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Divergenz der renalen Natrium- und Magnesiumexkretion nach Trometamol (Trispuffer), Amilorid-HCl, Acetazolamid und Parathormon — ein Effekt der Harnalkalisierung?

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Zusammenfassung

Eine Harnacidifizierung durch Ammoniumchlorid führt nach Wiley u. Mitarb. (1933) zu beschleunigter Magnesium- und Calciumexkretion. Über den Einfluß einer Harnalkalisierung bestehen keine gesicherten Vorstellungen. Zu diesem Problem wurde der Einfluß von Trometamol (20 g), Amilorid-HCl (20 mg), Acetazolamid (500 mg) und Parathormon (100 E) auf Glomerulumfiltrat, Harn-pH, sowie Clearance mono- und bivalenter Kationen geprüft.

Alle Pharmaka führten mit Anstieg von Harn-pH und Natriurese zu einer verzögerten Magnesiumexkretion. Sie war sowohl bei erhöhter Kalium-Clearance (Trometamol, Acetazolamid, und Parathormon) als auch bei verminderter Kalium-Clearance (Amilorid-HCl) ausgeprägt. Eine Diureseabhängigkeit bestand nicht. Die Calcium-Clearance zeigte nicht signifikante Änderungen. Auf das Glomerulumfiltrat hatte Parathormon keinen Einfluß; nach den anderen Pharmaka traten insignifikante Abnahmen auf.

Als Ursache der verzögerten Magnesium-Exkretion nach Harnalkalisierung kommt sowohl eine gesteigerte Magnesium-Reabsorption als auch eine Unterdrückung der hypothetischen Sekretion in Betracht. der hypothetischen Sekretion in Betracht.

Summary

Ammonium chloride induced urinary acidification is known to produce an increased excretion of magnesium and calcium. On the other hand the effect of urinary alcalization on these ions is not established, as yet. Increases of Mg-excretion obtained after NaHCO3 application in some experiments, could be explained by Na-loading, which enhances Mg-excretion.

To investigate a possible specific effect of urinary alcalization trometamol (tris-buffer), amiloride, acetazolamide and parathormone have been studied under clearance conditions.

All drugs resulted in an increase of urinary pH and Na-excretion, whereas Mg-excretion decreased. This effect was independant of potassium excretion, which increased after trometamol, acetazolamide and parathormone and decreased after amiloride.

Changes of Ca-clearance were variable. Following acetazolamide application, there was a mean increase of 18%, whereas parathormone and amiloride resulted in an decrease of 6 or 28% respectively. Trometamol did not exert any effect on calcium excretion. The decrease in Mg-excretion after urinary alcalization might be due to an increased tubular reabsorption and/or depression of as yet hypothetical secretion.

Assuming that the delayed Mg-excretion is present after chronic drug application, the potassium sparing amiloride should be able to reduce Mg-loss, induced by diuretic or corticosteroid therapy.

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  1. Medizinische Universitätsklinik Würzburg, Germany

    A. Heidland, A. Röckel, R. Maidhof & H. Hennemann

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Heidland, A., Röckel, A., Maidhof, R. et al. Divergenz der renalen Natrium- und Magnesiumexkretion nach Trometamol (Trispuffer), Amilorid-HCl, Acetazolamid und Parathormon — ein Effekt der Harnalkalisierung?. Klin Wochenschr 48, 371–374 (1970). https://doi.org/10.1007/BF01484867

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