Máttyus I, Miltényi M, Zimmerhackl L B, Schwarz A, Hentschel M, Brandis M, Tulassay T
First Department of Paediatrics, Semmelweis Medical University Budapest, Hungary.
Pediatr Nephrol. 1994 Jun;8(3):304-8. doi: 10.1007/BF00866342.
Urinary excretion of endothelin was measured by radioimmunoassay in children with diabetes mellitus during severe ketoacidosis and 12 days later when blood pH and blood glucose concentrations were normal. Metabolically stable diabetic children served as controls. Results from apparently healthy children without diabetes mellitus were used as normal values. Renal tubular injury was evaluated by the urinary excretion of the proximal tubular marker alpha 1-microglobulin and the distal tubular marker Tamm-Horsfall protein (THP). During ketoacidosis we detected a decreased glomerular filtration rate associated with highly significant changes in the excretion of alpha 1-microglobulin, indicating proximal tubular damage, and THP, suggesting disturbance of cells of the ascending loop of Henle. The daily excretion of endothelin was unaltered but the ratio of endothelin/creatinine or endothelin excretion/creatinine clearance were significantly enhanced. In conclusion, we could demonstrate that, despite a proximal and distal tubular cell dysfunction, endothelin excretion is not elevated during ketoacidosis. The increased endothelin excretion when related to creatinine clearance may be a consequence of disturbed proximal tubular function or dysfunction of the renal medulla.
采用放射免疫分析法测定了糖尿病患儿在严重酮症酸中毒期间及12天后（此时血液pH值和血糖浓度正常）的内皮素尿排泄量。代谢稳定的糖尿病患儿作为对照。无糖尿病的明显健康儿童的检测结果用作正常值。通过近端肾小管标志物α1 -微球蛋白和远端肾小管标志物Tamm - Horsfall蛋白（THP）的尿排泄量评估肾小管损伤。在酮症酸中毒期间，我们检测到肾小球滤过率降低，同时α1 -微球蛋白排泄量发生高度显著变化，表明近端肾小管受损，THP排泄量变化表明髓袢升支细胞受到干扰。内皮素的每日排泄量未改变，但内皮素/肌酐比值或内皮素排泄量/肌酐清除率显著升高。总之，我们可以证明，尽管存在近端和远端肾小管细胞功能障碍，但酮症酸中毒期间内皮素排泄并未升高。与肌酐清除率相关的内皮素排泄增加可能是近端肾小管功能紊乱或肾髓质功能障碍的结果。
