Vallés P, Cruzado M
Cátedra de Fisiología Patológica, Facultad de Ciencias Médicas, Universidad Nacional de Cuyo, Mendoza, Argentina.
Medicina (B Aires). 1993;53(6):507-13.
The acute effect of an oral protein load on glomerular filtration rate-renal functional reserve (RFR)- and albumin urinary excretion were evaluated in 9 patients with bilateral vesicoureteral grade IV reflux after surgical correction (Group I) and the results compared with 9 children with repeated urinary infection without reflux (Group II) and 6 healthy controls of similar age (Group III). Intravenous urography, performed in the year of the study, revealed renal scarring in 10 kidneys in Group 1 and 2 in Group II. All of them had normal values of plasma creatinine. Basal inulin clearance was significantly lower in vesicoureteral reflux patients. Good correlation was found between parenchymal area of both kidneys and baseline inulin. Following protein load an increase in creatinine and inulin clearance was recorded in urinary infection and control children. No change post load was observed in reflux patients. Microalbuminuria excretion was significantly higher in children with surgical correction during the control period. No changes were observed after load in any of the groups. We conclude that patients who had had bilateral vesicoureteral reflux grade IV showed an impaired renal response to a protein load. Long-term follow-up studies will confirm the value of this test for estimating the risk of further renal function deterioration in reflux nephropathy.
对9例双侧IV级膀胱输尿管反流手术矫正后的患者（第一组），评估口服蛋白质负荷对肾小球滤过率、肾功储备（RFR）及尿白蛋白排泄的急性影响，并将结果与9例反复泌尿系统感染但无反流的儿童（第二组）及6例年龄相仿的健康对照者（第三组）进行比较。在研究当年进行的静脉肾盂造影显示，第一组有10个肾脏、第二组有2个肾脏存在肾瘢痕形成。所有患者的血浆肌酐值均正常。膀胱输尿管反流患者的基础菊粉清除率显著降低。发现双肾实质面积与基础菊粉之间存在良好相关性。蛋白质负荷后，泌尿系统感染患儿及对照儿童的肌酐清除率和菊粉清除率均升高。反流患者负荷后未观察到变化。在对照期，手术矫正患儿的微量白蛋白尿排泄显著更高。负荷后，所有组均未观察到变化。我们得出结论，双侧IV级膀胱输尿管反流患者对蛋白质负荷的肾脏反应受损。长期随访研究将证实该检测对评估反流性肾病进一步肾功能恶化风险的价值。
