公式を使わずにクリアランスを簡単に理解する

腎臓・泌尿器科

クリアランス

[定義]

クリアランスとは、特定の物質が1分間に尿中に排泄された量と同量の特定の物質を含む血漿流量(mL/min)で表される。

(例題)

物質xの尿中濃度を0.5mg/mL、尿量を3mL/min、血漿中濃度を0.05mg/mLにしたときの物質xのクリアランスを考えてみる。

尿中濃度:0.5mg/mL×尿量:3mL/min=1.5mg/min

物質xは1分間で尿中に1.5mg排泄される。

物質xのクリアランスとは1分間で尿中に排泄される物質xと同量の物質xを含む1分間の血漿流量であるので、

1.5mg/min÷0.05mg/mL=30mL/min

1分間で1.5mgの物質xが尿中に排泄されるとき、1分間で30mLの血漿が「流れる」ことになる。

答え:30mL/min

「血漿流量・物質というのは実際にはフラスコに入っているわけではなく腎臓を流れている」ことがクリアランスを理解しにくくしている。物質が「どこを流れてきて尿中に排泄されたのか」ということによって、その物質が持つクリアランスの意味が変わってくるからである。

イヌリンのように糸球体濾過のみで尿中排泄される物質であれば、その1分間に尿中に排泄されたイヌリンの量と同量のイヌリンを含む血漿流量(イヌリンクリアランス)が意味するものは糸球体濾過量となる。

また、パラアミノ馬尿酸のように糸球体濾過+尿細管分泌によって全て尿中排泄される物質であれば、その1分間に尿中に排泄されたパラアミノ馬尿酸(PAH)の量と同量のパラアミノ馬尿酸(PAH)を含む血漿流量(PAHクリアランス)は有効腎血漿流量となる。

様々な物質のクリアランス

クリアランスを考えるときには物質の尿中排泄様式(糸球体濾過・尿細管分泌)と再吸収の程度に注目して考える必要がある。

物質の尿中排泄様式(糸球体濾過・尿細管分泌)と再吸収の程度の違いによってそれぞれの物資クリアランスは異なる特徴的な意味を持つからである。

また、腎臓に達する血漿の約20%が糸球体で濾過されることも前提として押さえておく。

イヌリン

イヌリンは糸球体濾過のみで尿中排泄される。加えて再吸収されることはない。

このためイヌリンクリアランスは糸球体濾過量(GFR)と等しい。

イヌリンはGFRの「gold standard」だとされている。「gold standard」とは最も正確にGFRを計測できるという意味である。

しかし、イヌリンは生体外物質なので人体に静注投与する必要があり手間がかかるので、日常臨床ではほとんど活用されていない。

パラアミノ馬尿酸(PAH)

パラアミノ馬尿酸は糸球体濾過と尿細管分泌で全て尿中排泄される。加えて再吸収されることはない。

このため、PAHクリアランスは有効腎血漿流量と等しい。

パラアミノ馬尿酸(PAH)は腎の排泄領域では1回の循環でほぼ100%除去されるが、腎の非排泄領域を流れる血流が10%あるので、実際の全腎での除去率は約90%となる。その意味でPAHクリアランスを正確には有効腎血漿流量と呼ぶことがある。

クレアチニン

クレアチニンは糸球体濾過とわずかな尿細管分泌で尿中排泄される。

実測CCr(クレアチニンクリアランス)は正確には24時間蓄尿によって測定しなければならないので手間がかかる。このため実測CCrはあまり臨床的には用いられない。

その代わりに、臨床的には血清クレアチニン値・年齢・性別を推算式に当てはめて算出したeGFR(推算糸球体濾過量)を腎機能評価に用いる。血清クレアチニン値を測るだけでeGFRは算出できるので簡単である。

グルコース

グルコースは糸球体濾過されるが、正常血糖値ではほぼ100%尿細管再吸収される。

しかし、正常血糖値より上昇すると再吸収に限界がきて尿中に排泄されるようになる。

まとめのpdf

コメント

  1. Larraine より:

    Hey there! Do you know if they make any plugins to
    assist with SEO? I’m trying to get my blog to rank for some targeted keywords but
    I’m not seeing very good success. If you know of any please share.
    Thanks! I saw similar text here: Eco bij

  2. trident poses より:

    It’s parallel computing that enables DNA to solve advanced mathematical issues in hours, whereas it’d take electrical computer systems lots of of years to complete them.

  3. Slottica Casino より:

    The next time I read a blog, I hope that it does not fail me as much as this one. I mean, I know it was my choice to read through, but I actually thought you would have something helpful to talk about. All I hear is a bunch of whining about something you could possibly fix if you were not too busy looking for attention.

  4. pandora jewelry より:

    I like reading through an article that will make men and women think. Also, thank you for permitting me to comment.

  5. This is a topic that is close to my heart… Take care! Exactly where are your contact details though?

  6. 라 카지노 より:

    This site was… how do you say it? Relevant!! Finally I have found something that helped me. Thank you!

  7. I was more than happy to uncover this site. I need to to thank you for your time due to this wonderful read!! I definitely appreciated every bit of it and i also have you book-marked to check out new things in your website.

  8. This is much less more likely to get misplaced than the paper, but you do threat losing the file if you have hardware failure.

  9. Spot on with this write-up, I absolutely believe this amazing site needs a lot more attention. I’ll probably be returning to read more, thanks for the info!

  10. His opinion was shared by chess historian Olimpiu G. Urcan, who added that the game itself was longer than all seven episodes of Netflix’s mini-collection The Queen’s Gambit.

  11. As I write this, we’re discussing whether or not we want to risk making some fairly radical modifications to the AI in a patch for a recreation that most people appear to love, and through which NPCs mainly behave as much like real people as they ever have in any game.

  12. He moved to Wilbur and resided right here for the past seven months.

  13. Hoka Shoes より:

    You need to take part in a contest for one of the most useful websites on the internet. I am going to highly recommend this web site!

  14. There is certainly a lot to find out about this topic. I really like all of the points you have made.

  15. Crypto より:

    Everyone loves it when people get together and share thoughts. Great blog, stick with it!

  16. I think this is the most common method to power more variety into checkers play.

  17. Everything is very open with a really clear description of the challenges. It was definitely informative. Your website is extremely helpful. Thanks for sharing.

  18. Bitcoin より:

    There’s definately a lot to know about this topic. I like all the points you made.

  19. Make your wedding ceremony/ party an ideal occasion with style and that features your invitation playing cards from the leading occasion planners in trichy.We’re making your wedding ceremony occasion management in Trichy so much easier with avsamevents.Discover out the best wedding cards in Trichy especially designed uniquely for you by our designers.

  20. Best Stocks より:

    Saved as a favorite, I like your web site.

  21. These items serve dual purposes: holding your room organized and trendy.

  22. EF2 to EF3 harm occurred in this space as multiple homes sustained main structural injury or were destroyed, metal power poles had been snapped, cell properties were obliterated, and lots of large bushes had been snapped and twisted.

  23. He loves animals and is dependable to those he’s friends with as shown with Music Xiaomi when he tries helping her with Ming Tian and housing Tian’s siblings after they lose their house.

  24. Fintech Domains より:

    Good post. I learn something new and challenging on sites I stumbleupon on a daily basis. It will always be useful to read through content from other writers and use something from other sites.

  25. Having read this I believed it was really informative. I appreciate you spending some time and effort to put this information together. I once again find myself personally spending way too much time both reading and posting comments. But so what, it was still worth it!

  26. Excellent site you have got here.. It’s difficult to find good quality writing like yours these days. I really appreciate people like you! Take care!!

  27. You’ll find stunning pure fossils, hand-blown glass art, luxury chandeliers made from art glass, decorative minerals, beautiful handmade jewellery and one-of-a-type oversize panorama decor.

  28. Service to military institutions and veterans.

  29. snaptik より:

    I’m impressed, I have to admit. Rarely do I come across a blog that’s equally educative and interesting, and let me tell you, you’ve hit the nail on the head. The issue is an issue that too few folks are speaking intelligently about. Now i’m very happy that I stumbled across this in my search for something regarding this.

  30. This is the right weblog for anybody who desires to find out about this topic. You realize so much its nearly exhausting to argue with you (not that I actually would need…HaHa). You positively put a new spin on a topic thats been written about for years. Great stuff, just nice! Miss Duke Nukem

  31. Pretty! This was an incredibly wonderful article. Thanks for supplying these details.

  32. Thanks for your entire labor on this web page. Kate really loves managing investigation and it’s really easy to see why. We hear all regarding the lively tactic you deliver informative ideas through the blog and therefore improve response from website visitors on the concern and our simple princess is really starting to learn a great deal. Take advantage of the rest of the new year. You have been conducting a fantastic job.

  33. I was suggested this website by my cousin. I am not sure whether this post is written by him as nobody else know such detailed about my trouble. You are wonderful! Thanks!Nice blog here! Also your web site loads up fast! What web host are you using? Can I get your affiliate link to your host? I wish my website loaded up as quickly as yours lol

  34. Tubidy より:

    An outstanding share! I have just forwarded this onto a coworker who has been doing a little homework on this. And he in fact ordered me lunch due to the fact that I discovered it for him… lol. So let me reword this…. Thanks for the meal!! But yeah, thanks for spending some time to talk about this topic here on your website.

  35. Sometimes I question the internet and what is posted? Honestly the internet used to be like a different place, although it seems to be changing for the better. What do you think?

  36. The next time I read a blog, Hopefully it won’t fail me just as much as this particular one. After all, Yes, it was my choice to read through, nonetheless I really thought you’d have something interesting to say. All I hear is a bunch of crying about something you could possibly fix if you weren’t too busy seeking attention.

  37. Pretty! This has been a really wonderful article. Thanks for supplying this info.

  38. Good blog post. I certainly love this website. Thanks!

  39. J’apprécie cette diapositive toutefois j’en ai auparavant vu de semblable de meilleures qualité supérieure

  40. Your current blogs usually have got a lot of really up to date info. Where do you come up with this? Just saying you are very inspiring. Thanks again

  41. i would have to make more christmas cards becuase next month is december already“

  42. Hello! .order viagra fast delivery , order cialis fast delivery , tadalafil , find cheap viagra , ,

  43. When I originally commented I clicked the -Notify me when new surveys are added- checkbox and after this each time a comment is added I recieve four emails with the exact same comment. Could there be in whatever way you’ll be able to remove me from that service? Thanks!

  44. Your posts continually include much of really up to date info. Where do you come up with this? Just declaring you are very resourceful. Thanks again

  45. Saved as a favorite, I love your web site.

  46. scaffold jacks より:

    we have different sectional sofas at home, i find them very comfortable and easy to setup,

  47. Great article! We are linking to this great post on our website. Keep up the good writing.

  48. My brother suggested I may like this website. He was totally right. This put up actually made my day. You cann’t consider just how much time I had spent for this info! Thanks!

  49. What youre saying is completely true. If I could write like you I would start my own blog.

  50. i would love to sip a cup of green tea each morning because it contains L-theanine which calms the mind..

  51. I would like to add to that statement,but I fear your wrath Sheila, lol! Permission to speak please ; )

  52. Hello there! I could have sworn I have been to this weblog before yet right after going through some of the submit My partner and i noticed it really is a new comer to me personally. Anyhow, Now i’m definitely pleased I came across that and also I’ll be book-marking as well as looking at again often!

  53. Greetings, have you at any time asked yourself to publish regarding Nintendo Dsi handheld?

  54. I am impressed, I must say. very seldom do I stumble upon a blog thats both educational and entertaining, and let me tell you, youve hit the nail on the head. Your post is important; the matter is something that not many of us are speaking intelligently regarding. i’m very happy that I stumbled across this in my explore for one thing relating to it.

  55. There is noticeably big money to understand about this. I suppose you made particular nice points in features also.

  56. Hi! I could have sworn I’ve visited this website before but after going through many of the posts I realized it’s new to me. Nonetheless, I’m definitely pleased I came across it and I’ll be bookmarking it and checking back frequently!

  57. Alfred North Whitehead~ Ideas wont keep something must be done about them. [Reply]

  58. i am amazed how cheap broadband internet is during these year, isps have some promo too.

  59. I have been examinating out a few of your posts and it’s pretty nice stuff. I will surely bookmark your site

  60. An impressive share, I merely given this onto a colleague who had been doing a small analysis within this. And that he actually bought me breakfast since I discovered it for him.. smile. So ok, i’ll reword that: Thnx for the treat! But yeah Thnkx for spending time to talk about this, I’m strongly about this and love reading regarding this topic. If you can, as you grow expertise, would you mind updating your website with more details? It is extremely of great help for me. Massive thumb up for this text!

  61. Bloghopping is really my forte and i like to visit blogs.  

  62. How is it that simply anybody can write a website and acquire as widespread as this? Its not like youve said something incredibly spectacular –more like youve painted a reasonably picture over a difficulty that you simply recognize nothing concerning I don’t want to sound mean, here. but do you really suppose that you can escape with adding some pretty pictures and not really say anything?

  63. You made some decent points there. I looked on the net for the issue and discovered most people will go along with with your web page.

  64. This is a great blog and i want to visit this every day of the week “  

  65. My wife and i got so thrilled that Albert could do his researching via the precious recommendations he had out of your blog. It is now and again perplexing just to always be making a gift of techniques that many the others could have been selling. And we all fully grasp we need the writer to give thanks to for that. All of the explanations you’ve made, the simple blog navigation, the friendships you aid to foster – it’s got everything spectacular, and it’s helping our son in addition to the family know that that subject is satisfying, which is certainly extremely fundamental. Thanks for everything!

  66. Dissipated December 11, 2:36 a.m.

  67. snaptik より:

    An impressive share! I have just forwarded this onto a friend who was doing a little homework on this. And he actually bought me breakfast due to the fact that I stumbled upon it for him… lol. So allow me to reword this…. Thanks for the meal!! But yeah, thanks for spending time to talk about this topic here on your web site.

  68. In 2004, Memorial was named one of many “one hundred Prime Educating Hospitals” by Thomson Reuters.

  69. The development of diaper latticed home windows was partially as a result of three common diamond-shaped panes could possibly be conveniently reduce from a bit of Crown glass, with minimal waste and with minimal distortion.

  70. I wanted to thank you for this great read!! I definitely enjoying every little bit of it I

  71. After I initially commented I appear to have clicked on the -Notify me when new comments are added- checkbox and from now on whenever a comment is added I get 4 emails with the same comment. There has to be a way you are able to remove me from that service? Kudos.

  72. I’m curious to find out what blog platform you have been utilizing? I’m having some minor security problems with my latest site and I would like to find something more risk-free. Do you have any suggestions?

  73. mini scaffold より:

    An impressive share, I just now with all this onto a colleague who had previously been doing small analysis within this. And then he the fact is bought me breakfast because I stumbled upon it for him.. smile. So i want to reword that: Thnx for that treat! But yeah Thnkx for spending any time to discuss this, Personally i think strongly about this and adore reading on this topic. If at all possible, as you become expertise, could you mind updating your website to comprehend details? It really is extremely ideal for me. Large thumb up with this writing!

  74. Good day”your writing style is great and i love it.   

  75. It’s difficult to acquire knowledgeable men and women during this topic, however, you seem like there’s more you are dealing with! Thanks

  76. Good post. I learn something totally new and challenging on sites I stumbleupon on a daily basis. It will always be helpful to read through articles from other writers and practice something from other websites.

  77. Excellent ideas throughout this post, personally I’m gonna have to bookmark this and come back to it. I’m curious if you have any follow ups to this post?

  78. Can I recently say what a relief to seek out someone who really knows what theyre discussing over the internet. You certainly learn how to bring a concern to light and produce it critical. The best way to ought to look at this and fully grasp this side from the story. I cant think youre less popular because you absolutely contain the gift.

  79. On May 28, the Atlanta Journal-Constitution reported that Barr had raised $163,000 in money donations.

  80. I got what you intend, thanks for putting up. Woh I am glad to find this website through google.

  81. find more より:

    May I simply just say what a relief to uncover someone who genuinely knows what they are discussing on the web. You definitely know how to bring a problem to light and make it important. More people should look at this and understand this side of your story. I was surprised that you are not more popular given that you definitely possess the gift.

  82. Company events hold high significance for corporations, as they’re good to boost the information, motivation and productivity.

  83. Can I simply just say what a comfort to find somebody that really knows what they are discussing online. You certainly know how to bring an issue to light and make it important. More and more people really need to look at this and understand this side of the story. I was surprised that you are not more popular given that you certainly have the gift.

  84. Different third moves for White such because the Konstantinopolsky Opening (3.g3), and Inverted Hungarian Opening (3.Be2) are rarely performed and provide White no benefit.

  85. Good post. I learn something totally new and challenging on blogs I stumbleupon on a daily basis. It will always be helpful to read through content from other authors and practice something from their sites.

  86. you have got a great weblog here! if you’d like to cook some invite posts on my blog?

  87. very good post, i certainly enjoy this site, go on it

  88. – Gulvafslibning | Kurt Gulvmand Fantastic goods from you, man. I’ve understand your stuff previous to and you’re just extremely magnificent. I really like what you have acquired here, really like what you’re stating and the way in which you say it. You make it entertaining and you still take care of to keep it smart. I cant wait to read far more – Gulvafslibning | Kurt Gulvmand again from you. Thanks For Share .

  89. certainly like your web-site but you have to check the spelling on quite a few of your posts. Many of them are rife with spelling problems and I in finding it very bothersome to inform the truth however I will definitely come again again.

  90. I tell all my friends to come to your site since you have such great info.

  91. Your style is really unique compared to other people I have read stuff from. Thanks for posting when you have the opportunity, Guess I will just bookmark this blog.

  92. You have made some good points there. I checked on the internet for more information about the issue and found most people will go along with your views on this website.

  93. Ufabet より:

    Good post. I learn something new and challenging on websites I stumbleupon everyday. It’s always useful to read articles from other authors and use a little something from their websites.

  94. I couldn’t refrain from commenting. Well written!

  95. 匿名 より:

    You completed certain good points there. I did searching on the subject matter and found most persons will go together with your blog

  96. This is my first time i visit here. I found so many entertaining stuff in your blog, especially its discussion. From the tons of comments on your articles, I guess I am not the only one having all the enjoyment here! Keep up the good work.

  97. Ufabet より:

    I used to be able to find good advice from your blog articles.

  98. The the very next time I read a blog, Lets hope so it doesnt disappoint me just as much as this. Come on, man, Yes, it was my replacement for read, but I just thought youd have something fascinating to mention. All I hear is really a handful of whining about something that you could fix in the event you werent too busy looking for attention.

  99. I am often to blogging i really appreciate your posts. The content has truly peaks my interest. I’m going to bookmark your website and maintain checking choosing data.

  100. Very nice write-up. I certainly appreciate this website. Thanks!

  101. 6335 株価 より:

    You may follow Vina Guerrero on her Instagram account here.

  102. With havin so much content and articles do you ever run into any issues of plagorism or copyright violation? My site has a lot of exclusive content I’ve either created myself or outsourced but it looks like a lot of it is popping it up all over the web without my permission. Do you know any solutions to help protect against content from being ripped off? I’d certainly appreciate it.

  103. You need to experience a tournament first of the finest blogs on the net. I’ll suggest this site!

  104. マナー意味 より:

    Fennelly and her teammates mentioned fans are drawn to Crooks, a self-described individuals one that often gets stopped for an image or chat when she goes out with mates and household.

  105. Good post. I learn something totally new and challenging on sites I stumbleupon everyday. It will always be helpful to read content from other authors and practice something from other web sites.

  106. Interment Wilbur Cemetery .

  107. Way cool! Some extremely valid points! I appreciate you penning this post plus the rest of the site is extremely good.

タイトルとURLをコピーしました