Aperia A, Broberger O, Ericsson N O, Wikstad I
Kidney Int. 1976 May;9(5):418-23. doi: 10.1038/ki.1976.51.
The functional damage caused by vesicoureteral reflux (VUR) has been examined by unilateral clearance studies in 22 children with recurrent urinary tract infection (UTI) and representing 23 kidneys with large VUR. 7 kidneys with small to moderate VUR and 14 kidneys without VUR. Inulin clearance, Na+ excretion and glucose reabsorption were determined. In kidneys without or with small and moderate VUR, UTI had no effect on renal function if treated. In kidneys with large VUR extending into the pelvis and dilating the ureter, there was a gradual deterioration of glomerular filtration rate (GFR) that was accelerated after the age of 6 yr. Before puberty more than 50% of renal function was lost despite strict medical care of the UTI. If this functional loss was unilateral, hyperfunction of the contralateral kidney was generally observed. Maximal glucose reabsorption was depressed in proportion to GFR. In kidneys with unilaterally low GFR, the fractional Na+ excretion was consistently increased as compared to the contralateral kidney with normal GFR. This adaptive increase in Na+ excretion must therefore be of intrarenal origin.
通过对22例复发性尿路感染（UTI）患儿（代表23个存在重度膀胱输尿管反流（VUR）的肾脏）进行单侧清除率研究，检测了膀胱输尿管反流所致的功能损害。另有7个存在轻度至中度VUR的肾脏以及14个无VUR的肾脏。测定了菊粉清除率、钠排泄及葡萄糖重吸收情况。在无VUR或存在轻度及中度VUR的肾脏中，若UTI得到治疗，则对肾功能无影响。在重度VUR累及肾盂并使输尿管扩张的肾脏中，肾小球滤过率（GFR）逐渐下降，6岁后加速。青春期前，尽管对UTI进行了严格医疗护理，但仍有超过50%的肾功能丧失。若这种功能丧失为单侧性，通常可观察到对侧肾脏功能亢进。最大葡萄糖重吸收与GFR成比例降低。在单侧GFR降低的肾脏中，与对侧GFR正常的肾脏相比，钠排泄分数持续增加。因此，这种钠排泄的适应性增加必定源于肾脏内部。
