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1 Department of Obstetrics and Gynecology, University of Newcastle upon Tyne, Newcastle upon Tyne, NE1 4LP United Kingdom; and 2 Departments of Medicine, Obstetrics and Gynecology, and Clinical Pharmacology, University of Chicago, Chicago, Illinois 60637
Human pregnancy is associated with
substantial increments in glomerular filtration rate (GFR) and renal
plasma flow (RPF). We have previously demonstrated that permselectivity
to neutral dextrans is altered in pregnancy, theoretical analysis of
the dextran sieving curves suggesting that elevated GFR is due to increased RPF and decreased glomerular oncotic pressure
(
GC) with no evidence of increased transglomerular
hydrostatic pressure difference (
P). These conclusions have been
challenged, with claims that the rise in GFR is primarily a result of a
decrement in
GC. With refined laboratory and infusion
protocols, we have reexplored the determinants of ultrafiltration in a
serial study of 11 healthy women in late pregnancy (LP) and 4 mo
postpartum (PP), both in the baseline state and after increasing GFR
and RPF by infusion of amino acids. Results were analyzed using two computer modeling programs. Increased GFR in LP (38%, P < 0.05) was due to a combination of elevated RPF (22%) and a decrement in
GC and associated with an increased ultrafiltration
coefficient, without evidence of increased
P, and additional amino
acid-provoked GFR increments (P < 0.05) produced
similar findings. In addition, refined methodology permitted collection
of sufficient data on excreted large-radii dextrans (>60 Å) to
better define the nondiscriminatory "shunt" pathway
(
0) and the standard deviation of pore size
(S) about the mean radius of the distribution. Thus it was
possible to demonstrate that the physiological increase in total
protein excretion in LP is associated with a prominent shunt and an
upward shift in breadth of distribution of pore sizes. This ability to quantify
0 and S will now permit better
evaluation of the pathophysiological changes in the glomerulus
associated with pregnancy in women with renal disease and in gravidas
developing preeclampsia.
renal hemodynamics; dextran clearance; pregnancy
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