Tack I, Rostaing L, Tran-Van T, Lloveras J J, Durand D, Suc J M, Ader J L
Laboratoire d'Explorations Fonctionnelles Rénales et Métaboliques, Hôpital de Rangueil, CHU de Toulouse, France.
Nephrol Dial Transplant. 1995;10 Suppl 6:117-9. doi: 10.1093/ndt/10.supp6.117.
Renal functional reserve during infusion of an amino acid solution was examined in 12 cyclosporin-treated kidney recipients at 1 (T1) and 8 months (T2) after transplantation. Patients were retrospectively divided into six normotensive (NT) and six hypertensive recipients (HT) maintained on monotherapy with a calcium channel blocker. Baseline glomerular filtration rates (GFR) were similar in NT and HT at T1 and T2. Renal functional reserve was identical in NT and HT at T1 (15 +/- 7 vs 18 +/- 13 ml/min/1.73 m2) but significantly greater in HT at T2 (11 +/- 5 vs 23 +/- 10 ml/min/1.73 m2; P < 0.05). At T2, baseline proximal tubule outflow (lithium clearance) was greater in HT (26 +/- 8 vs 16 +/- 3 ml/min/1.73 m2; P < 0.05), whereas fractional proximal reabsorption was less (54 +/- 11% vs 67 +/- 5%; P < 0.05). These results indicate that: (i) hypertensive recipients on calcium channel blocker therapy do not exhibit permanent glomerular hyperfiltration until 8 months after transplantation, and have a reduced proximal reabsorption; (ii) measurement of amino acid-stimulated GFR and renal functional reserve is a more sensitive method than that of baseline GFR for evaluating renal function and the effects of therapy in kidney recipients.
在12例接受环孢素治疗的肾移植受者中，于移植后1个月（T1）和8个月（T2）时检测了输注氨基酸溶液期间的肾功储备。患者被回顾性分为6例血压正常（NT）和6例血压升高（HT）的受者，均接受钙通道阻滞剂单一疗法。NT组和HT组在T1和T2时的基线肾小球滤过率（GFR）相似。NT组和HT组在T1时的肾功储备相同（分别为15±7与18±13 ml/min/1.73 m²），但在T2时HT组的肾功储备显著更高（分别为11±5与23±10 ml/min/1.73 m²；P<0.05）。在T2时，HT组的基线近端肾小管流出量（锂清除率）更高（分别为26±8与16±3 ml/min/1.73 m²；P<0.05），而近端重吸收率更低（分别为54±11%与67±5%；P<0.05）。这些结果表明：（i）接受钙通道阻滞剂治疗的高血压受者在移植后8个月之前未表现出永久性肾小球高滤过，且近端重吸收减少；（ii）测量氨基酸刺激后的GFR和肾功储备比测量基线GFR是评估肾移植受者肾功能及治疗效果更为敏感的方法。
