薬剤の腎に与える影響について

Abstract

Blood transfusion is often needed in surgical operation. However, blood for transfusion is insufficient recently and furthermore blood transfusion accompanies a risk of serum hepatitis. Accordingly, various blood substitutes are devised. Plasma volume increasing agent is one of them.I had used sodium arginate preparation, a plasma volume increasing agent, from 1964 to 1966. In 31 or 65.9 per cent of the 47 cases receiving this preparation an increase of serum nitrogen level probaly due to it was observed. It was remarkable that a variation of serum nitrogen level was relatively small in the patients with normal renal function but radical those with lowered renal function. In addition, 14 of the 47 cases given this preparation died. Four of them autopsied. In all of them basophilic substance was found in tubular spaces of glomeruli and uriniferous tubles in the kidney without combined use of KM.Thus, I examined the influence of single use of plasma volume increasing agents and antibiotics and combined use of them upon the kidney in rats. Plasma volume increasing agents used were dextran preparation (20ml/day), sodium arginate solution (10ml/day), gelatin preparation (200ml/day) and polyvinylpyroridone preparation (20ml/day). Antibiotics used were SM (200mg/day: half dose in combined use of 2 antibiotics. The same condition was applied to the others), CP (200mg/day), KM (200mg/day) and CL (200, 000u/day). Plasma volume increasing agents were injected into the peritoneal cavity and antibiotics were intramuscularly used. Serum nitrogen level was measured and the kidney was examined histologically.1) So-called “osmotic nephrosis” was found in rats administered with any of plasma volume increasing agents. This change was most conspicuous in rats injected with sodium arginate preparation. Serum nitrogen level was scarecely influenced by any plasma volume increasing preparations.2) Serum nitrogen level varied most markedly in rats injected with KM or CL. Histologically all antibiotics caused the change similar to “osmotic nephrosis”. Specially strong change was observed in rats injected with KM or CL.3) Of combined uses of 2 antibotics the combination of KM and CL had the strongest influence upon serum nitrogen level. All combinations of 2 antibiotics brought about “osmotic nephrosis”. However, this phenomenon was most conspicuous in combinations including CL.4) Of combined uses of a plasma volume increasing agent and antibiotic the combination of sodium arginate solution and either KM or CL increased serum nitrogen to the highest level. Histologic change of the kidney was also most conspicuous in these 2 combination. The histologic change observed was so-called “osmotic nephrosis” in any combinations of a plasma volume increasing agent and an antibiotic.5) Serum nitrogen level and histologic change of the kidney were pursuited after stopping the treatment in rats administered with either gelatin preparation or polyvinyl preparation and one of the antibiotics jointly. Serum nitrogen level tended to rise temporarily when KM was combined. It decreased gradually after stopping combined use of CL. The histologic change of the kidney was temporarily strengthened after stopping combined use of KM. Abnormal changes of the kidney returned to normal little by little after stopping combined use of SM, CP or CL.