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首页> 外文期刊>American Journal of Physiology >The dynamics of glomerular filtration in the puerperium.
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The dynamics of glomerular filtration in the puerperium.

机译：产褥期肾小球滤过动力学。

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We evaluated the glomerular filtration rate (GFR) during the second postpartum week in 22 healthy women who had completed an uncomplicated pregnancy. We used physiological techniques to measure GFR, renal plasma flow, and oncotic pressure and computed a value for the two-kidney ultrafiltration coefficient (K(f)). We compared these findings with those in pregnant women previously studied on the first postpartum day as well as nongravid women of reproductive age. Healthy female transplant donors of reproductive age permitted the morphometric analysis of glomeruli and computation of the single-nephron K(f). The aforementioned physiological and morphometric measurements were utilized to estimate transcapillary hydraulic pressure (Delta P) from a mathematical model of glomerular ultrafiltration. We conclude that postpartum day 1 is associated with marked glomerular hyperfiltration (+41%). A theoretical analysis of GFR determinants suggests that depression of glomerular capillary oncotic pressure, the force opposing the formation of filtrate, is the predominant determinant of early elevation of postpartum GFR. A reversal of the gestational hypervolemia and hemodilution, still evident on postpartum day 1, eventuates by postpartum week 2. An elevation of oncotic pressure in the plasma that flows axially along the glomerular capillaries to supernormal levels ensues; however, GFR remains modestly elevated (+20%) above nongravid levels. An analysis of filtration dynamics at this time suggests that a significant increase in Delta P by up to 16%, an approximately 50% increase in K(f), or a combination of smaller increments in both must be invoked to account for the persistent hyperfiltration.
机译：我们评估了22名健康孕妇的产后第二周肾小球滤过率（GFR）。我们使用生理学技术测量GFR，肾血浆流量和血浆渗透压，并计算了两个肾脏的超滤系数（K（f））的值。我们将这些发现与以前在产后第一天进行研究的孕妇以及育龄期的非妊娠妇女进行了比较。健康的育龄女性移植供体可以对肾小球进行形态分析并计算单肾单位K（f）。利用上述生理学和形态学测量来从肾小球超滤的数学模型估计经毛细血管液压（Delta P）。我们得出的结论是，产后第1天与明显的肾小球超滤有关（+ 41％）。对GFR决定因素的理论分析表明，抑制肾小球毛细血管渗透压的作用是与产后GFR早期升高有关的主要决定因素，该作用是与滤液形成相反的作用力。妊娠高血脂和血液稀释的逆转，在产后第1天仍然很明显，到产后第2周才发生。血浆中的渗透压升高，沿肾小球毛细血管轴向流动至超常水平;随后，血浆中的渗透压升高。但是，GFR仍比非重力水平略微提高（+ 20％）。此时对过滤动力学的分析表明，必须调用Delta P高达16％的显着增加，K（f）约50％的增加或两者中较小的增加的组合，才能解决持久性超滤问题。 。

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