Epstein M, Ramachandran M, DeNunzio A G
Miner Electrolyte Metab. 1982 Jun;7(6):305-15.
Although the sodium retention of cirrhosis is attributable primarily to enhanced tubular reabsorption of sodium, the precise nephron sites responsible remain the subject of continuing controversy. Since changes in phosphate clearance may be used as an index of proximal sodium reabsorption, we undertook to characterize the effects of immersion-induced volume expansion on renal sodium and phosphate handling in order to clarify further the nephron sites of enhanced Na reabsorption. 18 cirrhotic patients were studied twice while in balance on a 10-mEq sodium. 100-mEq potassium diet during a control period and during water immersion. Cirrhotic patients manifested a wide continuum of responses characterized by either a sluggish or barely discernible natriuretic response (group I, n = 5) or an appropriate natriuretic response (group II, n = 13). Despite widely varying natriuretic responses, group I patients manifested a phosphaturic response to water immersion which was virtually identical to that of group II patients. The current findings indicate that distal sodium reabsorption contributes importantly to the sodium content of the final urine in cirrhotic patients with sodium retention.
尽管肝硬化患者的钠潴留主要归因于肾小管对钠的重吸收增强，但负责该过程的精确肾单位部位仍是持续争论的主题。由于磷酸盐清除率的变化可用作近端钠重吸收的指标，我们着手研究浸泡诱导的容量扩张对肾脏钠和磷酸盐处理的影响，以进一步阐明钠重吸收增强的肾单位部位。18例肝硬化患者在摄入10 mEq钠、100 mEq钾饮食的对照期和水浸泡期处于平衡状态时接受了两次研究。肝硬化患者表现出广泛连续的反应，其特征为利钠反应迟缓或几乎难以察觉（第一组，n = 5）或适当的利钠反应（第二组，n = 13）。尽管利钠反应差异很大，但第一组患者对水浸泡表现出的磷酸盐尿反应与第二组患者几乎相同。目前的研究结果表明，在有钠潴留的肝硬化患者中，远端钠重吸收对终尿中的钠含量有重要贡献。
