Westenfelder C, Loghman-Adham M, Baranowski R L, Brownley R, Kablitz C
Division of Adult Nephrology, University of Utah and Veterans Affairs Medical Centers, Salt Lake City 84148, USA.
Nephrol Dial Transplant. 1998 Jul;13(7):1675-81. doi: 10.1093/ndt/13.7.1675.
Proximal tubular reabsorption of glucose (G), phosphate (Pi) and amino acids is energized by the transmembrane Na+ gradient, which explains why decreased concentration of one solute can enhance the transport of another. Accordingly, we postulated that the consistent increase in Pi reabsorption seen in the post-obstructed kidney (POK) could be caused, in part, by the low filtered load of glucose and reversed by glucose loading.
Renal function was examined before and after i.v. glucose loading in POKs (after release of 24 h of unilateral ureteral obstruction) and control kidneys (CK) of 10 adult rats. Brush-border membrane vesicle (BBMV) transports of Pi and glucose were assessed in POKs and CKs.
In POKs GFR, urine flow and Na+ excretion were significantly reduced and tubular reabsorption of both Pi (T(P)/GFR) and glucose (TG/GFR) were significantly increased: T(P)/GFR, 2.0 +/- 0.2 vs 1.36 +/- 0.1; TmG/GFR, 23.4 +/- 1.7 vs 18.9 +/- 1.1 mmol/l. Glucose loading inhibited T(P)/GFR only in the CK. Initial Na+ gradient-dependent uptakes of D-glucose and Pi were similar in BBMVs from POK and CK.
The increases in T(P)/GFR and TG/GFR seen in the POK do not result from decreased glucose delivery or from alterations in BBM Pi and glucose transporters. The reduced ability of glucose to inhibit Pi reabsorption in the POK results primarily from a generalized increase in proximal tubular reabsorption of Na+ and cotransported Pi and glucose. A specific rise in distal Pi transport capacity may be an additional adaptive response to the low filtered load of Pi in the POK. In addition, absent distal glucose reabsorption may further facilitate Pi reclamation at these sites.
近端肾小管对葡萄糖(G)、磷酸盐(Pi)和氨基酸的重吸收由跨膜Na⁺梯度提供能量,这解释了为何一种溶质浓度降低会增强另一种溶质的转运。因此,我们推测梗阻后肾脏(POK)中Pi重吸收持续增加可能部分是由于葡萄糖滤过负荷低所致,且可通过葡萄糖负荷逆转。
对10只成年大鼠的POK(单侧输尿管梗阻24小时解除后)和对照肾脏(CK)进行静脉注射葡萄糖负荷前后的肾功能检查。评估POK和CK中刷状缘膜囊泡(BBMV)对Pi和葡萄糖的转运。
在POK中,肾小球滤过率(GFR)、尿流和Na⁺排泄显著降低,Pi(T(P)/GFR)和葡萄糖(TG/GFR)的肾小管重吸收均显著增加:T(P)/GFR,2.0±0.2对1.36±0.1;TmG/GFR,23.4±1.7对18.9±1.1 mmol/l。葡萄糖负荷仅在CK中抑制T(P)/GFR。POK和CK的BBMV中D - 葡萄糖和Pi的初始Na⁺梯度依赖性摄取相似。
POK中T(P)/GFR和TG/GFR的增加并非源于葡萄糖输送减少或BBM Pi和葡萄糖转运体的改变。POK中葡萄糖抑制Pi重吸收的能力降低主要源于近端肾小管对Na⁺以及共转运的Pi和葡萄糖重吸收的普遍增加。远端Pi转运能力的特异性增加可能是对POK中Pi滤过负荷低的额外适应性反应。此外,远端葡萄糖重吸收缺失可能进一步促进这些部位的Pi回收。