素从0.06微单位/毫升增加到7.5微单位/毫升(P < 0.05)。然而,低氧血症与心输出量(CO,从4.2升/分钟增加到4.7升/分钟)、平均动脉压(MAP,从143毫米汞柱增加到149毫米汞柱)、肾小球滤过率(GFR,从46毫升/分钟降低到42毫升/分钟)、溶质排泄率(SV,从302毫摩尔/分钟降低到297毫摩尔/分钟)或滤过分数(从0.26增加到0.27,无显著性差异)的显著变化无关。低氧血症与肾血管阻力增加相关(从0.49毫米汞柱/毫升每分钟增加到0.58毫米汞柱/毫升每分钟,P < 0.01)。低氧血症诱导的抗利尿作用在有神经支配的肾脏和去神经支配的肾脏中程度相同。为了进一步研究血管加压素在这种抗利尿作用中的作用,对垂体切除的动物诱导低氧血症。低氧血症对垂体切除动物的CO、MAP、GFR、SV和肾血流量的影响与完整动物相同。然而,与完整动物不同的是,低氧血症在垂体切除的动物中并未诱导出显著的抗利尿作用(Uosm从72毫摩尔/千克H₂O增加到82毫摩尔/千克H₂O)。为了确定低氧血症刺激血管加压素释放的传入途径,对化学感受器或压力感受器去神经支配的犬诱导低氧血症。低氧血症对去神经支配动物的CO、MAP、GFR、SV和肾血流量的影响与未去神经支配的动物相同。低氧血症在化学感受器去神经支配的动物中导致抗利尿作用(Uosm从113毫摩尔/千克H₂O增加到357毫摩尔/千克H₂O,P < 0.001),但在压力感受器去神经支配的动物中未导致抗利尿作用(Uosm从116毫摩尔/千克H₂O增加到138毫摩尔/千克H₂O,无显著性差异)。为了确定低氧血症是否改变肾脏对血管加压素的反应,对常氧和低氧两组犬给予外源性血管加压素。血管加压素在这两组中的抗利尿作用没有差异。这些结果表明,低氧血症诱导抗利尿作用,该作用独立于心输出量、平均动脉压、溶质排泄率、滤过分数、肾神经或肾脏对血管加压素的反应的改变,并且通过压力感受器介导的血管加压素释放发生。压力感受器刺激的本质仍有待阐明。

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