腎不全に対する泌尿・器科的治療法に関する研究 第2編: 腎不全時における赤血球内カリウム値および残余窒素値とその意義について

Abstract

Although the proper time to perform perfusion or dialysis and judgement of prognosis have so far determined by measurements of serum electrolytes and nitrogen containing substances, it is assumed that the electrolytes and nitrogen containing substances of the body as the whole are insufficiently estimated by simple serum assay of such substances. It is an interesting problem to know the change of intracellular fluid brought by a rapid change of extracellular fluid. Abnormal pattern of electroencephalogram seen during blood dialysis is due to different rates of urea clearance between serum, cerebrospinal fluid and brain cells. To clarify the significance of intracellular electrolytes, studies were performed to determine intraerythrocytic concentration of potassium and non-protein nitrogen in normal human subjects, patients with acute and chronic renal insufficiencies, renal insufficiency with and without edema, two cases done blood dialysis with the Kolff-type artificial kidney and a case given Amberlite IRP-64. It was found that intracellular potassium in patient with renal insufficiency (intraerythrocytic potassium concentration of 77.32 mEq/L) was lower than that of in normal subjects (normal intraerythrocytic potassium 87.25 mEq/L). Furthermore the intraerythrocytic potassium in patients with renal insufficiency with edema (72.90 mEq/L) was much lower than that in patients with renal insufficiency without edema (81.75 mEq/L). The intraerythrocyti c NPN concentration showed almost positive correlation to the serum NPN level in normal subjects. The intraerythrocytic NPN in patients with renal insufficiency demonstrated positive correlations to the serum NPN in some degree up to 80-90 mg/dl but it rose one and a half or two hold levels when the serum NPN leve l exceeded 80--90 mg/d1. This trend of increase was especially marked in patients with renal insufficiency with edema.