Korean Journal of Nephrology 1992;11(4):341-350.

한국형 출혈열에서 회복기의 신세뇨관 기능 평가

김근호 , 김연수 , 한진석 , 김성권 , 이정상

Abstract

To evaluate the renal tubular functions in the con- valescent phase of Korean hemorrhagic fever (KHF) and to verify the mechanisms of tubular dysfunctions in KHF, we performed water loading, water deprivation- vasopressin stimulation-hypertonic saline infusion, and acid loading test in 11 convalescent patients with KHF and compared with disease control group (8 acute renal failure patients in convalescence) and normal control group (9 healthy candidates for kidney donation). Urine osmolality after water loading was decreased to 89.5±22.1 (mean±SEM) mOsm/kg, and free-water clearance (Ch20/C,) at maximal diuresis was not dif- ferent from control groups. After water deprivation, maximal urine osmolality and urine-to-plasma os- molality ratio were 401.1±31.2 mOsm/kg and 1.4±0. 1, respectively, whieh were lower than 858.9±49.2 mOsm/kg and 2.9±0.2 of normal control, respec- tively (p<0.05). Plasma vasopressin values measured at basal state and after water deprivation were not differ- ent from control groups, and there was no significant increase in urine osmolality and urine-to-plasma os- molality ratio after subcutaneous injection of aqueous pitressin 5 units, Free-water reabsorption (T' h20/C,) measured under the condition of sufficient plasma vaso- pressin level and adequately concentrated medullary interstitium by water deprivation-pitressin stimulation- 3% hypertonic saline infusion was 0.4±0.2%, which was lower than 1.1 ±0.2% of normal control and 1.5±0.2 of disease control, respectively (p<0.01). It was correlated with the duration of oliguria (R=0.81, p<0.01), peak hemoglobin (r=0.80, p=0.01) and lactate dehydrogenase level (r=0.73, p<0.05), and WHO severity criteria (R=0.84, p<0.01), respectively. There was no differences from control groups in acid loading test and in the indexes reflecting proximal or distal tubular damage such as fractional excretion of sodium, potassium or bicarbonate, lithium clearance, and net acid excretion. In conclusion, during the convalescent phase of KHF, urinary concentration was impaired mainly due to poor responsiveness of collecting ducts, anti-diuretic hormone to the comparing to the other causes of acute renal failure.