Roccatello D, Mengozzi G, Ferro M, Cesano G, Polloni R, Mosso R, Bonetti G, Inconis T, Paradisi L, Sena L M
Istituto di Nefrourologia, Università di Torino, Italy.
Clin Nephrol. 1995 Sep;44(3):163-9.
An endothelin urinary hyperexcretion, which is not counterbalanced by an adequate increase in cGMP biosynthesis, was previously detected in some patients with IgA Nephropathy (IgAN). Since this imbalance might potentiate local ET1-mediated hemodynamics effects, 9 IgAN patients with an increased (> or = 0.1) urinary ET1/cGMP ratio (group 1) and 5 IgAN patients with comparable renal function and reduced ET1/cGMP ratio (group 2) were given standard doses of isosorbide 5 mononitrate (as a nitric oxide source). Blood nitric oxide (NO) levels, as detected by electron paramagnetic resonance, significantly increased after isosorbide administration (p < 0.01) and decreased after drug discontinuation in both groups. Nitric oxide levels were significantly related with those of the effective renal plasma flow (p < 0.02), but not with the glomerular filtration rate. Proteinuria levels significantly decreased after drug administration (p < 0.009) in group 1 and returned to baseline levels thereafter, except two cases showing persisting low levels. Values of filtration fraction in the same group decreased after iso5M administration (p < 0.02 compared to basal levels). These results may possibly be related to the counterbalancing effects of nitric oxide on endothelin-mediated mesangial contraction.
先前在一些IgA肾病（IgAN）患者中检测到内皮素尿排泄过多，而cGMP生物合成的充分增加并未对其起到平衡作用。由于这种失衡可能会增强局部ET1介导的血流动力学效应，因此对9例尿ET1/cGMP比值升高（≥0.1）的IgAN患者（第1组）和5例肾功能相当且ET1/cGMP比值降低的IgAN患者（第2组）给予标准剂量的5-单硝酸异山梨酯（作为一氧化氮来源）。通过电子顺磁共振检测发现，两组患者服用5-单硝酸异山梨酯后血中一氧化氮（NO）水平显著升高（p<0.01），停药后降低。一氧化氮水平与有效肾血浆流量显著相关（p<0.02），但与肾小球滤过率无关。第1组患者用药后蛋白尿水平显著降低（p<0.009），此后除2例持续处于低水平外，其余均恢复至基线水平。同一组患者服用5-单硝酸异山梨酯后滤过分数值降低（与基础水平相比，p<0.02）。这些结果可能与一氧化氮对内皮素介导的系膜收缩的平衡作用有关。
