The Renal Extraction OF Para-Aminohippurate in Normal Persons and in Patients with Diseased Kidneys

Bergström, Jonas; Bucht, H; J, Ek; Josephson, Bertil; Sundell, Håkan; Werkö, Lars

doi:10.3109/00365515909060466

Cited by 39 publications

(22 citation statements)

References 2 publications

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“…In the case of healthy controls, EpAH was assumed to be 0.85 (1 1). However, Epm has been shown to be moderately depressed in patients with proteinuric glomerular diseases, particularly when GFR is reduced (12)(13)(14)(15). To define a representative value of Epm in nephrotic subjects with membranous glomerulopathy, we determined this quantity directly on a separate occasion in four members of the experimental group.…”

Section: Methodsmentioning

confidence: 99%

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Nature of the glomerular capillary injury in human membranous glomerulopathy.

Shemesh¹,

Ross²,

Deen³

et al. 1986

J. Clin. Invest.

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A differential solute clearance technique was used to evaluate glomerular capillary wall function in 20 patients with membranous glomerulopathy and massive proteinuria. The clearance of inulin, the filtration fraction, and the fractional clearance of uncharged dextrans of a radius of 28-48 A were depressed significantly below control values in 20 healthy volunteers (P < 0.01). In contrast, the fractional clearance of dextrans of radius >50 A was elevated markedly. A theoretical model of solute transport that depicts the major portion of the glomerular capillary wall as an isoporous membrane and the minor portion as a nondiscriminatory shunt pathway revealed the calculated gomerular ultrafiltration coefficient to be five times lower and mean pore radius of the major membrane component to be 4 A smaller than control values. However, the fraction of filtrate volume permeating the shunt pathway was three-to fourfold above control values and correlated strongly in individual patients with the fractional clearance of albumin (r = 0.76) and of IgG (r = 0.80). Lowering renal plasma flow by 24% during indomethacin therapy in seven patients resulted in a 74% reduction in proteinuria accompanied by a corresponding diminution of filtrate formed through the shunt pathway. Morphometric analysis ofglomerular ultrastructure revealed the magnitude of depression of the glomerular filtration rate and of urinary protein leakage to be related strongly to changes in the epithelial layer of the glomerular capillary wall, but not to the density of subepithelial immune deposits. We conclude (a) that glomerular capillaries in membranous glomerulopathy are characterized by a loss of ultrafiltration capacity and of barrier size-selectivity, and (b) that subepithelial immune deposits do not provide a structural basis for these functional alterations.

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Section: Methodsmentioning

confidence: 99%

“…In each case a relapse of the underlying glomerulopathy with reappearance of massive proteinuria became manifest within the 12-mo period preceding the study. 14 patients had received one or more receiving prednisone (range 7.5-90 mg daily), which in two cases was combined with azathioprine (1.5-2.0 mg/kg. d).…”

Section: Methodsmentioning

confidence: 99%

Nature of the glomerular capillary injury in human membranous glomerulopathy.

Shemesh¹,

Ross²,

Deen³

et al. 1986

J. Clin. Invest.

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show abstract

“…Previous estimations of renal circulatory function (ERPF) in such patients have been based on para-aminohippurate (PAH) clearance alone (3,9,10), which may correlate poorly with renal plasma flow when renal function is severely impaired (12). In addition, the pathophysiologic mechanisms that may reduce renal hemodynamic function in hepatic disease have not been investigated comprehensively.…”

mentioning

confidence: 99%

Renal Circulation in Cirrhosis: Observations Based on Catheterization of the Renal Vein*

Baldus¹,

Summerskill²,

Hunt³

et al. 1964

J. Clin. Invest.

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“…E PAH concentration, on the other hand, has frequently been reported to be depressed in the presence of chronic renal disease. [4][5][6][7][8] Consequently, C PAH is likely to underestimate renal plasma flow under these circumstances. Despite these limitations, however, the current clinical gold standard for measuring renal blood flow is based on determination of the C PAH .…”

Section: Introductionmentioning

confidence: 97%