IgA肾病患者肾小球形态与氨基酸给药后肾脏血流动力学反应之间的相关性
Correlation between glomerular morphology and renal haemodynamic response to amino-acid administration in patients with IgA nephropathy.
作者信息
Pluvio C, de Pascale E, Giordano M, Cirillo D, Carone M, Pluvio M, Castellino P, Giordano C
机构信息
Istituto di Medicina Interna e Nefrologia, Seconda Università di Napoli, Italy.
出版信息
Nephrol Dial Transplant. 1996 Dec;11(12):2421-5. doi: 10.1093/oxfordjournals.ndt.a027208.
RATIONALE
To establish relationship, if any, between renal morphology and renal haemodynamic response to amino acids.
DESIGN AND METHODS
We investigated the correlation between renal haemodynamic regulation and morphology in a group of 15 patients with primary IgA nephropathy (IgAN) (age 26 +/- 2 years, BMI 24.4 +/- 1, GFR 64 +/- 5 ml/min, RPF 377 +/- 34 ml/min, FF 0.17 +/- 0.02). Twelve normal subjects (age 30 +/- 3 years, BMI 24 +/- 1, GFR 82 +/- 6 ml/min, RPF 421 +/- 42 ml/min, FF 0.19 +/- 0.02) were studied as controls. IgA patients were divided into two groups according to the histological staging of glomerular lesions: group I (n = 7) stage II, and group II (n = 8) stage III-IV.
RESULTS
In the basal state GFR was similar in the two groups and averaged 64 +/- 9 and 64 +/- 6 ml/min respectively. In contrast, FF was significantly lower in group II (0.14 +/- 0.01) (P < 0.05) in comparison to group I (0.21 +/- 0.03) and controls (0.19 +/- 0.02). In order to evaluate the renal functional reserve, all study groups underwent to an intravenous amino-acid infusion designed to increase plasma amino acid levels twofold (total from 2096 +/- 145 to 4301 +/- 221 mumol/l in IgA nephropathy patients and from 2272 +/- 83 to 3844 +/- 238 mumol/l in controls). In response to amino-acid infusion, GFR rose significantly in group I (GFR 20 +/- 2% and RPF 37 +/- 4% versus basal) and controls (GFR 20 +/- 2% and RPF 20 +/- 3% versus basal) (both P < 0.01 vs basal). In contrast, in patients with more severe glomerular lesions (group II) neither GFR nor RPF rose significantly (GFR -1 +/- 4% and RPF -8 +/- 6% versus basal) (P NS versus basal, P < 0.01 versus group I and controls).
CONCLUSIONS
The data show that in IgA nephropathy: severe forms of glomerular lesions are associated with a complex alteration of glomerular haemodynamic regulation, characterized by lower basal FF and loss of haemodynamic response to hyperaminoacidaemia.
原理
确定肾脏形态与肾脏对氨基酸的血流动力学反应之间是否存在关系（若存在关系）。
设计与方法
我们研究了15例原发性IgA肾病（IgAN）患者（年龄26±2岁，体重指数24.4±1，肾小球滤过率64±5 ml/分钟，肾血浆流量377±34 ml/分钟，滤过分数0.17±0.02）的肾脏血流动力学调节与形态之间的相关性。选取12名正常受试者（年龄30±3岁，体重指数24±1，肾小球滤过率82±6 ml/分钟，肾血浆流量421±42 ml/分钟，滤过分数0.19±0.02）作为对照进行研究。IgA患者根据肾小球病变的组织学分期分为两组：I组（n = 7）为II期，II组（n = 8）为III - IV期。
结果
在基础状态下，两组的肾小球滤过率相似，分别平均为64±9和64±6 ml/分钟。相比之下，II组的滤过分数（0.14±0.01）显著低于I组（0.21±0.03）和对照组（0.19±0.02）（P < 0.05）。为了评估肾脏功能储备，所有研究组均接受静脉输注氨基酸，以使血浆氨基酸水平加倍（IgA肾病患者从2096±145 μmol/L增至4301±221 μmol/L，对照组从2272±83 μmol/L增至3844±238 μmol/L）。在输注氨基酸后，I组（肾小球滤过率升高20±2%，肾血浆流量升高37±4%，与基础值相比）和对照组（肾小球滤过率升高20±2%，肾血浆流量升高20±3%，与基础值相比）的肾小球滤过率均显著升高（两者与基础值相比P < 0.01）。相比之下，在肾小球病变更严重的患者（II组）中，肾小球滤过率和肾血浆流量均未显著升高（肾小球滤过率为 -1±4%，肾血浆流量为 -8±6%，与基础值相比）（与基础值相比P无统计学意义，与I组和对照组相比P < 0.01）。
结论
数据表明，在IgA肾病中：严重形式的肾小球病变与肾小球血流动力学调节的复杂改变相关，其特征为基础滤过分数较低以及对高氨基酸血症的血流动力学反应丧失。
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