Transcription of カリウム代謝の考え方 - jsn.or.jp
1 2008 50. 2 84 90.. 98 .. K . 2K. HIGH K. K . ATP. 2 OUTPUT. 1 3 LOW K 90 . K 1 3Na INPUT. K 50 55 mEq kg 98 % K. 10 . K . 100 . 1 2 % 3Na ATP Na K K . K 2K. 1 K 1 .. 1 K 50 100 mEq .. K DCT . Na CCD .. K CCD . CD cell . mEq L K CD cell . K K Na . Na K Na Na K . 2 K Na K . K CD cell Na . K K K CCD . Na Na . K K . pH K. K 2 1 3 . K . K 70 80 % K . MCD .. TAL IC cell . H K K . Approach to disorders of potassium metabolism K IC cell H . pH . 1 85. CD cell . 70 80 . 3Na Na ATP. 2K. K . 100 K K. MR.. -IC cell . 15 20 . H. ATP MR. HCO3. H Cl ATP Cl K.. K15 . ATP ATP . MR CD cell -IC cell - . 2 K K K 3 . MR 2 K . CD cell K Na H . Na K Na H . K Na IC cell H Na . H Cl HCO3 Na Na . H K .. Na H Na 3 3 .. K mEq L .. 1 . 2 K 2 2 cAMP .. 3 K K K cAMP 5' AMP . K . cAMP Na K .. T U . K . 1 . 3 K . K K .. 86 .. 2- .. 20 mEq/ 20 mEq/ .. S . pH.. pH.. B . Cl Mg . Cl 10 mEq/ Cl 10m Eq/ .. Cl Cl Cl .. Bartter . Gitelman.
2 Cushing .. Liddle 17 hydroxylase . 11 hydroxylase .. AMES .. 3 3 . 1 87. 4 K CCD Na . K Na K . S . Na Cl K HCO3 . 3 .. 5 K .. 1 . RTA MCD . IC cell H Cushing . Sj gren .. IC cell H . H Cl HCO3 GFR CCD Na . RTA K . CCD Na . Na .. RTA . HCO3 HCO3 .. Fan- MR . coni HCO3 11 hydroxysteroid dehydrogenase 11 HSD . Na H H Na HCO3 type 2 CD cell .. HCO3 MR K . HCO3 Na Na . CCD Na .. HCO3 K .. AMES 11 HSD2 loss . 2 of function .. 1 . Cl 3 pH .. 2 . Cl CCD Na . K . Cl Cl CCD .. 3 K . Cl B Na Na K. CD cell K .. Cl . 2 . 3 Bart- 4 3 . ter TAL Na Cl . Gitelman K mEq L . DCT Na Cl . 1 . 2 . 88 .. - .. GFR 20mL/ GFR 20mL/ .. 1 1 . Addison .. 21-hydroxylase . 18-hydroxylase . 18-hydroxysteroid dehydrogenase 2 .. 2 3 .. 3 ST .. - .. 4 3 . K . 3 K K K . K K . T P K . PQ QRS K mEq L . P QRS . 1 89. 1 . K .. K K . K . MR .. 6 ST sulfamethoxazole trimethoprim . 2 K trimethoprim7 Na . Na K .. Na 3 . Addi- K son . K . K GFR.
3 4 . K 30 90 mL .. K 5 .. 8 . 8 . solvent drag K .. 3 K . K .. K K 8,9 .. K G K .. 8,9 . 4 K K . K . 1 . 2 CCD . K . 3 .. 1 K K . GFR 20 mL K . CCD Na . K . 1 Malnic G, Muto S, Giebisch G. Regulation of potassium 2 K excretion. In Alpern RJ, Hebert SC eds . Seldin and CCD K Giebisch's The Kidney Physiology and Pathophysiology, fourth ed. San Diego Elsevier, 2007 1301 1348.. 2 Muto S. Potassium transport in the mammalian collecting duct. RTA RTA H Physiol Rev 2001 81 85 116. IC cell K CD cell 3 K . 90 . 2005 93 883 890 duct. Brit J Pharmacol 1993 109 673 678. 4 Muto S, Sebata K, Ohashi M, Yamada T, Matsumoto H, 7 Muto S, Tsuruoka S, Miyata Y, Fujimura A, Kusano E. Effect Mukouyama T, Namiki S, Kusano E, Asano Y. Serum potas- of trimethoprim sulfamethoxazole on Na and K transport sium handling at pre and posthemodialysis in patients with properties in the rabbit cortical collecting duct perfused in end stage renal disease.
4 ASAIO J 2003 49 660 666. vitro. Nephron Physiol 2006 102 51 60. 5 Muto S, Sebata K, Watanabe H, Shoji F, Yamamoto Y, Ohashi 8 Palmer BF. Managing hyperkalemia caused by inhibitors of the M, Yamada T, Matsumoto H, Mukouyama T, Yonekura T, renin angiotensin aldosterone system. N Engl J Med 2004 . Namiki S, Kusano E. Effect of oral glucose administration on 351 585 592. serum potassium concentration in hemodialysis patients. Am J 9 Ahuja TS, Freema D, Mahnken JD, Agrahakar M, Siddiqui M, Kidney Dis 2005 46 697 705. Memon A. Predictors of the development of hyperkalemia in 6 Muto S, Imai M, Asano Y. Effect of nafamostat mesilate on patients using angiotensin converting enzyme inhibitors. Am J. Na and K transport properties in the rabbit cortical collecting Nephrol 2000 20 268 272.
