Blood, 1947, Vol. 2, No. 2, pp. 192-202.
© 1947 American Society of Hematology, Inc.
RENAL FUNCTION DURING CHRONIC ANEMIA IN MAN
STANLEY E. BRADLEY M.D.1 and
GERALDINE P. BRADLEY M.D.1
1 Evans Memorial, Massachusetts Memorial Hospitals, and the Department of Medicine,
Boston University School of Medicine.
1. Renal function has been studied quantitatively in 15 patients with chronic
anemia, 8 of whom were proved to have pernicious anemia. In 7 the anemia was
secondary to chronic blood loss, iron deficiency, paroxysmal nocturnal hemoglobinuria, and leukemia. The effective renal plasma flow and glomerular filtration
rate were measured by clearance technics; and tubular function, by saturation
methods (diodrast Tm and glucose Tm).
2. The effective renal plasma flow, the glomerular filtration rate, and the filtration fraction (percentage of plasma filtered at the glomerulus) were reduced slightly
below the normal values in most subjects. The effective renal whole blood flow
was always greatly reduced, by 46 per cent on the average in males and by 31.8
per cent in females.
3. Since arterial pressure was not significantly depressed it was concluded that
renal vasoconstriction occurs in chronic anemia, possibly as a homeostatic device
for the diversion of blood to tissues more sensitive to oxygen lack. The relatively
small reduction of filtration fraction implies afferent and efferent arteriolar vasoconstriction with dominance by the afferent arterioles. These changes were shown
to be reversible, a return to normal values paralleling the return of the blood picture
to normal.
4. Diodrast Tm was reduced significantly in 9 of 10 patients while the values of
glucose Tm were normal in 6 of 7 patients. The normal values for glucose Tm indicated continued operation of all glomeruli and implied the absence of shunting
or of cessation of blood flow in any significant portion of the kidney. The fall in
diodrast Tm, which appeared to be reversible in 2 of 4 individuals, was interpreted
as evidence of intracellular dysfunction rather than destruction or inactivation of
nephrons.
Note:
We wish to express our gratitude to the Misses Elizabeth Nolan and Constance Qua for technical
assistance.
