後天性心臓瓣膜疾患に於ける腎機能

In chronic congestive heart failure, disturbances of renal hemodynamics have long been observed by many investigators ; in 1995 I reported the renal function in congestive failure.In this study, the relationship between renal and cardiovascular hemodynamic functions in 59 with valvular disease and, especially, in 9 with mitral stenosis before and after commissurotomy, was investigated. These patients were divided into 3 groups : Group I, 24 without cardiac decompensation, Group II, 23 with edema-free caridac decompensation and Group III, 17 with edema in the state of cardiac decompensation.1) In compensated group, RPF was 464 ± 95cc/min, GFR 111 ± 18cc/min and FF 0.258 ± 0.056. In Group II, RPF was 308 ± 64cc/min, GFR 94 ± 20cc/min and FF 0.309 ± 0.036. In Group III, RPF WAS 192 ± 72cc/min, GFR 73 ± 21cc/min and FF 0.407 ± 0.108.2) Between renal blood flow and venous congestion, consistent relationship was observed : Correlation coefficient between log RBF and log peripheral venous pressure was -0.7538, and that between log RBF and log inferior vena cava pressure -0.6354.3) Correlation coefficient between RBF and pulmonary capillary mean pressure was -0.8803, and that between log RBF and log pulmonary artery means pressure -0.6231. Thus, there is parallelism between renal and pulmonary hemodynamic functions.4) There was no consistent relationship between renal blood flow and cardiac index.Renal fraction of cardiac output in the state of decompensation was generally lower but not correlated to degree of venous congestion.5) Studies before and after commissurotomy in mitral stenosis showed a slight increase in RBF, GFR and cardiac output, but there was no correlation between RBF and cardiac index. Pulmonary arterial and capillary pressure were reduced significantly. The calculated total renal resistance was not changed, but Ra (afferent arteriolar resistance) increased significantly and Re (efferent arteriolar resistance) decreased insignificantly and the balance between Ra and Re was restored. Total pulmonary resistance was reduced markedly, but arteriolar resistance showed no change ; therefore, mitral valvular resistance was markedly reduced.In conclusion, renal hemodynamic functions show sensitively the states of circulatory alterations in heart disease. And the above-mentioned resuls coincide with the "backward-failure theory" about the congestive heart failure rather than the "forward-failure theory".