Pathophysiology of protracted acute renal failure in man
Postischemic acute renal failure (ARF) induced by cardiac surgery is commonly prolonged and may be irreversible. To examine whether persistence of postischemic, tubular cell injury accounts for delayed recovery from ARF, we studied 10 patients developing protracted (36 +/- 4 d) ARF after cardiac surgery. The differential clearance and excretion dynamics of probe solutes of graded size were determined. Inulin clearance was depressed (5.0 +/- 1.7 ml/min), while the fractional urinary clearance of dextrans (radii 17-30 A) were elevated above unity. Employing a model of conservation of mass, we calculated that 44% of filtered inulin was lost via transtubular backleak. The clearance and fractional backleak of technetium-labeled DTPA ((/sup 99m/Tc)DTPA, radius = 4 A) were identical to those of inulin (radius 15 A). The time at which inulin or DTPA excretion reached a maximum after an intravenous bolus injection was markedly delayed when compared with control subjects with ARF of brief duration, 102 vs. 11 min. Applying a three-compartment model of inulin/DTPA kinetics (which takes backleak into account) revealed the residence time of intravenously administered inulin/DTPA in the compartment occupied by tubular fluid and urine to be markedly prolonged, 20 vs. 6 min in controls, suggesting reduced velocity of tubular fluid flow.
- Research Organization:
- Stanford Univ. School of Medicine, CA
- OSTI ID:
- 6082472
- Journal Information:
- J. Clin. Invest.; (United States), Vol. 4
- Country of Publication:
- United States
- Language:
- English
Similar Records
Effect of captopril on 99mTc-diethylenetriaminepentaacetic acid renograms in two-kidney, one clip hypertension
Predicting the kinetics of chelating agents in man from animal data
Related Subjects
62 RADIOLOGY AND NUCLEAR MEDICINE
DTPA
RENAL CLEARANCE
INULIN
SURGERY
SIDE EFFECTS
EXCRETION
HEART
ISOMERIC NUCLEI
KIDNEYS
PARTICLE SIZE
PATIENTS
RENIN
TECHNETIUM 99
TRACER TECHNIQUES
URINE
UROGENITAL SYSTEM DISEASES
AMINO ACIDS
BETA DECAY RADIOISOTOPES
BETA-MINUS DECAY RADIOISOTOPES
BIOLOGICAL MATERIALS
BIOLOGICAL WASTES
BODY
BODY FLUIDS
CARBOHYDRATES
CARBOXYLIC ACIDS
CARDIOVASCULAR SYSTEM
CHELATING AGENTS
CLEARANCE
DISEASES
DRUGS
ENZYMES
HOURS LIVING RADIOISOTOPES
HYDROLASES
INTERMEDIATE MASS NUCLEI
ISOMERIC TRANSITION ISOTOPES
ISOTOPE APPLICATIONS
ISOTOPES
MATERIALS
MEDICINE
NONSPECIFIC PEPTIDASES
NUCLEI
ODD-EVEN NUCLEI
ORGANIC ACIDS
ORGANIC COMPOUNDS
ORGANS
PEPTIDE HYDROLASES
POLYSACCHARIDES
RADIOISOTOPES
RADIOPROTECTIVE SUBSTANCES
SACCHARIDES
SIZE
TECHNETIUM ISOTOPES
WASTES
YEARS LIVING RADIOISOTOPES
550901* - Pathology- Tracer Techniques
550600 - Medicine