Decaux G, Dumont I, Naeije N, Mols P, Melot C, Mockel J
Am J Med. 1982 Sep;73(3):328-34.
Since urea and uric acid clearance are affected by the effective intravascular volume, we measured the fractional urea and uric acid excretion in cirrhosis. High urea and uric acid clearances were observed in 30 and 55 percent, respectively, of 20 consecutive cirrhotic patients with normal renal function. In seven patients with a high fractional uric acid excretion, 5 mg of isosorbide dinitrate every four hours for 24 hours induced a significant increase in the serum uric acid level (from 3.7 +/- 0.8 mg/dl to 4.4 +/- 0.8 mg/dl; less than 0.001) with a concomitant decrease in the fractional uric acid excretion (from 14.0 +/- 3.2 percent to 8.8 +/- 3.1 percent; less than 0.02). During the same test, the blood urea level increased from 3.3 +/- 1.1 mmol/liter to 4.1 +/- 1.2 mmol/liter (p less than 0.005) with a decrease in fractional excretion from 51 +/- 4.5 percent to 39 +/- 5 percent (p less than 0.001). The oral intake of sulfinpyrazone in six of these patients induced a normal uricosuric response. In two cirrhotic patients with ascites, 40 mg of furosemide associated with a 24-hour severe water restriction was also shown to normalize the high fractional excretion of both urea and uric acid. In nine patients with ascites, we observed a significant increase in blood urea and uric acid concentration despite the absence of change in creatinine clearance once ascites was removed by diuretics. On the basis of these findings, we believe that the high fractional excretion of both urea and uric acid frequently observed in cirrhosis is related to an increase in the effective vascular volume.
由于尿素和尿酸清除率受有效血管内血容量的影响，我们测定了肝硬化患者的尿素排泄分数和尿酸排泄分数。在20例肾功能正常的连续性肝硬化患者中，分别有30%和55%观察到高尿素清除率和高尿酸清除率。在7例尿酸排泄分数高的患者中，每4小时口服5mg硝酸异山梨酯，共24小时，可使血清尿酸水平显著升高（从3.7±0.8mg/dl升至4.4±0.8mg/dl；P<0.001），同时尿酸排泄分数降低（从14.0±3.2%降至8.8±3.1%；P<0.02）。在同一试验中，血尿素水平从3.3±1.1mmol/L升至4.1±1.2mmol/L（P<0.005），排泄分数从51±4.5%降至39±5%（P<0.001）。其中6例患者口服磺吡酮后产生了正常的促尿酸尿反应。在2例肝硬化腹水患者中，40mg呋塞米联合24小时严格限水也可使尿素和尿酸的高排泄分数恢复正常。在9例腹水患者中，我们观察到，用利尿剂清除腹水后，尽管肌酐清除率无变化，但血尿素和尿酸浓度显著升高。基于这些发现，我们认为肝硬化患者中常见的尿素和尿酸高排泄分数与有效血管容量增加有关。
