Peripheral microvascular parameters in the nephrotic syndrome

被引:28
作者
Lewis, DM
Tooke, JE
Beaman, M
Gamble, J
Shore, AC
机构
[1] Royal Devon & Exeter Hosp, Renal Unit, Exeter EX2 5DW, Devon, England
[2] Univ Exeter, Dept Vasc Med, Exeter, Devon, England
[3] Charing Cross & Westminster Med Sch, Dept Physiol, London, England
基金
英国惠康基金;
关键词
capillary pressure; capillary filtration capacity; nephrotic; edema; glomerulonephritis; diuretics; Starling forces;
D O I
10.1046/j.1523-1755.1998.00100.x
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background. Peripheral edema, in combination with severe proteinuria and low serum albumin levels, is pathognomonic of the nephrotic syndrome, yet the exact mechanism of its formation is unknown. Two of the most important of the factors in Starling's forces controlling fluid filtration across the capillary have hitherto not been studied in nephrotic subjects. Methods. The hydrostatic capillary pressure at the finger nailfold in actively nephrotic subjects and age and ses matched controls was studied, using direct puncture of the apex of the capillary under video microscopy, and a servonulling apparatus to give a direct measurement of capillary pressure. Capillary filtration capacity (CFC) at the calf was measured noninvasively by a modern derivative of the technique of mercury strain gauge plethysmography. Fifteen nephrotic subjects with a variety of underlying pathological lesions, and age matched controls were studied. Results. Contrary to the assumption of the "overflow" hypothesis of edema formation, there was no evidence of capillary hypertension. The capillary pressure showed no difference between nephrotic subjects and controls: median (range) of 17.6 (12.0 to 24.2) compared with 17.3 (9.0 to 21.6) mm Hg, P = NS. CFC was significantly higher in nephrotic subjects than controls [5.23 (3.28 to 8.52) x 10(-3) versus 3.55 (2.43 to 5.28) x 10(-3) ml/min/100 g/mm Hg, P < 0.01]. Conclusions. An increase in CFC provides a potentially novel mechanism contributing at least in part to the formation of peripheral edema in the nephrotic syndrome.
引用
收藏
页码:1261 / 1266
页数:6
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