| 特集名 | Uremic Toxins | |
|---|---|---|
| 題名 | 総論:尿毒症毒素 -- 古典的な概念から新しい考え方へ | |
| 発刊年月 | 1998年 04月 | |
| 著者 | 鈴木 正司 | 信楽園病院腎センター |
| 【 要旨 】 | 尿毒症を引き起こす原因物質を「尿毒症毒素」と考え，これまでにも2,000を超える物質が検出されている．しかし，1978年にBergstromとFurstにより定義された「尿毒症毒素」の条件では，(1) 化学的に同定され，定量できること，(2) その濃度は尿毒症状態では正常よりも高いこと，(3) その濃度が特有な尿毒症症状と相関すること，(4) 尿毒症での濃度で，in vivoあるいはin vitroでの毒性効果が証明されること，とされた．しかしこの4条件では，実態にそぐわない場合が少なくない．そのため最近では，必ずしも尿毒症症状の発現にかかわらず，腎機能低下を促進したり，腎不全状態で生体に障害を与えたり，透析合併症の誘因となりうる物質を広く「尿毒症毒素」として捉える考え方が主流になってきた． | |
| Theme | Uremic Toxins | |
|---|---|---|
| Title | Uremic toxins -- From the classical definition to the new concept | |
| Author | Masashi Suzuki | Kidney Center of Shinraku-En Hospital |
| [ Summary ] | In the terminal stage of kidney disease, a variety of clinical symptoms are recognized. "Uremia" was proposed to mean "urine in the blood" by Piorry and L'Heritier in 1840. Subsequently, more than 2,000 toxic substances were reported in uremic blood. Then, Bergstrom and Furst, in 1978, proposed minimal criteria for the identification of uremic toxins: 1) which should be chemically identifiable and quantifiable in biological fluids; 2) the concentration in uremic subjects should exceed that in nonuremic subjects; 3) the concentration should correlate with specific uremic symptoms that disappear at the normal concentration; 4) toxic effects in a test system should be demonstrable at the concentration found in uremic subjects. All of these criteria are rarely met, however, often for technical reasons. Recently, the concept of uremic toxins has changed. Thus, the definition proposed by Bergstrom and Furst should be considered classical. In the new concept, the substances that damage normal physiological functions, or interfere with physiological defence mechanisms in renal failure have also been recognized as "uremic toxins". Some may play a role in the progression of renal disease, inducing uremic symptoms, and may contribute to dialysis-related complications. |
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