Yersin B, Burnier M, Magnenat P
Service de Médecine B, Centre Hospitalier Universitaire Vaudois, Lausanne, Suisse.
Am J Nephrol. 1995;15(3):260-5. doi: 10.1159/000168843.
Two patients with severe hepatorenal syndrome associated with alcoholic hepatitis are reported, in whom repeated daily courses of head-out water immersion were dramatically effective in producing an improvement of the renal function. Using repeated 2-hour courses of head-out water immersion for 7 days in the 1st patient, an immediate increase in urine output was observed. A slight increase in renal sodium excretion was also noted. The patient lost 7 kg over 1 week. Serum creatinine decreased from 520 to 370 mumol/l, and the renal function continued to improve thereafter. In the 2nd patient, repeated head-out water immersion was associated with a progressive improvement of the renal function, an effect that was absent during an initial therapy of volume load. The acute effects of immersion in in this 2nd patient were characterized by a dramatic increase in urine output and renal sodium excretion as well as in p-aminohippurate and creatinine clearances. These effects were associated with a decrease in the activity of the renin-angiotensin system and a modest increase in plasma atrial natriuretic peptide levels. Thus, these 2 cases emphasize the potential benefits of repeated head-out water immersions in improving the renal function of patients with hepatorenal syndrome.
报告了2例伴有酒精性肝炎的严重肝肾综合征患者，每日反复进行头露出水面的水浸疗法对改善肾功能有显著效果。在第1例患者中，连续7天每天进行2小时的头露出水面水浸疗法，尿量立即增加，肾钠排泄也略有增加。该患者在1周内体重减轻了7公斤。血清肌酐从520降至370μmol/l，此后肾功能持续改善。在第2例患者中，反复进行头露出水面水浸疗法使肾功能逐渐改善，而在初始容量负荷治疗期间未出现这种效果。该第2例患者浸水的急性效应表现为尿量、肾钠排泄以及对氨基马尿酸和肌酐清除率显著增加。这些效应与肾素-血管紧张素系统活性降低以及血浆心钠素水平适度升高有关。因此，这2例病例强调了反复进行头露出水面水浸疗法在改善肝肾综合征患者肾功能方面的潜在益处。
