腎不全に併発する高血圧症についての研究

腎不全における血中および尿中 Catecholamine についての検討

抄録

For the purpose of investigating and the condition of catecholamines (CA) in renal failure, adrenaline (A) and noradrenaline (NA) levels in plasma and urine were determined by the trihydroxyindole method (a modified technique of Stern and Brody method). Plasma A and NA levels were observed in 18 dogs; in 6 of which the both ureters were ligated, in another 6 the both kidneys were removed and in the remaining 6 a sham operation was performed as a control group. Plasma A and NA levels were also observed in 51 human subjects; 3 were with acute renal failure, 17 with chronic renal failure, and as the control group, 14 normal subjects, 6 with pheochromocytoma and 11 with essential hypertension were observed. Urine A and NA levels were determined in 45 cases; 8 were with chronic renal failure, 13 with normal findings, 6 with pheochromocytoma and 18 with essential hypertension.
The results were as follow;
1) In dogs, plasma A and NA levels showed an increasing tendency after bilateral ureter ligitation or bilateral nephrectomy, but the changes were not significant.
2) In essential hypertension, A and NA levels in plasma and in urine were not different from those of normal subjects. On the other hand, in pheochromocytoma, plasma A and NA levels were elevated in the majority of cases and urine levels increased markely in almost all cases.
3) In acute renal failure, it was observed that plasma NA level was elevated in oliguric phase and plasma A and NA levels increased lightly in diuretic phase, however, final conclusion could not be drawn because of the small number of cases.
4) In chronic renal failure, plasma A and NA levels showed wide distribution as compared with the control groups and had the tendency of increase, although they did show such a marked increase as in pheochromocytoma.
5) Plasma A and NA levels had no differrence between arterial and venous bloods and had no significant correlation with each other in chronic renal failure.
6) There vvas no significant correlation between plasma A and NA levels and blood pressure in chronic renal failure.
7) Plasma A and NA levels in chronic renal failure seemed to increase in severe or insufficiently dialysed cases.
8) Plasma A and NA levels decreased significantly by hemodialysis. The degree of decrease was marked in NA.
9) Urine A and NA levels were significantly low in chronic renal failure as compared with the control groups.
The results reveal that plasma CA levels in renal failure, especially in chronic one, have a tendency of increase in general, although the distribution is considerably wide, and indicate that the increase may be mainly due to the marked decrease of urinary excretion of CA. The results also indicate that plasma CA does not increase whe nhemodialysis is performed suitably, because CA is easily removed by hemod-dialysis, and that plasma CA has little relation to the development of hypertension in renal failure.