AÚÙËÚȷ΋ Y¤ÚÙ·ÛË 18, 2-3: 146 - 163, 2009

ANA™∫O¶∏™∏

Δ· ‰ÈÔ˘ÚËÙÈο ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË. ª¤ÚÔ˜ ∞′:

ªË¯·ÓÈÛÌÔ› ‰Ú¿Û˘, Ê·ÚÌ·ÎÔÏÔÁÈΤ˜ ȉÈfiÙËÙ˜
Î·È ÎÏÈÓÈΤ˜ ÂӉ›ÍÂȘ ÙˆÓ ‰ÈÔ˘ÚËÙÈÎÒÓ

¶.π. °ÂˆÚÁÈ·Ófi˜ ¶∂ƒπ§∏æ∏

¶.∞. ™·Ú·Ê›‰Ë˜ Δ· ‰ÈÔ˘ÚËÙÈο Â›Ó·È ·fi Ù· ϤÔÓ ÛËÌ·ÓÙÈο Ê¿Ú̷η ÛÙÔ ıÂÚ·¢ÙÈÎfi ÔÏÔ-
¡. ™·‚‚›‰Ë˜ ÛÙ¿ÛÈÔ Î·È ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Â˘Ú¤ˆ˜ Â‰Ò Î·È ÂÚ›Ô˘ 50 ¯ÚfiÓÈ·, ·Ú¤¯ÔÓÙ·˜
ÛËÌ·ÓÙÈ΋ ‚Ô‹ıÂÈ· ÛÙË ıÂÚ·›· ÔÏÏÒÓ ·ı‹ÛˆÓ. ¶·ÚfiÙÈ fiÏ· Ù· ‰ÈÔ˘ÚË-
ÙÈο ‰ÚÔ˘Ó Î˘Ú›ˆ˜ ·ÚÂÌÔ‰›˙ÔÓÙ·˜ ÙËÓ Â·Ó·ÚÚfiÊËÛË ÙÔ˘ Ó·ÙÚ›Ô˘ ÛÙ· ÓÂ-
ÊÚÈο ÛˆÏËÓ¿ÚÈ·, ‰È·Ê¤ÚÔ˘Ó ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙÔ˘˜ ˆ˜ ÚÔ˜ ÙÔ Ì˯·ÓÈÛÌfi
Î·È ÙÔ ÛËÌÂ›Ô ‰Ú¿Û˘ Î·È ÂÔ̤ӈ˜ ÙȘ ÂȉÈΤ˜ Ê·ÚÌ·ÎÔÏÔÁÈΤ˜ ȉÈfiÙËÙ˜ ηÈ
ÙȘ ÎÏÈÓÈΤ˜ ÙÔ˘˜ ÂӉ›ÍÂȘ. Δ· ‰ÈÔ˘ÚËÙÈο Ù˘ ·Á·Ï˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Î˘-
Ú›ˆ˜ Û ÔȉËÌ·ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ (.¯. ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·, ÓÂÊÚˆÛÈÎfi Û‡Ó-
‰ÚÔÌÔ) Î·È ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È ÙÔ˘ fiÁÎÔ˘ ˘ÁÚÒÓ Û ·ÛıÂ-
Ó›˜ Ì ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ÓfiÛÔ. Δ· ıÂÈ·˙ȉÈο ‰ÈÔ˘ÚËÙÈο Â›Ó·È ·fi Ù· ϤÔÓ Â˘-
Ú¤ˆ˜ Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡ÌÂÓ· Ê¿Ú̷η ÛÙË ıÂÚ·›· Ù˘ ˘¤ÚÙ·Û˘, ÔÈ ·ÓÙ·-
ÁˆÓÈÛÙ¤˜ Ù˘ ·Ï‰ÔÛÙÂÚfiÓ˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ·Ú·‰ÔÛȷο ÛÙË ıÂÚ·›·
ÙÔ˘ ÚˆÙÔ·ıÔ‡˜ ·Ï‰ÔÛÙÂÚÔÓÈÛÌÔ‡ Î·È ÔÈ ¿ÏϘ ηÙËÁÔڛ˜ ‰ÈÔ˘ÚËÙÈÎÒÓ
¤¯Ô˘Ó ÈÔ ÂȉÈΤ˜ ÎÏÈÓÈΤ˜ ÂӉ›ÍÂȘ. ∂ÈϤÔÓ, Ë Û˘Ó¯‹˜ ¤Ú¢ӷ ¿Óˆ ÛÙÔ
·ÓÙÈΛÌÂÓÔ ·Ó·‰ÂÈÎÓ‡ÂÈ Â˘ÂÚÁÂÙÈΤ˜ ‰Ú¿ÛÂȘ ÔÚÈÛÌ¤ÓˆÓ ‰ÈÔ˘ÚËÙÈÎÒÓ Û ÎÏÈÓÈ-
Τ˜ ηٷÛÙ¿ÛÂȘ Û·ÊÒ˜ ‰È·ÎÚÈÙ¤˜ ·fi ÙȘ ·ÚȘ ıÂÚ·¢ÙÈΤ˜ ÂӉ›ÍÂȘ ·˘-
ÙÒÓ ÙˆÓ Ê·ÚÌ¿ÎˆÓ (.¯. ηډȷ΋ Î·È ÓÂÊÚÈ΋ ÚÔÛÙ·Û›· ÁÈ· ÙÔ˘˜ ·ÓÙ·Áˆ-
ÓÈÛÙ¤˜ Ù˘ ·Ï‰ÔÛÙÂÚfiÓ˘). ™Â οı ÂÚ›ÙˆÛË, Ë ÁÓÒÛË Ù˘ Ê·ÚÌ·ÎÔÏÔÁÈÎÒÓ
ȉÈÔÙ‹ÙˆÓ ÙˆÓ ‰ÈÔ˘ÚËÙÈÎÒÓ ·ÔÙÂÏ› ÙËÓ ··Ú·›ÙËÙË ÚÔ¸fiıÂÛË ÁÈ· ÙË Ûˆ-
ÛÙ‹ ÂÈÏÔÁ‹ Î·È ÙËÓ ÂÈÙ˘¯‹ ¯Ú‹ÛË ÙˆÓ ‰ÈÔ˘ÚËÙÈÎÒÓ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË. ΔÔ
¿ÚıÚÔ ·˘Ùfi ·ÔÙÂÏ› ÌÈ· ·Ó·ÛÎfiËÛË ÙˆÓ Ì˯·ÓÈÛÌÒÓ ‰Ú¿Û˘ Î·È ÙˆÓ Ê·Ú-
Ì·ÎÔÏÔÁÈÎÒÓ È‰ÈÔÙ‹ÙˆÓ ÙˆÓ ‰È¿ÊÔÚˆÓ Î·ÙËÁÔÚÈÒÓ ‰ÈÔ˘ÚËÙÈÎÒÓ ¤¯ÔÓÙ·˜ ˆ˜
ÛÙfi¯Ô Ó· ·Ú¤¯ÂÈ Û ‚¿ıÔ˜ ÁÓÒÛÂȘ Û¯ÂÙÈο Ì ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ¯Ú‹ÛË ÙˆÓ
‰ÈÔ˘ÚËÙÈÎÒÓ Û ·ÛıÂÓ›˜ Ì ‰È¿ÊÔÚ˜ ·ı‹ÛÂȘ.

∂π™∞°ø°∏
Δ· ‰ÈÔ˘ÚËÙÈο Â›Ó·È ıÂÚ·¢ÙÈο ÂÚÁ·Ï›· Ù· ÔÔ›· ¯ÚËÛÈ-
ÌÔÔÈÔ‡ÓÙ·È Â˘Ú¤ˆ˜ ÛÙË ıÂÚ·›· ÔÏÏÒÓ ·ı‹ÛÂˆÓ Û fiÏÔ ÙÔÓ
ÎfiÛÌÔ. ŸÏ· Ù· ‰ÈÔ˘ÚËÙÈο ‰ÚÔ˘Ó Î˘Ú›ˆ˜ ·ÚÂÌÔ‰›˙ÔÓÙ·˜ ÙËÓ
Â·Ó·ÚÚfiÊËÛË Na+ Î·È Î·Ù¿ Û˘Ó¤ÂÈ·, ÙËÓ Â·Ó·ÚÚfiÊËÛË ‡‰·-
ÙÔ˜ ÛÙ· ÓÂÊÚÈο ÛˆÏËÓ¿ÚÈ·. øÛÙfiÛÔ, ‰È·Ê¤ÚÔ˘Ó ·ÚÎÂÙ¿ ÌÂٷ͇
ΔÌ‹Ì· ¡ÂÊÚÔÏÔÁ›·˜ Î·È ÙÔ˘˜ ÛÙË ¯ËÌÈ΋ ÙÔ˘˜ ÚԤϢÛË Î·È ÛÙÔ Ì˯·ÓÈÛÌfi ‰Ú¿Û˘, .¯.
À¤ÚÙ·Û˘, ÛÙ· ÂȉÈο ÛˆÏËÓ·Úȷο Û˘ÛÙ‹Ì·Ù· ÌÂÙ·ÊÔÚ¿˜ ÈfiÓÙˆÓ Ì ٷ
∞ã ¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ∞¶£, ÔÔ›· ·ÏÏËÏÂȉÚÔ‡Ó. ΔÔ ÙÂÏÂ˘Ù·›Ô ηıÔÚ›˙ÂÈ ÙÔ ÛËÌÂ›Ô Î·Ù¿
¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞, Ì‹ÎÔ˜ ÙÔ˘ ÓÂÊÚÒÓ· ÛÙÔ ÔÔ›Ô Ë Î¿ı ηÙËÁÔÚ›· ‰ÈÔ˘ÚËÙÈÎÒÓ
£ÂÛÛ·ÏÔÓ›ÎË ·ÛΛ ÙË ‰Ú¿ÛË Ù˘ ηÈ, ηıÒ˜ Ê˘ÛÈÔÏÔÁÈο ÙÔ ÔÛfi ÙÔ˘ Na+
 AÚÙËÚȷ΋ Y¤ÚÙ·ÛË, 18, 2-3
Ô˘ Â·Ó·ÚÚÔÊ¿Ù·È ‰È·Ê¤ÚÂÈ ÌÂٷ͇ ÙˆÓ ‰È¿ÊÔ-
ÚˆÓ ÙÌËÌ¿ÙˆÓ ÙÔ˘ ÓÂÊÚÈÎÔ‡ ÛˆÏËÓ·Ú›Ô˘, ÙÔ ÛË-
ÌÂ›Ô ‰Ú¿Û˘ ÂÈϤÔÓ Î·ıÔÚ›˙ÂÈ ÙË Ó·ÙÚÈÔ˘ÚËÙÈ-
΋ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·, ÙȘ Ê·ÚÌ·ÎÔÏÔÁÈΤ˜ ‰Ú¿-
ÛÂȘ Î·È ÙȘ ÂȉÈΤ˜ ÎÏÈÓÈΤ˜ ÂӉ›ÍÂȘ οı ‰ÈÔ˘-
ÚËÙÈÎÔ‡1,2. ∫·Ù¿ Û˘Ó¤ÂÈ·, Ë ÁÓÒÛË Ù˘ Ê·ÚÌ·-
ÎÔÏÔÁ›·˜ ÙÔ˘ οı ‰ÈÔ˘ÚËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ·fi ÙË
Ì›· ÏÂ˘Ú¿ Î·È Ë Î·Ù·ÓfiËÛË Ù˘ ·ıÔÊ˘ÛÈÔÏÔ-
Á›·˜ Ù˘ ÓfiÛÔ˘ ÙÔ˘ ·ÛıÂÓÔ‡˜ ·fi ÙËÓ ¿ÏÏË ·Ô-
ÙÂÏÔ‡Ó ‚·ÛÈΤ˜ ÚÔ¸Ôı¤ÛÂȘ ÁÈ· ÙËÓ ÂÈÙ˘¯‹ ÂÈ-
ÏÔÁ‹ Î·È ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ¯Ú‹ÛË ÙˆÓ ‰ÈÔ˘ÚË-
ÙÈÎÒÓ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË.
∂Í·ÈÙ›·˜ ÙˆÓ ‰È·ÊÔÚÒÓ ÛÙȘ Ê·ÚÌ·ÎÔÏÔÁÈΤ˜
ȉÈfiÙËÙ˜, ÔÈ ‰È¿ÊÔÚ˜ ηÙËÁÔڛ˜ ÙˆÓ ‰ÈÔ˘ÚËÙÈÎÒÓ
¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› ‰È·ÊÔÚÂÙÈο ÛÙË ıÂÚ·›·
ÎÔÈÓÒÓ Î·È ÏÈÁfiÙÂÚÔ ÎÔÈÓÒÓ ·ı‹ÛˆÓ. Δ· ‰ÈÔ˘-
ÚËÙÈο Ù˘ ·Á·Ï˘ Â›Ó·È Û˘Ó‹ıˆ˜ Ë ÚÒÙË ÂÈÏÔ-
Á‹ Û ÔȉËÌ·ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ (.¯. ηډȷ΋ ·ÓÂ-
¿ÚÎÂÈ·, ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ, ΛÚÚˆÛË ‹·ÙÔ˜)
fiˆ˜ Î·È ÛÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ηÈ
ÙÔ˘ fiÁÎÔ˘ ˘ÁÚÒÓ Û ·ÛıÂÓ›˜ Ì ÚÔ¯ˆÚË̤ÓË ¯Úfi-
ÓÈ· ÓÂÊÚÈ΋ ÓfiÛÔ (á¡)1-3. Δ· ıÂÈ·˙ȉÈο ‰ÈÔ˘ÚË-
ÙÈο ·ÔÙÂÏÔ‡Ó ÁÈ· ¯ÚfiÓÈ· ÙÔÓ ·ÎÚÔÁˆÓÈ·›Ô Ï›ıÔ
ÛÙË ıÂÚ·›· Ù˘ ˘¤ÚÙ·Û˘, ÂÓÒ Ù· ηÏÈÔÛ˘ÓÙË-
ÚËÙÈο ‰ÈÔ˘ÚËÙÈο ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û˘Ó‹ıˆ˜ ÁÈ·
ÙË ‰ÈfiÚıˆÛË Ù˘ ·ÓÂ¿ÚÎÂÈ·˜ Î·Ï›Ô˘ Û ·ÛıÂÓ›˜
Ì ˘¤ÚÙ·ÛË ‹ ÁÈ· ÙÔÓ ÚˆÙÔ·ı‹ ·Ï‰ÔÛÙÂÚÔÓÈ-
ÛÌfi2,4. OÈ ¿ÏϘ ηÙËÁÔڛ˜ ÙˆÓ ‰ÈÔ˘ÚËÙÈÎÒÓ ¯ÚË-
ÛÈÌÔÔÈÔ‡ÓÙ·È Î˘Ú›ˆ˜ Û ÈÔ ÂȉÈΤ˜ ÎÏÈÓÈΤ˜ η-
Ù·ÛÙ¿ÛÂȘ, fiˆ˜ .¯. ÔÈ ·Ó·ÛÙÔÏ›˜ Ù˘ ηڂÔÓÈ΋˜
·Ó˘‰Ú¿Û˘ ÛÙÔ ÁÏ·‡ÎˆÌ· Î·È Ù· ˆÛ̈ÙÈο ‰ÈÔ˘-
ÚËÙÈο ÛÙÔ ÂÁÎÂÊ·ÏÈÎfi Ô›‰ËÌ·1-3. OÈ ‰È·ı¤ÛÈ̘ ‰È-
Ô˘ÚËÙÈΤ˜ ÂÓÒÛÂȘ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó
ÛÂ Û˘ÁÎÂÎÚÈ̤ÓÔ˘˜ Û˘Ó‰˘·ÛÌÔ‡˜ ·Ú¤¯ÔÓÙ·˜ ‚Ô‹-
ıÂÈ· ÛÙÔÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ fiÁÎÔ˘ ˘ÁÚÒÓ
Û ·ÛıÂÓ›˜ Ì ·ÓÙÔ¯‹ ÛÙË ıÂÚ·›· ‹ Û ·ÛıÂÓ›˜
Ì ÔÏÏ¿ ˘ÔΛÌÂÓ· ÚÔ‚Ï‹Ì·Ù·. ∂ÈϤÔÓ, Ë Û˘-
Ó¯È˙fiÌÂÓË ¤Ú¢ӷ ʤÚÓÂÈ ‰È·ÚÎÒ˜ ÛÙÔ Êˆ˜ ˘Ô-
Û¯fiÌÂÓ· ‰Â‰Ô̤ӷ Û¯ÂÙÈο Ì ¢ÂÚÁÂÙÈΤ˜ ‰Ú¿ÛÂȘ
ÔÚÈÛÌ¤ÓˆÓ Î·ÙËÁÔÚÈÒÓ ‰ÈÔ˘ÚËÙÈÎÒÓ Û ÎÏÈÓÈΤ˜
ηٷÛÙ¿ÛÂȘ ‰È·ÎÚÈÙ¤˜ ·fi ÙȘ ·ÚȘ ÎÏÈÓÈΤ˜ ÂÓ-
‰Â›ÍÂȘ ·˘ÙÒÓ ÙˆÓ Ê·Ú̿ΈÓ, ·Ú¤¯ÔÓÙ·˜ ÙË ‰˘-
Ó·ÙfiÙËÙ· ÁÈ· Ӥ˜ ıÂÚ·¢ÙÈΤ˜ ÂÈÏÔÁ¤˜ Û ÔÏ-
ÏÔ‡˜ ·ÛıÂÓ›˜.
∞˘Ùfi ÙÔ ¿ÚıÚÔ ·ÔÙÂÏ› ÙÔ ÚÒÙÔ Ì¤ÚÔ˜ ÌÈ·˜
·Ó·ÛÎfiËÛ˘ Ô˘ ·ÊÔÚ¿ ÙËÓ ÎÏÈÓÈ΋ ¯Ú‹ÛË ÙˆÓ ‰È-
Ô˘ÚËÙÈÎÒÓ, ÙÔ ÔÔ›Ô ·Ó·Ï‡ÂÈ ÙÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜
‰Ú¿Û˘ Î·È ÙȘ Ê·ÚÌ·ÎÔÏÔÁÈΤ˜ ȉÈfiÙËÙ˜ ÙˆÓ ‰È¿-
ÊÔÚˆÓ Î·ÙËÁÔÚÈÒÓ ÙˆÓ ‰ÈÔ˘ÚËÙÈÎÒÓ ÂÓÒÛÂˆÓ ÌÂ
ÛÎÔfi Ó· ·Ú¿Û¯ÂÈ ‚·ıÂÈ¿ ÁÓÒÛË ÛÙËÓ ·ÔÙÂÏÂ-
ÛÌ·ÙÈ΋ ¯Ú‹ÛË ·˘ÙÒÓ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÛÙȘ ‰È¿ÊÔÚ˜
147
ÎÏÈÓÈΤ˜ ηٷÛÙ¿ÛÂȘ, Ô˘ ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ÙȘ
ηıÈÂڈ̤Ó˜ Î·È ÙȘ ·Ó·‰˘fiÌÂÓ˜ ÎÏÈÓÈΤ˜ ÙÔ˘˜
ÂӉ›ÍÂȘ.
Δ∞•π¡Oª∏™∏, ª∏Ã∞¡π™ªO™
¢ƒ∞™∏™ ∫∞π ∫§π¡π∫∂™ ∂¡¢∂π•∂π™
Δø¡ ¢πOÀƒ∏Δπ∫ø¡
ŸÏ· Ù· ‰ÈÔ˘ÚËÙÈο Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È
ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË ‰ÚÔ˘Ó ·ÚÂÌÔ‰›˙ÔÓÙ·˜ ÙËÓ
Â·Ó·ÚÚfiÊËÛË ÙÔ˘ Na+ ÛÙ· ÓÂÊÚÈο ÛˆÏËÓ¿ÚÈ·,
Î·È Î·Ù¿ Û˘Ó¤ÂÈ·, ·˘Í¿ÓÔÓÙ·˜ ÙËÓ ÎÏ·ÛÌ·ÙÈ΋
·¤ÎÎÚÈÛË Na+ (FENa). °ÂÓÈο, οو ˘fi Û˘Óı‹-
Θ Ê˘ÛÈÔÏÔÁÈ΋˜ ÚfiÛÏ˄˘ Na+, Ë ÎÏ·ÛÌ·ÙÈ΋
·¤ÎÎÚÈÛË Na+ ·Ú·Ì¤ÓÂÈ Î¿Ùˆ ·fi 1%, ‰ËÏ·‰‹
¿Óˆ ·fi ÙÔ 99% Ù˘ ‰ÈËıÔ‡ÌÂÓ˘ ÔÛfiÙËÙ·˜ Na+
Â·Ó·ÚÚÔÊ¿Ù·È ÛÙ· ÓÂÊÚÈο ÛˆÏËÓ¿ÚÈ·. ∏ «ÎÈÓË-
Ù‹ÚÈÔ˜ ‰‡Ó·ÌË» ÁÈ· ÙËÓ Â·Ó·ÚÚfiÊËÛË ÙÔ˘ NaCl
ÚÔ¤Ú¯ÂÙ·È ·fi ÙË ‰Ú¿ÛË ÙÔ˘ ÂÓ˙‡ÌÔ˘ Na+-K+-
∞TP·ÛË Ù˘ ‚·ÛÂÔÏ¢ÚÈ΋˜ ÂÈÊ¿ÓÂÈ·˜ ÙˆÓ Ûˆ-
ÏËÓ·ÚÈ·ÎÒÓ ÂÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ, Ë ÔÔ›· ¯ÚË-
ÛÈÌÔÔÈ› ÂÓ¤ÚÁÂÈ· ÁÈ· Ó· ÌÂٷʤÚÂÈ Na+ ·fi ÙÔ
ÂÓ‰Ô·ÙÙ·ÚÈÔ ÛÙÔ ‰È·ÌÂÛÔÛˆÏËÓ·ÚÈ·Îfi Î·È ÛÙË Û˘-
Ó¤¯ÂÈ· ÛÙÔÓ ÂÓ‰·ÁÁÂÈ·Îfi ¯ÒÚÔ Î·È ∫+ ·fi ÙÔ ‰È·-
ÌÂÛÔÛˆÏËÓ·ÚÈ·Îfi ¯ÒÚÔ ÂÓÙfi˜ ÙÔ˘ ΢ÙÙ¿ÚÔ˘. ∞˘Ù‹
Ë Û˘Ó¯‹˜ ‰Ú¿ÛË Â›Ó·È ˘‡ı˘ÓË ÁÈ· ÙË ‰È·Ù‹ÚËÛË
¯·ÌËÏÒÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ Na+ Î·È ˘„ËÏÒÓ Û˘ÁÎÂ-
ÓÙÚÒÛÂˆÓ ∫+ ÛÙÔÓ ÂÓ‰Ô΢ÙÙ¿ÚÈÔ ¯ÒÚÔ, fiˆ˜ ηÈ
ÁÈ· ÙËÓ ÂÈÎÚ¿ÙËÛË ·ÚÓËÙÈÎÔ‡ ËÏÂÎÙÚÈÎÔ‡ ÊÔÚÙ›Ô˘
ÛÙÔ ÂÛˆÙÂÚÈÎfi ÙÔ˘ ΢ÙÙ¿ÚÔ˘ Û ۯ¤ÛË Ì ÙÔ Â͈-
΢ÙÙ¿ÚÈÔ ˘ÁÚfi. ∏ ÙÂÏÂ˘Ù·›· ËÏÂÎÙÚÔ¯ËÌÈ΋ ÎÏ›ÛË
·ÔÙÂÏ› ÙËÓ Ô‰ËÁfi ‰‡Ó·ÌË ÁÈ· ÙË ÌÂÙ·ÊÔÚ¿ ÙˆÓ
ıÂÙÈο ÊÔÚÙÈÛÌ¤ÓˆÓ ÈfiÓÙˆÓ Na+ ·fi ÙËÓ Â͈ÙÂÚÈ-
΋ ÌÂÌ‚Ú¿ÓË ÛÙÔ ÂÛˆÙÂÚÈÎfi ÙÔ˘ ΢ÙÙ¿ÚÔ˘. ∞˘Ù‹ Ë
·ıËÙÈ΋ ÌÂÙ·ÊÔÚ¿ Ï·Ì‚¿ÓÂÈ ¯ÒÚ· ̤ۈ ÂȉÈÎÒÓ
Û˘ÛÙËÌ¿ÙˆÓ ÌÂÙ·ÊÔÚ¿˜ Ù˘ ÌÂÌ‚Ú¿Ó˘ ÙÔ˘ ÛˆÏË-
Ó·ÚÈ·ÎÔ‡ ·˘ÏÔ‡, ÔÈ Ôԛ˜ ‰È·Ê¤ÚÔ˘Ó ÌÂٷ͇ ÙˆÓ
ÙÌËÌ¿ÙˆÓ ÙÔ˘ ÓÂÊÚÒÓ·, ÛÂ ·ÓÙ›ıÂÛË ÌÂ ÙÔ Û‡ÛÙË-
Ì· Ù˘ Na+-K+-ATP·Û˘ Ù˘ ‚·ÛÂÔÏ¢ÚÈ΋˜ ÂÈ-
Ê¿ÓÂÈ·˜, ÙÔ ÔÔ›Ô ˘¿Ú¯ÂÈ Ú·ÎÙÈο Û fiÏ· Ù· Ûˆ-
ÏËÓ·Úȷο ÂÈıËÏȷο ·ÙÙ·Ú·. ªÂ ÂÍ·›ÚÂÛË Ù·
ˆÛ̈ÙÈÎÒ˜ ‰ÚÒÓÙ· ‰ÈÔ˘ÚËÙÈο, fiϘ ÔÈ ˘fiÏÔÈ˜
ηÙËÁÔڛ˜ ‰ÈÔ˘ÚËÙÈÎÒÓ ‰ÚÔ˘Ó ·ÚÂÌÔ‰›˙ÔÓÙ·˜
ÙÔ ÂȉÈÎfi Û‡ÛÙËÌ· ÌÂÙ·ÊÔÚ¿˜ Ù˘ ÎÔÚ˘Ê·›·˜ ÌÂÌ-
‚Ú¿Ó˘. ∏ ÌÂÙ·ÊÔÚ¿ Na+ ηٿ ÙË ÊÔÚ¿ Ù˘ ËÏÂ-
ÎÙÚÔ¯ËÌÈ΋˜ ÙÔ˘ ‚·ıÌ›‰ˆÛ˘ ·fi ÙÔÓ ÛˆÏËÓ·ÚÈ·-
Îfi ·˘Ïfi ÛÙ· ÂÈıËÏȷο ·ÙÙ·Ú· Î·È ÙÔ ‰È·ÌÂÛÔ-
ÛˆÏËÓ·ÚÈ·Îfi ¯ÒÚÔ Û˘Óԉ‡ÂÙ·È Î·È ·fi ÌÂÙ·ÊÔ-
Ú¿ ‡‰·ÙÔ˜ Î·È ¿ÏÏˆÓ ‰È·Ï˘ÙÒÓ Ô˘ÛÈÒÓ Â›Ù ·ÓÙ›ıÂ-
Ù· ›Ù ·Ú¿ÏÏËÏ· ÚÔ˜ ÙËÓ ËÏÂÎÙÚÔ¯ËÌÈ΋ ÙÔ˘˜
ÎÏ›ÛË2.
148 AÚÙËÚȷ΋ Y¤ÚÙ·ÛË, 18, 2-3

∏ ÈÔ Û˘¯Ó‹ Î·È ÎÏÈÓÈο ‡¯ÚËÛÙË Ù·ÍÈÓfiÌËÛË
ÙˆÓ ‰ÈÔ˘ÚËÙÈÎÒÓ Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ˘˜ ÂȉÈÎÔ‡˜ Ì˯·-
ÓÈÛÌÔ‡˜ ‰Ú¿Û˘ Î·È Û˘ÓÂÒ˜ Ì ÙÔ Î‡ÚÈÔ ÛËÌ›Ô
¿ÛÎËÛ˘ Ù˘ ‰Ú¿Û˘ ÙÔ˘˜ ηٿ Ì‹ÎÔ˜ ÙÔ˘ ÓÂÊÚÒ-
Ó·. ªÂ ‚¿ÛË ·˘Ùfi, Ù· ‰ÈÔ˘ÚËÙÈο ÌÔÚÔ‡Ó Ó· ‰È·-
ÎÚÈıÔ‡Ó Û ·Ó·ÛÙÔÏ›˜ Ù˘ ηڂÔÓÈ΋˜ ·Ó˘‰Ú¿Û˘,
ˆÛ̈ÙÈÎÒ˜ ‰ÚÒÓÙ·, ‰ÈÔ˘ÚËÙÈο Ù˘ ·Á·Ï˘, ıÂÈ·-
˙›‰Â˜ Î·È Û˘Ó·Ê‹ ·Ú¿ÁˆÁ· Ù˘ ÛÔ˘ÏÊÔÓ·Ì›‰Ë˜
Î·È Î·ÏÈÔÛ˘ÓÙËÚËÙÈο ‰ÈÔ˘ÚËÙÈο, ÛÙ· ÔÔ›· ·Ó‹-
ÎÔ˘Ó Ë ·ÌÈÏÔÚ›‰Ë, Ë ÙÚÈ·ÌÙÂÚ¤ÓË Î·È ÔÈ ·ÓÙ·ÁˆÓÈ-
ÛÙ¤˜ Ù˘ ·Ï‰ÔÛÙÂÚfiÓ˘ (¶›Ó. 1)2,4. ∫·ıÒ˜ ÙÔ ÔÛfi
ÙÔ˘ Â·Ó·ÚÚÔÊÒÌÂÓÔ˘ Na+ ‰È·Ê¤ÚÂÈ ÛÙ· ‰È¿ÊÔÚ·
ÙÌ‹Ì·Ù· ÙÔ˘ ÓÂÊÚÒÓ·, ÙÔ ÛËÌÂ›Ô ‰Ú¿Û˘ ηıÔÚ›˙ÂÈ
Û ÌÂÁ¿ÏÔ ‚·ıÌfi ÙË Û¯ÂÙÈ΋ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·
ÙˆÓ ‰ÈÔ˘ÚËÙÈÎÒÓ, fiˆ˜ ·˘Ù‹ ÂÎÊÚ¿˙ÂÙ·È ·fi ÙÔ Ì¤-
ÁÈÛÙÔ ÔÛÔÛÙfi ÙÔ˘ ‰ÈËıË̤ÓÔ˘ ÊÔÚÙ›Ô˘ NaCl Ô˘
ÙÂÏÈο ·Ô‚¿ÏÏÂÙ·È Ì ٷ Ô‡Ú·. ∂ÈϤÔÓ, Ù· ‰È·-
ÊÔÚÂÙÈο ÛËÌ›· ‰Ú¿Û˘ ÙˆÓ ‰È¿ÊÔÚˆÓ Î·ÙËÁÔ-

¶›Ó·Î·˜ 1. Δ·ÍÈÓfiÌËÛË, ·ÚÈÔ ÛËÌÂ›Ô ‰Ú¿Û˘, ·ÚÈÔ˜ Ì˯·ÓÈÛÌfi˜ ‰Ú¿Û˘ Î·È ÎÏÈÓÈΤ˜ ¯Ú‹ÛÂȘ ÙˆÓ ‰ÈÔ˘ÚËÙÈÎÒÓ.

¢ÈÔ˘ÚËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ∫‡ÚÈÔ ÛËÌÂ›Ô ‰Ú¿Û˘ ªË¯·ÓÈÛÌfi˜ ‰Ú¿Û˘ ∫ÏÈÓÈΤ˜ ¯Ú‹ÛÂȘ

∞Ó·ÛÙÔÏ›˜ Ù˘ ηÚ- ∂ÁÁ‡˜ ÂÛÂÈڷ̤ÓÔ ∞Ó·ÛÙÔÏ‹ Ù˘ °Ï·‡ÎˆÌ·, ÌÂÙ·‚ÔÏÈ΋ ·ÏοψÛË,
‚ÔÓÈ΋˜ ·Ó˘‰Ú¿Û˘ ÛˆÏËÓ¿ÚÈÔ Î·Ú‚ÔÓÈ΋˜ ÓfiÛÔ˜ ÙˆÓ fiÚˆÓ, ·ÓÙ›ÛÙ·ÛË
∞ÎÂÙ·˙ÔÏ·Ì›‰Ë ·Ó˘‰Ú¿Û˘ ÛÙ· ‰ÈÔ˘ÚËÙÈο
øÛ̈ÙÈÎÒ˜ ‰ÚÒÓÙ· ∂ÁÁ‡˜ ÂÛÂÈڷ̤ÓÔ Ûˆ- øÛ̈ÙÈ΋ ‰Ú¿ÛË ∂ÁÎÂÊ·ÏÈÎfi Ô›‰ËÌ·
‰ÈÔ˘ÚËÙÈο ÏËÓ¿ÚÈÔ & ·¯‡ ÙÌ‹Ì·
ª·ÓÓÈÙfiÏË ÙÔ˘ ·ÓÈfiÓÙÔ˜ ÛΤÏÔ˘˜
Ù˘ ·Á·Ï˘ ÙÔ˘ Henle
¢ÈÔ˘ÚËÙÈο Ù˘ ·Á·Ï˘ ¶·¯‡ ÙÌ‹Ì· ÙÔ˘ ·ÓÈfiÓÙÔ˜ ∞Ó·ÛÙÔÏ‹ ÙÔ˘ OȉËÌ·ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ (Û˘ÌÊÔÚËÙÈ΋
ºÔ˘ÚÔÛÂÌ›‰Ë ÛΤÏÔ˘˜ Ù˘ ·Á·Ï˘ Û˘ÌÌÂÙ·ÊÔÚ¤· ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·, ΛÚÚˆÛË ÙÔ˘
ΔÔÚÛÂÌ›‰Ë ÙÔ˘ Henle Na+-K+-2Cl– ‹·ÙÔ˜, ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ),
μÔ˘ÌÂÙ·Ó›‰Ë ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·, ˘¤ÚÙ·ÛË ÛÂ
∂ı·ÎÚÈÓÈÎfi Ô͇ ÓÂÊÚÈ΋ ÓfiÛÔ, ˘ÂÚ·Û‚ÂÛÙÈ·ÈÌ›·,
˘ÔÓ·ÙÚÈ·ÈÌ›·, Û‡Ó‰ÚÔÌÔ ·ÚfiÛÊÔÚ˘
¤ÎÎÚÈÛ˘ ·ÓÙȉÈÔ˘ÚËÙÈ΋˜ ÔÚÌfiÓ˘,
ÓÂÊÚÈ΋ ÛˆÏËÓ·Úȷ΋ ÔͤˆÛË
£ÂÈ·˙›‰Â˜ Î·È ıÂÈ·-
˙ȉÈο ·Ó¿ÏÔÁ·
£ÂÈ·˙›‰Â˜ Õˆ ÂÛÂÈڷ̤ÓÔ ∞Ó·ÛÙÔÏ‹ ÙÔ˘ À¤ÚÙ·ÛË, ˘ÂÚ·Û‚ÂÛÙÈÔ˘Ú›·, ¿ÔÈÔ˜
À‰ÚԯψÚÔıÂÈ·˙›‰Ë ÛˆÏËÓ¿ÚÈÔ Û˘ÌÌÂÙ·ÊÔÚ¤· ‰È·‚‹Ù˘, ‹ÈÔ Ô›‰ËÌ·
ÃψÚÔıÂÈ·˙›‰Ë Na+-Cl–
μÂÓ‰ÚÔÊÏÔ˘ÌÂıÂÈ·˙›‰Ë
ΔÚȯψÚÌÂıÂÈ·˙›‰Ë
£ÂÈ·˙ȉÈο ·Ó¿ÏÔÁ· Õˆ ÂÛÂÈڷ̤ÓÔ ∞Ó·ÛÙÔÏ‹ ÙÔ˘ À¤ÚÙ·ÛË, ˘ÂÚ·Û‚ÂÛÙÈÔ˘Ú›·, ¿ÔÈÔ˜
ÃψÚÔı·ÏȉfiÓË ÛˆÏËÓ¿ÚÈÔ Û˘ÌÌÂÙ·ÊÔÚ¤· ‰È·‚‹Ù˘, ‹ÈÔ Ô›‰ËÌ·
πÓ‰··Ì›‰Ë Na+-Cl–
ªÂÙÔÓ·˙fiÏË
∫Ô˘ÈÓÂı·˙fiÓË
∫·ÏÈÔÛ˘ÓÙËÚËÙÈο
‰ÈÔ˘ÚËÙÈο
¶·Ú¿ÁˆÁ· Ù˘ ÙÂÚȉ›Ó˘ ºÏÔ˚ÈÎfi ÙÌ‹Ì· ∞Ó·ÛÙÔÏ‹ ÙˆÓ À¤ÚÙ·ÛË Ì ·ÒÏÂÈ· Î·Ï›Ô˘ ‹/ηÈ
∞ÌÈÏÔÚ›‰Ë ÙÔ˘ ·ıÚÔÈÛÙÈÎÔ‡ ÂÈıËÏÈ·ÎÒÓ Ì·ÁÓËÛ›Ô˘, Û‡Ó‰ÚÔÌÔ Liddle
ΔÚÈ·ÌÙÂÚ¤ÓË ÛˆÏËÓ·Ú›Ô˘ ‰È·‡ÏˆÓ Na+
∞ÓÙ·ÁˆÓÈÛÙ¤˜ ºÏÔ˚ÈÎfi ÙÌ‹Ì· ∞ÔÎÏÂÈÛÌfi˜ ÙˆÓ ¶ÚˆÙÔ·ı‹˜ ·Ï‰ÔÛÙÂÚÔÓÈÛÌfi˜, ˘¤Ú-
·Ï‰ÔÛÙÂÚfiÓ˘ ÙÔ˘ ·ıÚÔÈÛÙÈÎÔ‡ ˘Ô‰Ô¯¤ˆÓ Ù˘ Ù·ÛË Ì ·ÒÏÂȘ Î·Ï›Ô˘ ‹/Î·È Ì·ÁÓË-
™ÈÚÔÓÔÏ·ÎÙfiÓË ÛˆÏËÓ·Ú›Ô˘ ·Ï‰ÔÛÙÂÚfiÓ˘ Û›Ô˘, ‰Â˘ÙÂÚÔ·ı‹˜ ·Ï‰ÔÛÙÂÚÔÓÈÛÌfi˜
∂ÏÂÚÂÓfiÓË (Û˘ÌÊÔÚËÙÈ΋ ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·,
ΛÚÚˆÛË ÙÔ˘ ‹·ÙÔ˜, ÓÂÊÚˆÛÈÎfi Û‡Ó-
‰ÚÔÌÔ), ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·, ·ÓıÂ-
ÎÙÈ΋ ˘¤ÚÙ·ÛË
 AÚÙËÚȷ΋ Y¤ÚÙ·ÛË, 18, 2-3
ÚÈÒÓ ‰ÈÔ˘ÚËÙÈÎÒÓ ÂÈÙÚ¤Ô˘Ó ·ıÚÔÈÛÙÈο ·ÔÙÂ-
ϤÛÌ·Ù· fiÙ·Ó Ù· Ê¿Ú̷η ·˘Ù¿ ¯ÔÚËÁÔ‡ÓÙ·È ÛÂ
Û˘Ó‰˘·ÛÌfi, οÙÈ Ô˘ ÌÔÚ› Ó· Ê·Ó› ¯Ú‹ÛÈÌÔ ÛÂ
·ÛıÂÓ›˜ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ·ÓÙÔ¯‹ ÛÙ· ‰ÈÔ˘ÚËÙÈο1.
∞Ó·ÛÙÔÏ›˜ Ù˘ ηڂÔÓÈ΋˜ ·Ó˘‰Ú¿Û˘
∏ ·ÎÂÙ·˙ÔÏ·Ì›‰Ë Â›Ó·È ·Ú¿ÁˆÁÔ ÙÔ˘ ÛÔ˘Ï-
ÊÔÓ·ÌȉÈÎÔ‡ ·ÓÙÈ‚ÈÔÙÈÎÔ‡ ÛÔ˘ÏÊ·ÓÈÏ·Ì›‰Ë, Ë Ô-
Ô›· ›¯Â ·Ó·ÊÂÚı› fiÙÈ ÚÔηÏ› ‰ÈÔ‡ÚËÛË Ì ÌÂ-
Ù·‚ÔÏÈ΋ ÔͤˆÛË ÂÍ·ÈÙ›·˜ Ù˘ ·Ó·ÛÙÔÏ‹˜ Ù˘ ηÚ-
‚ÔÓÈ΋˜ ·Ó˘‰Ú¿Û˘. ªÂٷ͇ ÙˆÓ ·ÚÎÂÙÒÓ ¯ËÌÈÎÒÓ
ÙÚÔÔÔÈ‹ÛÂˆÓ ÙÔ˘ ÌÔÚ›Ô˘ Ù˘ ÛÔ˘ÏÊ·ÓÈÏ·Ì›‰Ë˜
Ô˘ ÌÂÏÂÙ‹ıËηÓ, Ë ·ÎÂÙ·˙ÔÏ·Ì›‰Ë ·ÚÔ˘Û›·Û ٷ
ϤÔÓ ÂÈı˘ÌËÙ¿ ¯·Ú·ÎÙËÚÈÛÙÈο1. Ÿˆ˜ Ù· Â-
ÚÈÛÛfiÙÂÚ· ‰ÈÔ˘ÚËÙÈο (Ì ÂÍ·›ÚÂÛË ÙËÓ ÛÈÚÔÓÔ-
Ï·ÎÙfiÓË Î·È ÙËÓ ÂÏÂÚÂÓfiÓË), Ë ·ÎÂÙ·˙ÔÏ·Ì›‰Ë
Ú¤ÂÈ Ó· Êı¿ÛÂÈ ÛÙÔÓ ·˘Ïfi ÙÔ˘ Ô˘ÚÔÊfiÚÔ˘ Ûˆ-
ÏËÓ·Ú›Ô˘ ÁÈ· Ó· ·Û΋ÛÂÈ ÙȘ ‰Ú¿ÛÂȘ Ù˘. ŒÙÛÈ, Ë
·ÎÂÙ·˙ÔÏ·Ì›‰Ë ÂÎÎÚ›ÓÂÙ·È ÂÓÂÚÁËÙÈο ÛÙÔ ÂÁÁ‡˜
ÛˆÏËÓ¿ÚÈÔ Ì¤Ûˆ Ù˘ ÂÎÎÚÈÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÙˆÓ
ÔÚÁ·ÓÈÎÒÓ ÔͤˆÓ. ™ÙÔ ÂÁÁ‡˜ ÛˆÏËÓ¿ÚÈÔ, ÛËÌ·ÓÙÈ-
΋ ÔÛfiÙËÙ· Na+ ‰È·ÂÚÓ¿ ÙËÓ ÎÔÚ˘Ê·›· ÌÂÌ‚Ú¿-
ÓË Û ·ÓÙ·ÏÏ·Á‹ Ì ∏+, ̤ۈ ÌÈ·˜ ÂȉÈ΋˜ ÌÔÚÊ‹˜
ÙÔ˘ ·ÓÙ·ÏÏ¿ÎÙË Na+/H+ (Na+-H+-exchanger, ¡∏∂),
Ù˘ ¡∏∂3 (ۇ̂ÔÏÔ ÁÔÓȉ›Ô˘ SLC9A3). ΔÔ Na+
‰È·ÂÚÓ¿ ÙËÓ ‚·ÛÂÔÏ¢ÚÈ΋ ÂÈÊ¿ÓÂÈ· ÙˆÓ Ûˆ-
ÏËÓ·ÚÈ·ÎÒÓ ÂÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Ì¤Ûˆ Ù˘ Na+-
K+-ATP·Û˘ Î·È ÂÓfi˜ Û˘ÛÙ‹Ì·ÙÔ˜ ÌÂÙ·ÊÔÚ¿˜
NaHCO3. Δ· ÂÎÎÚÈÓfiÌÂÓ· ÛÙÔÓ ·˘Ïfi ∏+ ÙÈÙÏÔÔÈ-
Ô‡Ó Ù· ‰ÈÙÙ·ÓıÚ·ÎÈο ÈfiÓÙ· (HCO3–) Ù· ÔÔ›·
¤¯Ô˘Ó ‰ÈËıËı› ·fi ÙÔ Û›ڷ̷ ÁÈ· Ó· Û¯ËÌ·ÙÈ-
Ûı› H2CO3, ÙÔ ÔÔ›Ô ‰È·Û¿Ù·È Û H2O Î·È CO2 ÌÂ
ÙËÓ Î·Ù·Ï˘ÙÈ΋ ‰Ú¿ÛË Ù˘ ηڂÔÓÈ΋˜ ·Ó˘‰Ú¿Û˘
Ù˘ „ËÎÙÚÔÂȉԇ˜ ·Ú˘Ê‹˜ ÙˆÓ ÂÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿-
ÚˆÓ ÙÔ˘ ÂÁÁ‡˜ ÛˆÏËÓ·Ú›Ô˘. ¶·Ú¿ÏÏËÏ·, Ë Î·Ú‚ÔÓÈ-
΋ ·Ó˘‰Ú¿ÛË Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙÔ ÂÛˆÙÂÚÈÎfi ÙˆÓ ÂÈ-
ıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·Ù·Ï‡ÂÈ ÙÔ Û¯ËÌ·ÙÈÛÌfi H+ ηÈ
HCO3– ·fi ÙÔ H2CO3. Δ· ·Ú·ÁfiÌÂÓ· H+ ÌÂÙ·ÎÈ-
ÓÔ‡ÓÙ·È ÛÙÔÓ ·˘Ïfi ̤ۈ ÙÔ˘ ¡∏∂3 Î·È Ù· (HCO3–)
ÂͤگÔÓÙ·È Ì¤Ûˆ Ù˘ ‚·ÛÂÔÏ¢ÚÈ΋˜ ÂÈÊ¿ÓÂÈ·˜
ÛÙÔ ‰È·ÌÂÛÔÛˆÏËÓ·ÚÈ·Îfi ¯ÒÚÔ. ΔÔ ÙÂÏÈÎfi ÏÂÈÙÔ˘Ú-
ÁÈÎfi ·ÔÙ¤ÏÂÛÌ· fiÏˆÓ ·˘ÙÒÓ ÙˆÓ ‰Ú¿ÛÂˆÓ Â›Ó·È Ë
ÌÂÙ·ÊÔÚ¿ Na+ Î·È HCO3– ·fi ÙÔÓ ·˘Ïfi ÛÙÔ ‰È·ÌÂ-
ÛÔÛˆÏËÓ·ÚÈ·Îfi ¯ÒÚÔ2,3. OÈ ·Ó·ÛÙÔÏ›˜ Ù˘ ηڂÔ-
ÓÈ΋˜ ·Ó˘‰Ú¿Û˘ ·ÚÂÌÔ‰›˙Ô˘Ó ÙËÓ ÂÓÂÚÁfiÙËÙ· ÙÔ˘
ÂÓ˙‡ÌÔ˘ ÙfiÛÔ ÛÙËÓ „ËÎÙÚÔÂȉ‹ ·Ú˘Ê‹ fiÛÔ Î·È ÛÙÔ
ÂÛˆÙÂÚÈÎfi ÙˆÓ ÛˆÏËÓ·ÚÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ, ÂÌÔ‰›˙Ô-
ÓÙ·˜ ÙËÓ Â·ÓÓ·ÚfiÊËÛË Na+, HCO3– Î·È ÓÂÚÔ‡. ∏
·ÒÏÂÈ· HCO3– ÚÔηÏ› ÌÂÙ·‚ÔÏÈ΋ ÔͤˆÛË, Ë
ÔÔ›· ¯·Ú·ÎÙËÚ›˙ÂÈ ·˘Ù‹Ó ÙË Î·ÙËÁÔÚ›· ‰ÈÔ˘ÚËÙÈ-
149
ÎÒÓ. ∏ ·˘ÍË̤ÓË ÌÂÙ·ÊÔÚ¿ Na+ ÛÙÔÓ ¿ˆ ÓÂÊÚÒ-
Ó· Î·È Ù· ·ıÚÔÈÛÙÈο ÛˆÏËÓ¿ÚÈ· Ô‰ËÁ› Û ·˘ÍË̤-
ÓË ·ÓÙ·ÏÏ·Á‹ Ì ∫+, Ë ÔÔ›· ‰È¢ÎÔχÓÂÙ·È ·fi ÙÔ
·ÚÓËÙÈÎfi ËÏÂÎÙÚÈÎfi ÊÔÚÙ›Ô Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡Ó Ù·
HCO3– ÙÔ˘ ·˘ÏÔ‡. ∫·Ù¿ Û˘Ó¤ÂÈ·, ÙÔ Û˘ÓÔÏÈÎfi ·Ô-
Ù¤ÏÂÛÌ· Ù˘ ‰Ú¿Û˘ Ù˘ ·ÎÂÙ·˙ÔÏ·Ì›‰Ë˜ Â›Ó·È Ë ·˘-
ÍË̤ÓË ·ÒÏÂÈ· Na+, HCO3–, K+ Î·È ÓÂÚÔ‡ ÛÙ·
Ô‡Ú·1,2.
∫·ıÒ˜ ÛÙÔ ÂÁÁ‡˜ ÛˆÏËÓ¿ÚÈÔ Ï·Ì‚¿ÓÂÈ ¯ÒÚ· Ë
Â·Ó·ÚÚfiÊËÛË Ù˘ ÌÂÁ·Ï‡ÙÂÚ˘ ÔÛfiÙËÙ·˜ ÙÔ˘
‰ÈËıÔ‡ÌÂÓÔ˘ Na+ (60-70%), ı· ÂÚ›ÌÂÓ ηÓ›˜
¤Ó· ‰ÈÔ˘ÚËÙÈÎfi Ô˘ ‰Ú· ÛÙÔ ÂÁÁ‡˜ ÙÌ‹Ì· ÙÔ˘ Ûˆ-
ÏËÓ·Ú›Ô˘ Ó· ¤¯ÂÈ ÌÂÁ¿ÏË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·.
∞˘Ùfi ‰Â Û˘Ì‚·›ÓÂÈ ÂÍ·ÈÙ›·˜ ·Ó¿Ù˘Í˘ ·ÓÙÈÚÚÔÈ-
ÛÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ. ŸÙ·Ó Ë Â·Ó·ÚÚfiÊËÛË ÛÙÔ ÂÁ-
Á‡˜ ÛˆÏËÓ¿ÚÈÔ ·Ó·ÛÙ¤ÏÏÂÙ·È, ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜
ÙÔ˘ ÂÓ·Ô̤ÓÔÓÙÔ˜ Na+ Î·È ÙˆÓ ‰È·Ï˘ÙÒÓ Ô˘ÛÈÒÓ
ÌÔÚÔ‡Ó Ó· Â·Ó·ÚÚÔÊËıÔ‡Ó Û ÈÔ ·ÔÌ·ÎÚ˘-
Ṳ̂ӷ ÙÌ‹Ì·Ù· ÙÔ˘ ÛˆÏËÓ·Ú›Ô˘ (΢ڛˆ˜ ÛÙÔ ·¯‡
ÙÌ‹Ì· ÙÔ˘ ·ÓÈfiÓÙÔ˜ ÛΤÏÔ˘˜ Ù˘ ·Á·Ï˘ ÙÔ˘
Henle). ∂ÈϤÔÓ, Ë ·Ó·ÛÙÔÏ‹ Ù˘ Â·Ó·ÚÚfiÊËÛ˘
Na+ ÛÙÔ ÂÁÁ‡˜ ÛˆÏËÓ¿ÚÈÔ ·˘Í¿ÓÂÈ ÙËÓ ¿ÊÈÍË Na+
Î·È ‰È·Ï˘ÙÒÓ Ô˘ÛÈÒÓ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ˘ÎÓ‹˜ ÎË-
Ï›‰·˜ ÂÓÂÚÁÔÔÈÒÓÙ·˜ ÙÔÓ ÛÂÈÚ·Ì·ÙÔ-ÛˆÏËÓ·-
ÚÈ·Îfi Ì˯·ÓÈÛÌfi ·Ï›Ó‰ÚÔÌ˘ ·Ó·ÙÚÔÊÔ‰fiÙËÛ˘,
Ô ÔÔ›Ô˜ ηٷÛÙ¤ÏÏÂÈ ÙÔ Ú˘ıÌfi ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹-
ıËÛ˘ Î·È ÙÔ ÔÛfi ÙˆÓ Ô˘ÛÈÒÓ Ô˘ ‰ÈËıÔ‡ÓÙ·È ·fi
ÙÔ Û›ڷ̷. ∂ÈϤÔÓ, Ë ·ÏηÏÈ΋ ‰ÈÔ‡ÚËÛË ÚÔ-
ηÏ› Ì›ˆÛË ÙˆÓ HCO3– ÙÔ˘ ÔÚÔ‡, Ì ·ÔÙ¤ÏÂÛÌ·
ÌÈÎÚfiÙÂÚË ÔÛfiÙËÙ· HCO3– Ó· ‰ÈËı›ٷÈ, ηıÈÛÙÒ-
ÓÙ·˜ ¤ÙÛÈ ÏÈÁfiÙÂÚÔ ÛËÌ·ÓÙÈ΋ ÙËÓ ÂÍ·ÚÙÒÌÂÓË ·fi
ÙËÓ Î·Ú‚ÔÓÈ΋ ·Ó˘‰Ú¿ÛË Â·Ó·ÚÚfiÊËÛË Na+ 1,2.
∂Í·ÈÙ›·˜ Ù˘ ·ÛıÂÓÔ‡˜ ‰Ú¿Û˘ Î·È Ù˘ ·Ó·fi-
Ê¢ÎÙ˘ ÌÂÙ·‚ÔÏÈ΋˜ ÔͤˆÛ˘ Ô˘ ·Ú·ÙËÚ›ٷÈ
ηٿ ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ıÂÚ·›·, Ë ¯Ú‹ÛË Ù˘ ·ÎÂ-
Ù·˙ÔÏ·Ì›‰Ë˜ ˆ˜ ‰ÈÔ˘ÚËÙÈÎÔ‡ Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË.
ªÈ· Û¿ÓÈ· ¤Ó‰ÂÈÍË Ù˘ ·ÎÂÙ·˙ÔÏ·Ì›‰Ë˜ Â›Ó·È ÛÂ
·ÛıÂÓ›˜ Ì ·ÓÙ›ÛÙ·ÛË ÛÙË ‰Ú¿ÛË ÙˆÓ ‰ÈÔ˘ÚËÙÈÎÒÓ
Ù˘ ·Á·Ï˘, ȉ›ˆ˜ ·ÛıÂÓ›˜ Ì ηډȷ΋ ·ÓÂ¿Ú-
ÎÂÈ·, fiÔ˘ Ë Â·Ó·ÚÚfiÊËÛË Na+ ÛÙÔ ÂÁÁ‡˜ ÛˆÏË-
Ó¿ÚÈÔ ·˘Í¿ÓÂÙ·È, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÊÙ¿ÓÂÈ ÌÈÎÚfi-
ÙÂÚË ÔÛfiÙËÙ· Na+ ÛÙËÓ ·Á·ÏË ÙÔ˘ Henle5. ∏
ÚÔÛı‹ÎË ·ÎÂÙ·˙ÔÏ·Ì›‰Ë˜ Û ·˘Ù‹Ó ÙËÓ ÂÚ›Ùˆ-
ÛË ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÎÏÈÓÈο ÛËÌ·ÓÙÈ΋ ·‡ÍË-
ÛË Ù˘ ‰ÈÔ‡ÚËÛ˘6,7. øÛÙfiÛÔ, ηıÒ˜ Ë Î·Ú‚ÔÓÈ΋
·Ó˘‰Ú¿ÛË ·›ÚÓÂÈ Ì¤ÚÔ˜ ÛÙÔ Û¯ËÌ·ÙÈÛÌfi ÙÔ˘ ÂÓ-
‰ÔÊı¿ÏÌÈÔ˘ ˘ÁÚÔ‡ (aqueous humor), Ë ·ÎÂÙ·˙Ô-
Ï·Ì›‰Ë Î·È ÙÔ ·Ú¿ÁˆÁfi Ù˘ ÌÂı·˙ÔÏ·Ì›‰Ë (Ô˘
·Ó·Ù‡¯ıËΠÒÛÙ ӷ ‰Ú· ÛÙË Î·Ú‚ÔÓÈ΋ ·Ó˘‰Ú¿-
ÛË ÙÔ˘ ÔÊı·ÏÌÔ‡ ¤¯ÔÓÙ·˜ ÂÏ¿¯ÈÛÙ˜ Û˘ÛÙËÌ·ÙÈΤ˜
‰Ú¿ÛÂȘ) Â›Ó·È Â˘Ú¤ˆ˜ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ· Ê¿ÚÌ·-
150 AÚÙËÚȷ΋ Y¤ÚÙ·ÛË, 18, 2-3
η ÛÙË ıÂÚ·›· ÙÔ˘ ÁÏ·˘ÎÒÌ·ÙÔ˜3,8. ∂ÈϤÔÓ, Ë
Û˘ÛÙËÌ·ÙÈ΋ ÌÂÙ·‚ÔÏÈ΋ ÔͤˆÛË Ô˘ ÚÔηÏ›ٷÈ
·fi ÙËÓ ·ÎÂÙ·˙ÔÏ·Ì›‰Ë ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı›
ÁÈ· ÙË ‰ÈfiÚıˆÛË Ù˘ ÌÂÙ·‚ÔÏÈ΋˜ ·ÏοψÛ˘. ∞˘Ù‹
Ë ıÂÚ·¢ÙÈ΋ ¤Ó‰ÂÈÍË ÌÔÚ› Ó· Â›Ó·È ¯Ú‹ÛÈÌË
fiÙ·Ó Ô ˘Ô·ÂÚÈÛÌfi˜ Ô˘ ÚÔηÏÂ›Ù·È ·fi ÙË ÌÂÙ·-
‚ÔÏÈ΋ ·ÏοψÛË ÁÈ· ÙË ‰ÈfiÚıˆÛË ÙÔ˘ PH ‰È·Ù·-
Ú¿ÛÛÂÈ ÙËÓ ·ÓÙ·ÏÏ·Á‹ ÙˆÓ ·Ó·Ó¢ÛÙÈÎÒÓ ·ÂÚ›ˆÓ
Î·È ÚÔηÏ› ÛËÌ·ÓÙÈ΋ ˘ÔÍ·ÈÌ›· Û ·ÛıÂÓ›˜ ÌÂ
ÚԉȿıÂÛË (.¯. Û ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· ·ÔÊÚ·-
ÎÙÈ΋ Ó¢ÌÔÓÔ¿ıÂÈ·) Î·È È‰›ˆ˜ Û ·ÛıÂÓ›˜
ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó
·Ï·ÙÔ‡¯ÔÈ ÔÚÔ› ÂÍ·ÈÙ›·˜ Û˘Ó˘¿Ú¯Ô˘Û·˜ ˘ÂÚ-
ÊfiÚÙˆÛ˘ fiÁÎÔ˘ ˘ÁÚÒÓ2,3,9. ∞ÎfiÌË, Ë ·ÎÂÙ·˙ÔÏ·-
Ì›‰Ë ‚Ú¤ıËΠӷ Â›Ó·È ¯Ú‹ÛÈÌË ÛÙË ıÂÚ·›· ηÈ
ÙËÓ ÚfiÏË„Ë Ù˘ ÔÍ›·˜ ÓfiÛÔ˘ ÙˆÓ ÔÚ¤ˆÓ. ∞˘Ùfi ı·
ÌÔÚÔ‡Û ӷ ¤¯ÂÈ Û¯¤ÛË Ì ÙËÓ ÚÔηÏÔ‡ÌÂÓË ·fi
ÙÔ Ê¿ÚÌ·ÎÔ ÌÂÙ·‚ÔÏÈ΋ ÔͤˆÛË, ·ÏÏ¿ ÔÈ ·ÎÚȂ›˜
Ì˯·ÓÈÛÌÔ› ·Ú·Ì¤ÓÔ˘Ó ¿ÁÓˆÛÙÔÈ1-3. ªÂ ¯ÚfiÓÔ
ËÌ›ÛÈ·˜ ˙ˆ‹˜ ÂÚ›Ô˘ 13 ÒÚ˜, Ë ¯ÔÚ‹ÁËÛË ·ÎÂÙ·-
˙ÔÏ·Ì›‰Ë˜ ‰‡Ô ÊÔÚ¤˜ ËÌÂÚËÛ›ˆ˜ ıˆÚÂ›Ù·È Â·Ú-
΋˜, ÂÓÒ ÛÙ·ıÂÚ¤˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘
ÂÈÙ˘Á¯¿ÓÔÓÙ·È ÌÂÙ¿ ·fi ‰‡Ô Ë̤Ú˜ ıÂÚ·›·˜1,3.
øÛÙfiÛÔ, fiˆ˜ fiÏ· Ù· ‰ÈÔ˘ÚËÙÈο, Ë ·ÎÂÙ·˙ÔÏ·Ì›-
‰Ë ·Ô‚¿ÏÏÂÙ·È Ì ٷ Ô‡Ú·, Î·È ¤ÙÛÈ Ë ÓÂÊÚÈ΋ Ù˘
οı·ÚÛË ˘ÔÏ›ÂÙ·È Û ·ÛıÂÓ›˜ Ì ÓÂÊÚÈ΋ ·ÓÂ-
¿ÚÎÂÈ·, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ··ÈÙÂ›Ù·È È‰È·›ÙÂÚË ÚÔ-
ÛÔ¯‹ ÛÙË ¯ÔÚ‹ÁËÛË8,10,11.
øÛ̈ÙÈο ‰ÈÔ˘ÚËÙÈο
Δ· ˆÛ̈ÙÈÎÒ˜ ‰ÚÒÓÙ· ‰ÈÔ˘ÚËÙÈο ‰ÂÓ ·ÚÂÌ-
‚·›ÓÔ˘Ó ÛÙ· ÛˆÏËÓ·Úȷο Û˘ÛÙ‹Ì·Ù· ÌÂÙ·ÊÔÚ¿˜
ËÏÂÎÙÚÔÏ˘ÙÒÓ, ·ÏÏ¿ ‰ÚÔ˘Ó ˆ˜ ˆÛ̈ÙÈο ÌfiÚÈ·
ÂÓÙfi˜ ÙÔ˘ ÛˆÏËÓ·ÚÈ·ÎÔ‡ ˘ÁÚÔ‡2. ∏ Ì·ÓÓÈÙfiÏË Â›Ó·È
¤Ó· ۿί·ÚÔ ÙÔ ÔÔ›Ô ·Ú·Ì¤ÓÂÈ ÛÙÔ ·ÁÁÂÈ·Îfi
¯ÒÚÔ, ‰ÈËıÂ›Ù·È ÂχıÂÚ· ·fi Ù· ÛÂÈÚ¿Ì·Ù· ηÈ
Â·Ó·ÚÚÔÊ¿Ù·È Û Ôχ ÌÈÎÚfi ‚·ıÌfi ηٿ Ì‹ÎÔ˜
ÙÔ˘ ÔıÚÔÊfiÚÔ˘ ÛˆÏËÓ·Ú›Ô˘12. ∫·Ù¿ Û˘Ó¤ÂÈ·,
·ÊÔ‡ ‰ÈËıËı›, Ë Ì·ÓÓÈÙfiÏË ·ÛΛ ˆÛ̈ÙÈ΋ ‰Ú·-
ÛË Î·Ù¿ Ì‹ÎÔ˜ fiÏÔ˘ ÙÔ˘ ÓÂÊÚÈÎÔ‡ ÛˆÏËÓ·Ú›Ô˘,
·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ Î·Ù¿ÛÙ·ÛË ÂÓ˘‰¿ÙˆÛ˘. ∏ ·˘-
ÍË̤ÓË ˆÛ̈ÙÈÎfiÙËÙ· ÙÔ˘ ÛˆÏËÓ·ÚÈ·ÎÔ‡ ˘ÁÚÔ‡
‰È·Ù·Ú¿ÛÛÂÈ ÙË Ê˘ÛÈÔÏÔÁÈ΋ Â·Ó·ÚÚfiÊËÛË ‡‰·-
ÙÔ˜ ηٿ Ì‹ÎÔ˜ ÙÔ˘ ÛˆÏËÓ·Ú›Ô˘, Ë ÔÔ›· ηıÔÚ›-
˙ÂÙ·È ·fi ÙȘ ˆÛ̈ÙÈΤ˜ ÎÏ›ÛÂȘ Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡Ó
Ù· Û˘ÛÙ‹Ì·Ù· ÌÂÙ·ÊÔÚ¿˜ ÈfiÓÙˆÓ ÛÙ· ‰È¿ÊÔÚ· ÙÌ‹-
Ì·Ù· ÙÔ˘ ÓÂÊÚÒÓ·. Δ· ˆÛ̈ÙÈο ‰ÈÔ˘ÚËÙÈο η-
Ù·ÛÙÚ¤ÊÔ˘Ó ÙËÓ ˆÛ̈ÙÈ΋ ‚·ıÌ›‰ˆÛË ÙˆÓ ‰È·Ï˘-
ÙÒÓ Ô˘ÛÈÒÓ ÛÙË Ì˘ÂÏÒ‰Ô˘˜ ÌÔ›Ú·˜ ÙÔ˘ ÓÂÊÚÔ‡, ‰È·-
Ù·Ú¿ÛÛÔÓÙ·˜ Û ÌÂÁ¿ÏÔ ‚·ıÌfi ÙË Û˘Ì˘ÎÓˆÙÈ΋
ÈηÓfiÙËÙ· ÙÔ˘ ÓÂÊÚÔ‡3,7,12. ∞˘Ù‹ Ë ‰Ú¿ÛË Â›Ó·È
fiÌÔÈ· Ì ÙËÓ ˆÛ̈ÙÈ΋ ‰ÈÔ‡ÚËÛË Î·È ÙËÓ ÔÏ˘Ô˘-
Ú›· Ô˘ ÚÔηÏ› Ë ˘„ËÏ‹ ÁÏ˘Îfi˙Ë ·›Ì·ÙÔ˜ ÛÂ
·ÛıÂÓ›˜ Ì ·ÚÚ‡ıÌÈÛÙÔ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË. ∏
·Ó·ÛÙÔÏ‹ Ù˘ Â·Ó·ÚÚfiÊËÛ˘ ‡‰·ÙÔ˜ ·Ú·ÈÒÓÂÈ ÙÔ
ÂÓ‰ÔÛˆÏËÓ·ÚÈ·Îfi ˘ÁÚfi, Î·È ·˘Ùfi ·ÎÔÏÔ‡ıˆ˜ ÚÔ-
‰È·ı¤ÙÂÈ Û ·ÏÈÓ‰ÚfiÌËÛË NaCl, ‰È·Ù·Ú¿ÛÛÔÓÙ·˜
Ì ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ÙËÓ ÈηÓfiÙËÙ· Â·Ó·ÚÚfiÊËÛ˘
Na+ Î·È Cl– ÛÙÔ ÂÁÁ‡˜ ÂÛÂÈڷ̤ÓÔ ÛˆÏËÓ¿ÚÈÔ Î·È
ÛÙÔ ·¯‡ ÙÌ‹Ì· ÙÔ˘ ·ÓÈfiÓÙÔ˜ ÛΤÏÔ˘˜ Ù˘ ·Á·Ï˘
ÙÔ˘ Henle. ∏ ·˘ÍË̤ÓË ÚÔÛÊÔÚ¿ Na+ ÛÙ· ·Ô-
Ì·ÎÚ˘Ṳ̂ӷ ÙÌ‹Ì·Ù· ÙÔ˘ Ô˘ÚÔÊfiÚÔ˘ ÛˆÏËÓ·Ú›Ô˘
ÂÈÙÚ¤ÂÈ ÙËÓ ·˘ÍË̤ÓË ·ÓÙ·ÏÏ·Á‹ Ì ∫+, Ì ·Ô-
Ù¤ÏÂÛÌ· Ó· ¯¿ÓÂÙ·È Â›Û˘ ∫+ ÛÙ· Ô‡Ú·. ∂ÈÚfi-
ÛıÂÙ·, Ë ˆÛ̈ÙÈ΋ ‰Ú¿ÛË Ù˘ Ì·ÓÓÈÙfiÏ˘ ÛÙÔ ÂÁÁ‡˜
ÛˆÏËÓ¿ÚÈÔ ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ Â·Ó·ÚÚfiÊËÛË HCO3–,
·ÏÏ¿ ·˘Ù‹ Ë ‰Ú¿ÛË Â›Ó·È Ôχ ·ÛıÂÓ¤ÛÙÂÚË Ù˘
·ÒÏÂÈ·˜ Na+ Î·È Cl– 1-3.
∏ Ì·ÓÓÈÙfiÏË Â›Ó·È È‰È·›ÙÂÚ· ·ÔÙÂÏÂÛÌ·ÙÈ΋
ÛÙË Ì›ˆÛË ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ Ôȉ‹Ì·ÙÔ˜ (ÚÒÙ· ÌÂ
ˆÛ̈ÙÈ΋ ÌÂٷΛÓËÛË ‡‰·ÙÔ˜ ·fi ÙÔÓ ÂÁΤʷÏÔ
Î·È ¤ÂÈÙ· Ì ˆÛ̈ÙÈ΋ ‰ÈÔ‡ÚËÛË) Î·È ¯ÚËÛÈÌÔ-
ÔÈÂ›Ù·È Û‹ÌÂÚ· Û ·ÛıÂÓ›˜ Ì ÏÔÈÌÒÍÂȘ ÙÔ˘ ÎÂ-
ÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ÌÂÙ¿ ·fi Ó¢ÚÔ-
¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ ‹ ÙÚ·˘Ì·ÙÈÛÌÔ‡˜ ÙÔ˘ ÎÚ·-
Ó›Ô˘1-3. ∏ Ì·ÓÓÈÙfiÏË ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› ˆ˜ ÚÔ-
ÏËÙÈÎfi ̤ÙÚÔ ¤Ó·ÓÙÈ Ù˘ ·Ó¿Ù˘Í˘ ÔÍ›·˜ ÓÂÊÚÈ-
΋˜ ·ÓÂ¿ÚÎÂÈ·˜ (O¡∞) Û ·ÛıÂÓ›˜ ˘„ËÏÔ‡ ÎÈÓ-
‰‡ÓÔ˘, fiˆ˜ .¯. ÌÂÙ¿ ·fi ηډÈÔÓ¢ÌÔÓÈΤ˜ ¯ÂÈ-
ÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ, ÌÂÙ¿ ·fi ¤ÎıÂÛË Û ÛÎÈ·-
ÛÙÈο ‹ Û ·ÛıÂÓ›˜ Ì ڷ‚‰ÔÌ˘fiÏ˘ÛË. øÛÙfiÛÔ,
˘¿Ú¯Ô˘Ó ÂÏ¿¯ÈÛÙ· ‰Â‰Ô̤ӷ fiÙÈ ·˘Ù‹ Ë ÛÙÚ·ÙËÁÈ-
΋ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ·fi ÙËÓ ·Ï‹ ÂÍ·-
ÛÊ¿ÏÈÛË ÈηÓÔÔÈËÙÈ΋˜ ‰ÈÔ‡ÚËÛ˘ Ì ÙËÓ Â·Ú΋
·ÚÂÓÙÂÚÈ΋ ¯ÔÚ‹ÁËÛË ˘ÁÚÒÓ. ∏ Ì·ÓÓÈÙfiÏË ¤¯ÂÈ
¯ÚËÛÈÌÔÔÈËı› ·ÎfiÌË Û ·ÛıÂÓ›˜ Ì ÔÏÈÁÔ˘ÚÈ΋
O¡∞ Û ÌÈ· ÚÔÛ¿ıÂÈ· ·‡ÍËÛ˘ Ù˘ ‰ÈÔ‡ÚËÛ˘.
OÌÔ›ˆ˜ Î·È ÛÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹, ÏfiÁˆ Ù˘ ·Ô˘-
Û›·˜ ÎÏÈÓÈÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ Ô˘ Ó· ÂÈÙÚ¤Ô˘Ó ÙËÓ
ÂÍ·ÁˆÁ‹ ·ÛÊ·ÏÒÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ, Ë ÂÍ·ÛÊ¿ÏÈÛË
ÈηÓÔÔÈËÙÈ΋˜ ÂÓ˘‰¿ÙˆÛ˘ Ê·›ÓÂÙ·È fiÙÈ ·ÔÙÂÏ›
ÙËÓ Î·Ï‡ÙÂÚË ÂÈÏÔÁ‹12,13. ∏ Ì·ÓÓÈÙfiÏË ·Ô‚¿ÏÏÂ-
Ù·È ÁÚ‹ÁÔÚ· ¤¯ÔÓÙ·˜ ¯ÚfiÓÔ ËÌ›ÛÈ·˜ ˙ˆ‹˜ ÂÚ›Ô˘
Ì›· ÒÚ· Û ·ÛıÂÓ›˜ ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ÓÂÊÚÈ΋ ÏÂÈ-
ÙÔ˘ÚÁ›·14 Î·È ÁÈ· ·˘Ùfi ÙÔ ÏfiÁÔ Ú¤ÂÈ Ó· ¯ÔÚËÁ›-
Ù·È Û ٷÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· (Û˘Ó‹ıˆ˜ ·Ó¿ 3-
4 ÒÚ˜) ‹ ˘fi ÙË ÌÔÚÊ‹ Û˘Ó¯ԇ˜ ÂÓ‰ÔÊϤ‚È·˜ ¤Á-
¯˘Û˘. ∂›Ó·È ¿ÍÈÔ ÚÔÛÔ¯‹˜ fiÙÈ Ë ·Ô‚ÔÏ‹ Ù˘ Ì·Ó-
ÓÈÙfiÏ˘ Â›Ó·È ÂÌÊ·ÓÒ˜ ÌÂȈ̤ÓË Û ·ÛıÂÓ›˜ ÌÂ
ÚÔ¯ˆÚË̤ÓË ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· (¯ÚfiÓÔ˜ ËÌ›-
ÛÈ·˜ ˙ˆ‹˜ 36 ÒÚ˜). ∏ ηٷÎÚ¿ÙËÛË Ì·ÓÓÈÙfiÏ˘ ÛÂ
 AÚÙËÚȷ΋ Y¤ÚÙ·ÛË, 18, 2-3
·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ÌÔÚ› Ó· Â›Ó·È ÂÈΛӉ˘ÓË,
ηıÒ˜ Ë Ô˘Û›· ·Ú·Ì¤ÓÂÈ ÛÙÔÓ ·ÁÁÂÈ·Îfi ¯ÒÚÔ Î·È
Ì ÙËÓ ˆÛ̈ÙÈ΋ Ù˘ ‰Ú¿ÛË ·˘Í¿ÓÂÈ ÙÔÓ ÂÓ‰·ÁÁÂÈ-
·Îfi fiÁÎÔ, Ì ΛӉ˘ÓÔ ÂÌÊ¿ÓÈÛ˘ Û˘Ìو̿وÓ
˘ÂÚÊfiÚÙˆÛ˘ ÙÔ˘ ΢ÎÏÔÊÔÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜15.
°È· ·˘Ùfi ÙÔ ÏfiÁÔ Ë Ì·ÓÓÈÙfiÏË ı· Ú¤ÂÈ Ó· ·Ô-
ʇÁÂÙ·È Û ·ÛıÂÓ›˜ ÌÂ Û˘ÌÊÔÚËÙÈ΋ ηډȷ΋
·ÓÂ¿ÚÎÂÈ·.
¢ÈÔ˘ÚËÙÈο Ù˘ ·Á·Ï˘
∏ ÊÔ˘ÚÔÛÂÌ›‰Ë Î·È ÙÔ Âı·ÎÚÈÓÈÎfi Ô͇ ·Ó·-
Ù‡¯ıËÎ·Ó ·ÓÂÍ¿ÚÙËÙ· Î·È Ô˘ÛÈ·ÛÙÈο Ù·˘Ùfi¯ÚÔÓ·
ÙË ‰ÂηÂÙ›· ÙÔ˘ 1960, ÂÓÒ ·ÎÔÏÔ‡ıˆ˜ ÂÌÊ·Ó›ÛıË-
Î·Ó Î·È ¿ÏÏ· ‰Ú·ÛÙÈο ÛÔ˘ÏÊ·ÌÔ˘Ï·ÓıÚ·ÓÈÏÈο
Ôͤ·, fiˆ˜ Ë ‚Ô˘ÌÂÙ·Ó›‰Ë Î·È Ë ÙÔÚÛÂÌ›‰Ë1. Δ· ‰È-
Ô˘ÚËÙÈο Ù˘ ·Á·Ï˘ ‹Ù·Ó ÌÈ· ÛËÌ·ÓÙÈ΋ ·Ó·Î¿-
Ï˘„Ë ÏfiÁˆ Ù˘ ÈÛ¯˘Ú‹˜ ÙÔ˘˜ ‰Ú¿Û˘, Ë ÔÔ›· Ù· η-
Ù¤ÛÙËÛ ¯Ú‹ÛÈÌ· Û ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›-
ÓÔÓÙ·È Â·ÚÎÒ˜ ÛÙȘ ¿ÏϘ ηÙËÁÔڛ˜ ‰ÈÔ˘ÚËÙÈ-
ÎÒÓ. ∂Í·ÈÙ›·˜ ÙÔ˘ ˘„ËÏÔ‡ ÔÛÔÛÙÔ‡ Û‡Ó‰ÂÛ˘ ÌÂ
ÙËÓ ·Ï‚Ô˘Ì›ÓË ÙÔ˘ ÔÚÔ‡ (95%), ÌfiÓÔ ¤Ó· ÌÈÎÚfi
ÔÛfi ·˘ÙÒÓ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Êı¿ÓÂÈ ÛÙÔ ÛˆÏËÓ·-
ÚÈ·Îfi ·˘Ïfi Ì ÛÂÈÚ·Ì·ÙÈ΋ ‰È‹ıËÛË Î·È Ë ÌÂÙ·-
ÊÔÚ¿ ÙÔ˘˜ ÛÙÔ ÂÁÁ‡˜ ÛˆÏËÓ¿ÚÈÔ Á›ÓÂÙ·È Û¯Â‰fiÓ
·ÔÎÏÂÈÛÙÈο Ì ÂÓÂÚÁËÙÈ΋ ¤ÎÎÚÈÛË, ̤ۈ ÙÔ˘ ÂÎ-
ÎÚÈÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÙˆÓ ÔÚÁ·ÓÈÎÒÓ ÔͤˆÓ16. Δ·
‰ÈÔ˘ÚËÙÈο Ù˘ ·Á·Ï˘ ‰ÚÔ˘Ó ÛÙÔ ·¯‡ ÙÌ‹Ì· ÙÔ˘
·ÓÈfiÓÙÔ˜ ÛΤÏÔ˘˜ Ù˘ ·Á·Ï˘ ÙÔ˘ Henle, fiÔ˘
Â·Ó·ÚÚÔÊ¿Ù·È ÂÚ›Ô˘ ÙÔ 20-30% ÙÔ˘ ‰ÈËıÔ‡ÌÂ-
ÓÔ˘ NaCl17. ∫·ıÒ˜ Ë Ì¤ÁÈÛÙË ‰fiÛË ÂÓfi˜ ‰ÈÔ˘ÚËÙÈ-
ÎÔ‡ Ù˘ ·Á·Ï˘ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ·Ô‚ÔÏ‹
ÙÔ˘ 20-25% ÙÔ˘ ‰ÈËıË̤ÓÔ˘ Na+, Ú·ÎÙÈο Ù· Ê¿Ú-
̷η ·˘Ù‹˜ Ù˘ ηÙËÁÔÚ›·˜ ÌÔÚÔ‡Ó Ó· ·Ó·ÛÙ›-
ÏÔ˘Ó Û¯Â‰fiÓ Ï‹Úˆ˜ ÙËÓ Â·Ó·ÚÚfiÊËÛË Na+ Ô˘
Ê˘ÛÈÔÏÔÁÈο Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ
ÙÌ‹Ì· ÙÔ˘ ÓÂÊÚÒÓ·1.
∏ ÈÔ ÛËÌ·ÓÙÈ΋ Ô‰fi˜ ÌÂÙ·ÊÔÚ¿˜ ÈfiÓÙˆÓ ÛÙËÓ
ÎÔÚ˘Ê·›· ÌÂÌ‚Ú¿ÓË ÙˆÓ ÂÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ
ÛÙÔ ·¯‡ ÙÌ‹Ì· ÙÔ˘ ·ÓÈfiÓÙÔ˜ ÛΤÏÔ˘˜ Ù˘ ·Á·Ï˘
ÙÔ˘ Henle Â›Ó·È Ô ËÏÂÎÙÚÈο Ô˘‰¤ÙÂÚÔ˜ Û˘ÌÌÂÙ·-
ÊÔÚ¤·˜ Na+-K+-2Cl– (NKCC2, ÁÔÓȉȷÎfi ۇ̂ÔÏÔ
SLC12A1)3,18, Ô ÔÔ›Ô˜ ÌÂٷʤÚÂÈ ·ıËÙÈο 1 Na+,
1 K+ Î·È 2 Cl– ÛÙÔ ÂÛˆÙÂÚÈÎfi ÙÔ˘ ΢ÙÙ¿ÚÔ˘ ‚·ÛÈ-
˙fiÌÂÓÔ˜ ÛÙËÓ ËÏÂÎÙÚÔ¯ËÌÈ΋ ÎÏ›ÛË ÙÔ˘ Na+ Ô˘ ‰Ë-
ÌÈÔ˘ÚÁÂ›Ù·È ·fi ÙË ‰Ú¿ÛË Ù˘ Na+-K+-ATP·ÛË Ù˘
‚·ÛÂÔÏ¢ÚÈ΋˜ ÌÂÌ‚Ú¿Ó˘. ªÈ· ÛËÌ·ÓÙÈ΋ ÔÛfi-
ÙËÙ· ∫+ Ô˘ ÌÂٷʤÚÂÙ·È Ì ÙÔÓ Û˘ÌÌÂÙ·ÊÔÚ¤·
Na+-K+-2Cl– ÂÈÛÙÚ¤ÊÂÈ ÛÙÔÓ ·˘Ïfi ̤ۈ ÙˆÓ ‰È-
·‡ÏˆÓ ∫+ Ù˘ ÎÔÚ˘Ê·›·˜ ÌÂÌ‚Ú¿Ó˘. ∫·Ù¿ Û˘Ó¤-
ÂÈ·, Ù· ÙÂÏÈο ·ÔÙÂϤÛÌ·Ù· ·˘Ù‹˜ Ù˘ Ô‰Ô‡ ›ӷÈ
151
Ë Â·Ó·ÚÚfiÊËÛË NaCl Î·È Ë ‰ËÌÈÔ˘ÚÁ›· ‰È·ÊÔÚ¿˜
‰˘Ó·ÌÈÎÔ‡ ÛÙÔ ÙÔ›¯ˆÌ· ÙÔ˘ ÛˆÏËÓ·Ú›Ô˘, Ì ÙÔÓ
·˘Ïfi ÊÔÚÙÈṲ̂ÓÔ ıÂÙÈο Û ۯ¤ÛË Ì ÙÔ ‰È·ÌÂÛÔ-
ÛˆÏËÓ·ÚÈ·Îfi ¯ÒÚÔ2,19. Δ· ‰ÈÔ˘ÚËÙÈο Ù˘ ·Á·Ï˘
Û˘Ó‰¤ÔÓÙ·È ÛÙÔÓ ÚˆÙÂ˚ÓÈÎfi ÌÂÙ·ÊÔÚ¤· Na+-K+-
2Cl– 18,20 Î·È ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙË ‰Ú¿ÛË ÙÔ˘, ·ÚÂÌÔ-
‰›˙ÔÓÙ·˜ Ì ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ÙËÓ Â·Ó·ÚÚfiÊËÛË
ÙˆÓ ÈfiÓÙˆÓ Na+, K+ Î·È Cl– ÛÙÔ ·¯‡ ÙÌ‹Ì· ÙÔ˘
·ÓÈfiÓÙÔ˜ ÛΤÏÔ˘˜ Ù˘ ·Á·Ï˘ ÙÔ˘ Henle. ∂ÎÙfi˜
·fi ÙËÓ ·Ó·ÛÙÔÏ‹ Ù˘ Â·Ó·ÚÚfiÊËÛ˘ ∫+, Ù· ‰È-
Ô˘ÚËÙÈο Ù˘ ·Á·Ï˘ ÚÔ¿ÁÔ˘Ó ÙËÓ ¤ÎÎÚÈÛË ∫+
·fi Ù· ·ÔÌ·ÎÚ˘Ṳ̂ӷ ÙÌ‹Ì·Ù· ÙÔ˘ Ô˘ÚÔÊfiÚÔ˘
ÛˆÏËÓ·Ú›Ô˘ ÏfiÁˆ Ù˘ ·˘ÍË̤Ó˘ ÚÔÛÊÔÚ¿˜ Na+
ÂΛ. ∂ÈϤÔÓ, ÙÔ ıÂÙÈÎfi ËÏÂÎÙÚÈÎfi ‰˘Ó·ÌÈÎfi ÙÔ˘
·˘ÏÔ‡ ÛÙÔ ·¯‡ ÙÌ‹Ì· ÙÔ˘ ·ÓÈfiÓÙÔ˜ ÛΤÏÔ˘˜ Ù˘
·Á·Ï˘ ÙÔ˘ Henle Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ Â·Ó·ÚÚfiÊËÛË
ÙˆÓ ÈfiÓÙˆÓ Ca++ Î·È Mg++ Û ·˘Ùfi ÙÌ‹Ì· ÙÔ˘ ÓÂ-
ÊÚÒÓ·. ∫·Ù¿ Û˘Ó¤ÂÈ·, Ù· ‰ÈÔ˘ÚËÙÈο Ù˘ ·Á·Ï˘
ÚÔηÏÔ‡Ó Â›Û˘ ·ÒÏÂÈ· Ca++ Î·È Mg++ ÛÙ·
Ô‡Ú·1-3,19,21. ∫·ıÒ˜ ÙÔ ·¯‡ ÙÌ‹Ì· ÙÔ˘ ·ÓÈfiÓÙÔ˜
ÛΤÏÔ˘˜ Â›Ó·È ·‰È·¤Ú·ÛÙÔ ÁÈ· ÙÔ ÓÂÚfi, Ë ·ÔÌ¿-
ÎÚ˘ÓÛË ÙˆÓ ‰È·Ï˘ÙÒÓ Ô˘ÛÈÒÓ ·fi ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ
ÙÌ‹Ì· ÙÔ˘ ÓÂÊÚÒÓ· Â›Ó·È ˘‡ı˘ÓË ÁÈ· ÙÔÓ Ì˯·-
ÓÈÛÌfi ÙÔ˘ ·ÓÙ›ÚÚÔÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ Î·È ÙË ‰Ë-
ÌÈÔ˘ÚÁ›· ÙÔ˘ ˘¤ÚÙÔÓÔ˘ ‰È¿ÌÂÛÔ˘ ¯ÒÚÔ˘ Ù˘ Ì˘Â-
ÏÒ‰Ô˘˜ ÌÔ›Ú·˜, Ô ÔÔ›Ô˜ ÛÙË Û˘Ó¤¯ÂÈ· ÏÂÈÙÔ˘ÚÁ›
ˆ˜ Ë ˆÛ̈ÙÈ΋ Ô‰ËÁfi˜ ‰‡Ó·ÌË ÁÈ· ÙËÓ Â·Ó·ÚÚfi-
ÊËÛË ÓÂÚÔ‡ ÛÙ· ·ıÚÔÈÛÙÈο ÛˆÏËÓ¿ÚÈ· ˘fi ÙËÓ
Â›‰Ú·ÛË Ù˘ ·ÓÙȉÈÔ˘ÚËÙÈ΋˜ ÔÚÌfiÓ˘ (ADH). ∏
·Ó·ÛÙÔÏ‹ Ù˘ ‰Ú¿Û˘ ÙÔ˘ Û˘ÌÌÂÙ·ÊÔÚ¤· Na+-K+-
2Cl– ·fi Ù· ‰ÈÔ˘ÚËÙÈο Ù˘ ·Á·Ï˘ ·ÚÂÌÔ‰›˙ÂÈ
ÙËÓ ·ÔÌ¿ÎÚ˘ÓÛË ÙˆÓ ‰È·Ï˘ÙÒÓ Ô˘ÛÈÒÓ ·fi ÙÔ
·¯‡ ÙÌ‹Ì· ÙÔ˘ ·ÓÈfiÓÙÔ˜ ÛΤÏÔ˘˜ Î·È ÌÂÈÒÓÂÈ ÙËÓ
ˆÛ̈ÙÈ΋ Ô‰ËÁfi ‰‡Ó·ÌË Â·Ó·ÚÚfiÊËÛ˘ ÓÂÚÔ‡,
‰È·Ù·Ú¿ÛÛÔÓÙ·˜ Ì ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ÙËÓ Û˘Ì˘-
ÎÓˆÙÈ΋ ÈηÓfiÙËÙ· ÙÔ˘ ÓÂÊÚÔ‡1-3. ∂›Û˘, ÛÙÔ Ê˘-
ÛÈÔÏÔÁÈÎfi ÓÂÊÚfi Ë ·ÔÌ¿ÎÚ˘ÓÛË ÙˆÓ ‰È·Ï˘ÙÒÓ Ô˘-
ÛÈÒÓ ·fi ÙÔ ·¯‡ ÙÌ‹Ì· ÙÔ˘ ·ÓÈfiÓÙÔ˜ ÛΤÏÔ˘˜ ‚ÔË-
ı¿ ÛÙËÓ ·Ú·›ˆÛË ÙÔ˘ ÛˆÏËÓ·ÚÈ·ÎÔ‡ ˘ÁÚÔ‡ ηÈ
ÚÔ¿ÁÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ÂχıÂÚÔ˘ ‡‰·ÙÔ˜, fiÔÙÂ
·˘Ùfi Â›Ó·È ··Ú·›ÙËÙÔ. ∫·Ù¿ Û˘Ó¤ÂÈ·, Ù· ‰ÈÔ˘ÚË-
ÙÈο Ù˘ ·Á·Ï˘ ·Ú·‚Ï¿ÙÔ˘Ó Â›Û˘ Î·È ÙËÓ
·Ú·ÈˆÙÈ΋ ÈηÓfiÙËÙ· ÙÔ˘ ÓÂÊÚÔ‡2,3.
¶·Ú¿ÏÏËÏ· Ì ٷ ·Ú·¿Óˆ, Ù· ‰ÈÔ˘ÚËÙÈο
Ù˘ ·Á·Ï˘ ·ÛÎÔ‡Ó ·ÈÌÔ‰˘Ó·ÌÈΤ˜ ‰Ú¿ÛÂȘ ÙfiÛÔ
ÛÙË Û˘ÛÙËÌ·ÙÈ΋ fiÛÔ Î·È ÛÙËÓ ÂÓ‰ÔÓÂÊÚÈ΋ ÌÈÎÚÔ-
΢ÎÏÔÊÔÚ›·. ∏ ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ‰ÈÔ˘ÚËÙÈÎÒÓ
Ù˘ ·Á·Ï˘ ¤¯ÂÈ ÌÈ· ‚Ú·¯˘ÚfiıÂÛÌË ·ÁÁÂÈԉȷ-
ÛÙ·ÏÙÈ΋ Â›‰Ú·ÛË, ÂÍ·ÈÙ›·˜ Ù˘ ÓÂÊÚÈ΋˜ ·ÂÏ¢-
ı¤ÚˆÛ˘ ·ÁÁÂÈԉȷÛÙ·ÏÙÈÎÒÓ ÚÔÛÙ·ÁÏ·Ó‰ÈÓÒÓ3,22.
∞˘Ù‹ Ë ·ÁÁÂÈԉȷÛÙÔÏ‹ ÌÔÚ› Ó· ÚÔηϤÛÂÈ Ì›-
152 AÚÙËÚȷ΋ Y¤ÚÙ·ÛË, 18, 2-3
ˆÛË ÙÔ˘ ηډȷÎÔ‡ ÚÔÊÔÚÙ›Ô˘, ÂÚÌËÓ‡ÔÓÙ·˜ ÙËÓ
¿ÌÂÛË ‚ÂÏÙ›ˆÛË Ù˘ ÎÏÈÓÈ΋˜ Û˘Ìو̷ÙÔÏÔÁ›·˜
Ô˘ Û˘¯Ó¿ ·Ú·ÙËÚÂ›Ù·È Û ·ÛıÂÓ›˜ Ì Ô͇ Ó¢-
ÌÔÓÈÎfi Ô›‰ËÌ· ÚÈÓ ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ‰ÈÔ˘ÚËÙÈ΋˜
‰Ú¿Û˘ ÙˆÓ Ô˘ÛÈÒÓ ·˘ÙÒÓ1. ™Â ÔÚÈṲ̂Ó˜ ÂÚÈ-
ÙÒÛÂȘ, ˆÛÙfiÛÔ, Ù· ‰ÈÔ˘ÚËÙÈο Ù˘ ·Á·Ï˘ ÌÔ-
ÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó Ù¤ÙÔÈ· ·ÓÙ·Ó·ÎÏ·ÛÙÈ΋ ÂÓÂÚ-
ÁÔÔ›ËÛË ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜
Î·È ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÚÂÓ›Ó˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘, ÒÛÙÂ
Ó· ÚÔηϤÛÔ˘Ó ÛËÌ·ÓÙÈ΋ ·ÁÁÂÈÔÛ‡Û·ÛË Î·È ·‡-
ÍËÛË ÙÔ˘ ÌÂÙ·ÊÔÚÙ›Ô˘ Ù˘ ηډȿ˜23. ∞Ó·ÊÔÚÈο
Ì ÙËÓ ·ÈÌÔ‰˘Ó·ÌÈ΋ ÛÙÔ Â›Â‰Ô ÙÔ˘ ÓÂÊÚÔ‡, Ù· ‰È-
Ô˘ÚËÙÈο Ù˘ ·Á·Ï˘ Ù›ÓÔ˘Ó Ó· ‰È·ÙËÚ‹ÛÔ˘Ó ‹ Ó·
·˘Í‹ÛÔ˘Ó ÙÔ Ú˘ıÌfi ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘
(GFR), ·ÎfiÌË Î·È Û ÂÚÈÙÒÛÂȘ ˘ÔÔÁηÈÌ›·˜,
ÂÍ·ÈÙ›·˜ Ù˘ ÌÂÛÔÏ·‚Ô‡ÌÂÓ˘ ·fi ÙȘ ÚÔÛÙ·ÁÏ·Ó-
‰›Ó˜ ‰È·ÛÙÔÏ‹˜ ÙÔ˘ ÚÔÛ·ÁˆÁÔ‡ ·ÚÙËÚȉ›Ô˘ ÙÔ˘
ÓÂÊÚÔ‡ Î·È ÙÔ˘ ·ÔÎÏÂÈÛÌÔ‡ ÙÔ˘ ÛÂÈÚ·Ì·ÙÔÛˆ-
ÏËÓ·ÚÈ·ÎÔ‡ Ì˯·ÓÈÛÌÔ‡ ·Ï›Ó‰ÚÔÌ˘ ·Ó·ÙÚÔÊÔ-
‰fiÙËÛ˘2.
ŸÙ·Ó ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Ù· ‰ÈÔ˘ÚËÙÈο Ù˘
·Á·Ï˘, ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘fi„Ë ÔÚÈ-
Ṳ̂ӷ ÛËÌ·ÓÙÈο ı¤Ì·Ù· Û¯ÂÙÈο Ì ÙË Ê·ÚÌ·ÎÔ-
ÎÈÓËÙÈ΋ ÙÔ˘˜, ÒÛÙ ӷ ÂÍ·ÛÊ·Ï›˙ÂÙ·È Ë ÎÏÈÓÈ΋
ÙÔ˘˜ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·. ∏ ÊÔ˘ÚÔÛÂÌ›‰Ë Î·È Ë
‚Ô˘ÌÂÙ·Ó›‰Ë ¤¯Ô˘Ó Ù·¯Â›· ‰Ú¿ÛË Î·È ÌÈÎÚfi ¯ÚfiÓÔ
ËÌ›ÛÂÈ·˜ ˙ˆ‹˜. ªÂÙ¿ ·fi ÂÓ‰ÔÊϤ‚È· ¤Á¯˘ÛË, Ë
‰Ú¿ÛË ÍÂÎÈÓ¿ÂÈ Û ϛÁ· ÏÂÙ¿, ÂÓÒ ÌÂÙ¿ ·fi ¯Ô-
Ú‹ÁËÛË ·fi ÙÔ ÛÙfiÌ· Ë Ì¤ÁÈÛÙË ‰Ú¿ÛË ÂÌÊ·Ó›˙ÂÙ·È
Û 30-90 ÏÂÙ¿. ™Â ·ÌÊfiÙÂÚ˜ ÙȘ ÂÚÈÙÒÛÂȘ Ë
‰Ú¿ÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ‰È·ÚΛ ‰‡Ô Ì ÙÚÂȘ ÒÚ˜
ηÈ, ÂÔ̤ӈ˜, Û ÔÏÏÔ‡˜ ·ÛıÂÓ›˜ ·˘Ù¿ Ù· Ê¿Ú-
̷η Ú¤ÂÈ Ó· ¯ÔÚËÁÔ‡ÓÙ·È ÔÏϤ˜ ÊÔÚ¤˜ ÙËÓ Ë-
̤ڷ1,19. ∏ ÙÔÚÛÂÌ›‰Ë ¤¯ÂÈ Î¿ˆ˜ ÌÂÁ·Ï‡ÙÂÚÔ ¯Úfi-
ÓÔ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜ Î·È ÌÂÁ·Ï‡ÙÂÚË ‰È¿ÚÎÂÈ· ‰Ú¿Û˘
Î·È ¤ÙÛÈ ÌÔÚ› Ó· ¯ÔÚËÁËı› Ì ÌÈÎÚfiÙÂÚË Û˘¯Ófi-
ÙËÙ·24. ™Â οı ÂÚ›ÙˆÛË, ÙÔ Û‡ÓËı˜ ¯ÚÔÓÈÎfi ‰È¿-
ÛÙËÌ· ÌÂٷ͇ ÙˆÓ ¯ÔÚËÁÔ‡ÌÂÓˆÓ ‰fiÛÂˆÓ ÁÈ· fiÏ·
Ù· ‰ÈÔ˘ÚËÙÈο Ù˘ ·Á·Ï˘ ˘ÂÚ‚·›ÓÂÈ ÙË ¯ÚÔÓÈ΋
‰È¿ÚÎÂÈ· ηٿ ÙËÓ ÔÔ›· Â·ÚΛ˜ ÔÛfiÙËÙ˜ ÙÔ˘
Ê·ÚÌ¿ÎÔ˘ ‚Ú›ÛÎÔÓÙ·È ÛÙ· ÛËÌ›· ‰Ú¿Û˘ ÙÔ˘. ™ÙÔ
¯ÚfiÓÔ Î·Ù¿ ÙÔÓ ÔÔ›Ô ÛÙ· ÛËÌ›· ‰Ú¿Û˘ ‚Ú›ÛÎÔ-
ÓÙ·È ·ÓÂ·ÚΛ˜ ÔÛfiÙËÙ˜ ÙÔ˘ ‰ÈÔ˘ÚËÙÈÎÔ‡, Ô ÓÂ-
ÊÚÒÓ·˜ Â·Ó·ÚÚÔÊ¿ Ì·˙Èο Na+, ÚÔηÏÒÓÙ·˜
ÙËÓ ·ÔηÏÔ‡ÌÂÓË ÌÂÙ·‰ÈÔ˘ÚËÙÈ΋ (post-diuretic) ‹
·ÓÙ·Ó·ÎÏ·ÛÙÈ΋ (rebound) ηٷÎÚ¿ÙËÛË Na+.
∞˘Ù‹ Ë Î·Ù·ÎÚ¿ÙËÛË Na+ ÌÔÚ› Ó· Â›Ó·È ÙfiÛÔ
ÂÎÙÂÓ‹˜, ÒÛÙ ӷ ·Î˘ÚÒÓÂÈ ÙËÓ fiÔÈ· ÚÔËÁËı›-
Û· Ó·ÙÚÈÔ‡ÚËÛË, ÂȉÈο fiÙ·Ó ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜
‰Ú¿Û˘ ‰ÈÔ˘ÚËÙÈο Ù˘ ·Á·Ï˘ ¯ÔÚËÁÔ‡ÓÙ·È Ì›·
ÊfiÚ· ËÌÂÚËÛ›ˆ˜ Î·È Ë ÚfiÛÏË„Ë NaCl Â›Ó·È ÌÂ-
Á¿ÏË2,19,25,26. ∞˘Ùfi ÙÔ Úfi‚ÏËÌ· ÌÂÁÂı‡ÓÂÙ·È fiÙ·Ó
Ë ‰È·ÈÙËÙÈ΋ ÚfiÛÏË„Ë Î·È Ë ÂÓÙÂÚÈ΋ ·ÔÚÚfiÊË-
ÛË NaCl ‰ÂÓ ‚Ú›ÛÎÂÙ·È Û ·ÓÙÈÛÙÔȯ›· Ì ÙË ‰Ú¿ÛË
ÙÔ˘ Ê·ÚÌ¿ÎÔ˘25. ŒÓ· ¿ÏÏÔ ÛËÌ·ÓÙÈÎfi ˙‹ÙËÌ· Ê·Ú-
Ì·ÎÔÎÈÓËÙÈ΋˜ Â›Ó·È Ë ‚ÈԉȷıÂÛÈÌfiÙËÙ· ÙˆÓ Ê·Ú-
Ì¿ÎˆÓ ·˘ÙÒÓØ Ë ‚Ô˘ÌÂÙ·Ó›‰Ë Î·È Ë ÙÔÚÛÂÌ›‰Ë
·ÔÚÚÔÊÒÓÙ·È Ï‹Úˆ˜ ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Ûˆ-
Ï‹Ó· (>=80%), ÂÓÒ Î·Ù¿ ̤ÛÔ fiÚÔ ·ÔÚÚÔÊ¿Ù·È
ÌfiÓÔ ÙÔ 50% Ù˘ ¯ÔÚËÁÔ‡ÌÂÓ˘ ‰fiÛ˘ Ù˘ ÊÔ˘ÚÔ-
ÛÂÌ›‰Ë˜. ∫·Ù¿ Û˘Ó¤ÂÈ·, Ë ‰ÔÛÔÏÔÁ›· Ù˘ ÊÔ˘ÚÔ-
ÛÂÌ›‰Ë˜ fiÙ·Ó ¯ÔÚËÁÂ›Ù·È ·fi ÙÔ ÛÙfiÌ· Ú¤ÂÈ Ó· ›-
Ó·È Û¯Â‰fiÓ ‰ÈÏ¿ÛÈ· ·fi ÙËÓ ÂÓ‰ÔÊϤ‚È·1,3,19. ¢˘-
ÛÙ˘¯Ò˜, Ë ·ÔÚÚfiÊËÛË Ù˘ ÊÔ˘ÚÔÛÂÌ›‰Ë˜ fiÙ·Ó ¯Ô-
ÚËÁËı› ·fi ÙÔ ÛÙfiÌ· ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈ΋ ÌÂ-
Ù·‚ÏËÙfiÙËÙ· ÌÂٷ͇ ÙˆÓ ·ÛıÂÓÒÓ, ·ÏÏ¿ Î·È ÛÙÔÓ
›‰ÈÔ ·ÛıÂÓ‹ ·fi Ë̤ڷ Û Ë̤ڷ (Î˘Ì·ÈÓfiÌÂÓË ·fi
10-100%)27, ÂÓÒ Ë Ù·˘Ùfi¯ÚÔÓË Ï‹„Ë ÊÔ˘ÚÔÛÂÌ›‰Ë˜
Î·È ‚Ô˘ÌÂÙ·Ó›‰Ë˜ Ì ÙÔ Ê·ÁËÙfi ÚÔηÏ› ‰Ú·Ì·ÙÈ-
΋ Ì›ˆÛË Ù˘ ‚ÈԉȷıÂÛÈÌfiÙËÙ¿˜ ÙÔ˘˜28. ∏ ÙÔÚÛÂ-
Ì›‰Ë ‰ÂÓ ¤¯ÂÈ ·˘Ù¿ Ù· ÌÂÈÔÓÂÎÙ‹Ì·Ù·29 οÙÈ Ô˘
ÌÔÚ› Ó· ¤¯ÂÈ ÎÏÈÓÈ΋ ÛËÌ·Û›·, fiˆ˜ Ê¿ÓËΠηÈ
Û ̛· ÚfiÛÊ·ÙË ÌÂϤÙË Ë ÔÔ›· ·Ó¤ÊÂÚ ÏÈÁfiÙÂ-
Ú˜ ÂÈÛ·ÁˆÁ¤˜ Û ÓÔÛÔÎÔÌ›· Î·È Î·Ï‡ÙÂÚË ÔÈfi-
ÙËÙ· ˙ˆ‹˜ Û ·ÛıÂÓ›˜ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·
˘fi ıÂÚ·›· Ì ÙÔÚÛÂÌ›‰Ë Û ۇÁÎÚÈÛË Ì ÙË ÊÔ˘-
ÚÔÛÂÌ›‰Ë30.
∞Ó·ÊÔÚÈο Ì ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi, ÙÔ 50% Ù˘
ÊÔ˘ÚÔÛÂÌ›‰Ë˜ ·Ô‚¿ÏÏÂÙ·È ¯ˆÚ›˜ η̛· ÌÂÙ·ÙÚÔ-
‹ ÛÙ· Ô‡Ú· Î·È ÙÔ ˘fiÏÔÈÔ Û˘Ó‰¤ÂÙ·È Ì ÁÏ˘-
ÎÔ˘ÚÔÓÈÎfi Ô͇ ÛÙÔ ÓÂÊÚfi31. ∏ ‚Ô˘ÌÂÙ·Ó›‰Ë Î·È Ë
ÙÔÚÛÂÌ›‰Ë ¤¯Ô˘Ó ÛËÌ·ÓÙÈÎfi ÌÂÙ·‚ÔÏÈÛÌfi (50% ηÈ
80% ·ÓÙ›ÛÙÔȯ·) Ô ÔÔ›Ô˜ Â›Ó·È Î˘Ú›ˆ˜ Ë·ÙÈÎfi˜
·Ú¿ ÓÂÊÚÈÎfi˜24,32. ∫·Ù¿ Û˘Ó¤ÂÈ·, Ô ¯ÚfiÓÔ˜ ËÌ›-
ÛÂÈ·˜ ˙ˆ‹˜ Ï¿ÛÌ·ÙÔ˜ Î·È Ë ‰È¿ÚÎÂÈ· ‰Ú¿Û˘ Ù˘
ÊÔ˘ÚÔÛÂÌ›‰Ë˜ Â›Ó·È ·Ú·ÙÂٷ̤ÓÔÈ Û ·ÛıÂÓ›˜ ÌÂ
ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ÏfiÁˆ ·ÊÂÓfi˜ Ù˘ ÌÂȈ̤Ó˘
ÓÂÊÚÈ΋˜ ·Ô‚ÔÏ‹˜ Î·È ·ÊÂÙ¤ÚÔ˘ Ù˘ ÌÂȈ̤Ó˘
ÓÂÊÚÈ΋˜ Û‡Ó‰ÂÛ˘ Ì ÁÏ˘ÎÔ˘ÚÔÓÈÎfi Ô͇, ÂÓÒ ÔÈ
¯ÚfiÓÔÈ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜ Ù˘ ‚Ô˘ÌÂÙ·Ó›‰Ë˜ Î·È Ù˘ ÙÔÚ-
ÛÂÌ›‰Ë˜ ·Ú·Ì¤ÓÔ˘Ó ·ÌÂÙ¿‚ÏËÙÔÈ, ηıÒ˜ ÙÔ ‹·Ú
·Ú¤¯ÂÈ Ì›· ÂÓ·ÏÏ·ÎÙÈ΋ Ô‰fi ÁÈ· ÙËÓ ·Ô‚ÔÏ‹ ·˘-
ÙÒÓ ÙˆÓ Ô˘ÛÈÒÓ ·fi ÙÔÓ ÔÚÁ·ÓÈÛÌfi3,7,19. øÛÙfiÛÔ, Ë
ÓÂÊÚÈ΋ ÓfiÛÔ˜ ‰È·Ù·ÚÚ¿ÛÂÈ ÙË ÌÂÙ·ÊÔÚ¿ fiÏˆÓ ÙˆÓ
‰ÈÔ˘ÚËÙÈÎÒÓ Ù˘ ·Á·Ï˘ ÛÙÔ ÛˆÏËÓ·ÚÈ·Îfi ·˘Ïfi,
ηıÒ˜ Ë ·¤ÎÎÚÈÛ‹ ÙÔ˘˜ ÛÙÔÓ ·˘Ïfi ̤ۈ ÙÔ˘ Û˘-
ÛÙ‹Ì·ÙÔ˜ ÙˆÓ ÔÚÁ·ÓÈÎÒÓ ÔͤˆÓ ˘Ê›ÛÙ·Ù·È ·ÓÙ·Áˆ-
ÓÈÛÌfi ·fi ÂÓ‰ÔÁÂÓÒ˜ ·Ú·ÁfiÌÂÓ· ÔÚÁ·ÓÈο Ôͤ·,
Ù· ÔÔ›· Û˘ÛÛˆÚ‡ÔÓÙ·È ÚÔԉ¢ÙÈο fiÛÔ ÌÂÈÒÓÂ-
Ù·È Ë ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›·. ∂Ô̤ӈ˜, ·˘Ù¿ Ù· Ê¿Ú-
̷η Ú¤ÂÈ Ó· ¯ÔÚËÁÔ‡ÓÙ·È Û ÌÂÁ·Ï‡ÙÂÚ˜ ‰fiÛÂȘ,
ÒÛÙ ӷ ÂÈÙ¢¯ıÔ‡Ó Â·ÚΛ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÛÙ·
 AÚÙËÚȷ΋ Y¤ÚÙ·ÛË, 18, 2-3
ÛËÌ›· ‰Ú¿Û˘3,7,19,33. ™Â ·ÛıÂÓ›˜ Ì Ë·ÙÈ΋ ÓfiÛÔ,
ÔÈ ¯ÚfiÓÔÈ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜ Ï¿ÛÌ·ÙÔ˜ Ù˘ ‚Ô˘ÌÂÙ·Ó›-
‰Ë˜ Î·È Ù˘ ÙÔÚÛÂÌ›‰Ë˜ Â›Ó·È ·Ú·ÙÂٷ̤ÓÔÈ, οÙÈ
Ô˘ ÌÔÚ› Ó· ÂÓÈÛ¯‡ÛÂÈ ÙËÓ ·ÓÙ·fiÎÚÈÛË ÛÙ· Ê¿Ú-
̷η ·˘Ù¿19,34.
Δ· ‰ÈÔ˘ÚËÙÈο Ù˘ ·Á·Ï˘ Â›Ó·È Ù· ÈÔ ·Ô-
ÙÂÏÂÛÌ·ÙÈο ‰ÈÔ˘ÚËÙÈο Ô˘ ¤¯Ô˘Ì ÛÙË ‰È¿ıÂÛË
Ì·˜ ηÈ, ηٿ Û˘Ó¤ÂÈ·, ·ÔÙÂÏÔ‡Ó Ê¿Ú̷η ÂÎÏÔ-
Á‹˜ ÛÙË ıÂÚ·›· ÔȉËÌ·ÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, fiˆ˜
Ë Û˘ÌÊÔÚËÙÈ΋ ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·, Ë ‚·ÚÈ¿
Ë·ÙÈ΋ ΛÚÚˆÛË Î·È ÙÔ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ,
ȉ›ˆ˜ Â¿Ó Ë Î¿ı·ÚÛË ÎÚ·ÙÈÓ›Ó˘ Â›Ó·È ÌÈÎÚfiÙÂÚË
·fi ÂÚ›Ô˘ 40 mL/min/1,73 m2, fiÔ˘ Ù· ıÂÈ·˙ȉÈ-
ο ‰ÈÔ˘ÚËÙÈο ˆ˜ ÌÔÓÔıÂÚ·›· Â›Ó·È ÏÈÁfiÙÂÚÔ È-
ı·Ófi Ó· ¤¯Ô˘Ó ÎÏÈÓÈ΋ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·, fiˆ˜
ı· Û˘˙ËÙËı› ·Ó·Ï˘ÙÈο ·Ú·Î¿Ùˆ1,19. ∞˘Ù¿ Ù·
Ê¿Ú̷η ·ÔÙÂÏÔ‡Ó Â›Û˘ Ù· ‰ÈÔ˘ÚËÙÈο ÂÎÏÔÁ‹˜
ÁÈ· ÙË ıÂÚ·›· Ù˘ ˘¤ÚÙ·Û˘ ‹ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô
ÙÔ˘ fiÁÎÔ˘ ˘ÁÚÒÓ Û ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· ÓÂÊÚÈ΋
ÓfiÛÔ (á¡) Î·È Î¿ı·ÚÛË ÎÚ·ÙÈÓ›Ó˘ οو ·fi ÙÔ
ÚÔ·Ó·ÊÂÚı¤Ó fiÚÈÔ. ™Â ·ÛıÂÓ›˜ Ì á¡, Ë Ê·Ú-
Ì·ÎÔ‰˘Ó·ÌÈ΋ ÙˆÓ ‰ÈÔ˘ÚËÙÈÎÒÓ Ù˘ ·Á·Ï˘ ‰ÂÓ
ÂËÚ¿˙ÂÙ·È ÛËÌ·ÓÙÈο, ηıÒ˜ ÔÈ ˘ÔÏÂÈfiÌÂÓÔÈ
ÓÂÊÚÒÓ˜ Ê·›ÓÂÙ·È Ó· ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È «Ê˘ÛÈÔÏÔ-
ÁÈο», (‰ËÏ·‰‹ Ì ÎÏ·ÛÌ·ÙÈ΋ ·¤ÎÎÚÈÛË Na+
fiÌÔÈ· Ì ·˘Ù‹ ÙˆÓ ˘ÁÈÒÓ ·ÙfïÓ35), ·ÏÏ¿ Ë Û˘ÓÔ-
ÏÈ΋ (·fiÏ˘ÙË) ·Ô‚ÔÏ‹ Na+ Â›Ó·È ¯·ÌËÏfiÙÂÚË
ÂÍ·ÈÙ›·˜ Ù˘ Ì›ˆÛ˘ ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ÊÔÚÙ›Ô˘ Na+
Ô˘ ‰ÈËıÂ›Ù·È ÛÙÔ Û›ڷ̷1,3,19,33. ∂ÈϤÔÓ, ÂÍ·È-
Ù›·˜ Ù˘ ÚÔ·Ó·ÊÂÚı›۷˜ ‰È·Ù·Ú·Á̤Ó˘ ÌÂÙ·-
ÊÔÚ¿˜ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ·˘ÙÒÓ ÛÙ· Ô‡Ú·, Ë Â›Ù¢ÍË
̤ÁÈÛÙ˘ ‰Ú¿Û˘ ··ÈÙ› ˘„ËÏfiÙÂÚ˜ ‰fiÛÂȘ. OÈ Ì¤-
ÁÈÛÙ˜ ‰fiÛÂȘ ÁÈ· οı ¤Ó·Ó ·fi ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜
·˘ÙÔ‡˜ ¤¯Ô˘Ó ÚÔÛ‰ÈÔÚÈÛı› Û ÎÏÈÓÈΤ˜ ÌÂϤÙ˜
(¶›Ó. 2). ¶Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÌÂÁ·Ï‡ÙÂÚ˜ ‰fi-
ÛÂȘ ·fi ·˘Ù¤˜ Ô˘ ·ÂÈÎÔÓ›˙ÔÓÙ·È ÛÙÔÓ ›Ó·Î· 2
‰ÂÓ ı· ·˘Í‹ÛÔ˘Ó ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·, ηıÒ˜
ÙÔ plateau ÛÙËÓ Î·Ì‡ÏË ‰fiÛ˘-·ÓÙ·fiÎÚÈÛ˘ ¤¯ÂÈ
‹‰Ë ÂÈÙ¢¯ı›. ∞ÓÙ›ıÂÙ·, ÔÈ ˘„ËÏfiÙÂÚ˜ ‰fiÛÂȘ ı·
·˘Í‹ÛÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ Ù˘ ÙÔÍÈÎfiÙËÙ·˜. ∫·Ù¿ Û˘Ó¤-
ÂÈ·, Ô ÌfiÓÔ˜ ÙÚfiÔ˜ ÁÈ· Ó· ÂÈÙ¢¯ı› ·ıÚÔÈÛÙÈÎfi
·ÔÙ¤ÏÂÛÌ· Â›Ó·È Ë ¯ÔÚ‹ÁËÛË ·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ ‰fi-
ÛÂˆÓ ÔÏϤ˜ ÊÔÚ¤˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤-
Ú·˜1,7,19. ∂›Û˘, ÂÓÒ ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ·fi ·˘ÙÔ‡˜
ÙÔ˘˜ ·ÛıÂÓ›˜ ı· ¯ÚÂÈ·ÛıÔ‡Ó ÌÂÁ¿Ï˜ ‰fiÛÂȘ, Ë ıÂ-
Ú·›· Ú¤ÂÈ Ó· ÍÂÎÈÓ¿ ·fi ¯·ÌËϤ˜ ‰fiÛÂȘ Î·È Ó·
·ÎÔÏÔ˘ıÂ›Ù·È ·fi ·ÓÔ‰È΋ ÙÈÙÏÔÔ›ËÛË Û‡Ìʈӷ ÌÂ
ÙËÓ ÎÏÈÓÈ΋ ·ÓÙ·fiÎÚÈÛË Î·È ÙÔ ÛÙfi¯Ô Ù˘ ıÂÚ·›-
·˜. ∞˘Ùfi ··ÈÙÂ›Ù·È È‰È·›ÙÂÚ· ÛÙËÓ ÂÚ›ÙˆÛË Ù˘
·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ¯ÔÚ‹ÁËÛ˘ ÊÔ˘ÚÔÛÂÌ›‰Ë˜, ÂÍ·È-
Ù›·˜ Ù˘ ÚÔ·Ó·ÊÂÚı›۷˜ ÚÔ‚ÏËÌ·ÙÈ΋˜ Ê·ÚÌ·-
153
ÎÔÎÈÓËÙÈ΋˜.
™Â ·ÛıÂÓ›˜ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·, ΛÚ-
ÚˆÛË ‹ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ Ë Ê·ÚÌ·ÎÔ‰˘Ó·ÌÈ΋
ÙˆÓ ‰ÈÔ˘ÚËÙÈÎÒÓ Ù˘ ·Á·Ï˘ ·ÏÏ¿˙ÂÈ, Ì ·ÔÙ¤-
ÏÂÛÌ· Î·È Ë Ì¤ÁÈÛÙË ‰Ú¿ÛË Ó· Â›Ó·È Â›Û˘ ÌÈÎÚfi-
ÙÂÚË. ∞˘Ùfi ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û ·˘ÍË̤ÓË Â·-
Ó·ÚÚfiÊËÛË Na+ ÛÙÔ ÂÁÁ‡˜ ‹/Î·È ÛÙÔ ¿ˆ ÛˆÏË-
Ó¿ÚÈÔ, ‹ ·ÎfiÌË Î·È Û ·ÏÏ·Á‹ Ù˘ ‰˘Ó·ÌÈ΋˜ Ù˘
·ÏÏËÏÂ›‰Ú·Û˘ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ·˘ÙÒÓ Ì ÙÔ Û˘Ì-
ÌÂÙ·ÊÔÚ¤· Na+-K+-2Cl–, fiˆ˜ ÚÔ·ÙÂÈ ·fi ÂÈ-
Ú·Ì·ÙÈΤ˜ ÌÂϤÙ˜36. ŸÔÈ· Î·È ·Ó Â›Ó·È Ë ·ÈÙ›·,
Ë ÎÏÈÓÈ΋ ÛËÌ·Û›· ·˘ÙÔ‡ ÙÔ˘ Ê·ÈÓÔ̤ÓÔ˘ Â›Ó·È fiÙÈ
·˘Ù‹ Ë ÌÂȈ̤ÓË ·ÓÙ·fiÎÚÈÛË ÛÙ· ‰ÈÔ˘ÚËÙÈο Ù˘
·Á·Ï˘ ‰Â ‚ÂÏÙÈÒÓÂÙ·È Ì ÙË ¯ÔÚ‹ÁËÛË ÌÂÁ¿ÏˆÓ
‰fiÛˆÓ, Î·È ÂÔ̤ӈ˜, ÔÈ Ì¤ÁÈÛÙ˜ ÂÈÙÚÂÙ¤˜ ‰fi-
ÛÂȘ ÙˆÓ ‰ÈÔ˘ÚËÙÈÎÒÓ Ù˘ ·Á·Ï˘ Û ·ÛıÂÓ›˜ ÌÂ
ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· Î·È Î›ÚÚˆÛË ¯ˆÚ›˜ ÓÂÊÚÈ΋
·ÓÂ¿ÚÎÂÈ· ‰ÂÓ Â›Ó·È Ôχ ˘„ËϤ˜1,19. ™Â ·ÛıÂÓ›˜
Ì ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ ¤¯Ô˘Ó ÚÔÙ·ı› ÂÈÚfi-
ÛıÂÙ· ÚÔ‚Ï‹Ì·Ù· Ê·ÚÌ·ÎÔÎÈÓËÙÈ΋˜ ÙˆÓ ‰ÈÔ˘ÚË-
ÙÈÎÒÓ Ù˘ ·Á·Ï˘, Ù· ÔÔ›· Ô‰ËÁÔ‡Ó Û Ì›ˆÛË Ù˘
ÔÛfiÙËÙ·˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙÔ ÛËÌÂ›Ô ‰Ú¿Û˘, fiˆ˜
Ë ·ÓÂ·Ú΋˜ ¤ÎÎÚÈÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ·fi ÙÔ ·›Ì·
ÛÙÔÓ ·˘Ïfi ÙÔ˘ ÓÂÊÚÒÓ· ÏfiÁˆ Ù˘ ˘ÔÏÂ˘ÎˆÌ·ÙÈ-
Ó·ÈÌ›·˜ Î·È Û˘ÓÂÒ˜ ÙÔ˘ ÌÂÁ·Ï‡ÙÂÚÔ˘ fiÁÎÔ˘ ηٷ-
ÓÔÌ‹˜ ÙÔ˘ ‹ Ë Û‡Ó‰ÂÛË ÙÔ˘ ‰ÈÔ˘ÚËÙÈÎÔ‡ Ù˘ ·Á·Ï˘
Ì ÙËÓ ÏÂ˘ÎˆÌ·Ù›ÓË ÂÓÙfi˜ ÙÔ˘ ÛˆÏËÓ·ÚÈ·ÎÔ‡ ·˘-
ÏÔ‡1,19,33. ∞ÌÊfiÙÂÚ˜ ÔÈ ˘Ôı¤ÛÂȘ ·˘Ù¤˜ ˘ÔÛÙËÚ›-
˙ÔÓÙ·È ·fi Â˘Ú‹Ì·Ù· ÂÈÚ·Ì·ÙÈÎÒÓ ÌÂÏÂÙÒÓ37,38,
Ô˘ Ô‰‹ÁËÛ·Ó ÛÙËÓ ·Ó¿Ù˘ÍË ÛÙÚ·ÙËÁÈÎÒÓ ¤Á¯˘Û˘
ÙÔ˘ ‰ÈÔ˘ÚËÙÈÎÔ‡ Ù˘ ·Á·Ï˘ Ì·˙› Ì ÏÂ˘ÎˆÌ·Ù›ÓË,
Ì ÛÙfi¯Ô Ó· ·˘ÍËı› ÙÔ ÔÛfi ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Ô˘ ı·
Êı¿ÛÂÈ ÛÙÔ ÛËÌÂ›Ô ‰Ú¿Û˘. øÛÙfiÛÔ, ÚfiÛÊ·Ù˜ ÌÂ-
ϤÙ˜ Û ·ÛıÂÓ›˜ Ì ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ Î·È Ï¢-
Έ̷ٛÓË ÔÚÔ‡ >2 gr/ dL ÛÙÔ˘˜ ÔÔ›Ô˘˜ ¤ÁÈÓÂ Û˘Á-
¯ÔÚ‹ÁËÛË ÏÂ˘ÎˆÌ·Ù›Ó˘ Î·È ÊÔ˘ÚÔÛÂÌ›‰Ë˜39,40 ‹ ÌÂ-
ϤÙ˜ Ô˘ ¯ÚËÛÈÌÔÔÈ‹Û·Ó ¤Ó·Ó ·Ú¿ÁÔÓÙ· Ô˘ ÌÂ-
Ù·ÙÔ›˙ÂÈ ÙË ÊÔ˘ÚÔÛÂÌ›‰Ë ·fi ÙË ÏÂ˘ÎˆÌ·Ù›ÓË ÙˆÓ
Ô‡ÚˆÓ41 ¤‰ÂÈÍ·Ó ÌˉÂÓÈ΋ ‹ ÂÏ¿¯ÈÛÙË ‚ÂÏÙ›ˆÛË Ù˘
‰Ú¿Û˘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘. ∂Ô̤ӈ˜, Ë Â›Ù¢ÍË Èη-
ÓÔÔÈËÙÈ΋˜ ‰ÈÔ‡ÚËÛ˘ Û ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜
··ÈÙ› ¯ÔÚ‹ÁËÛË Ì¤ÁÈÛÙˆÓ ‰fiÛÂˆÓ ÙˆÓ ‰ÈÔ˘ÚËÙÈ-
ÎÒÓ Ù˘ ·Á·Ï˘ ÔÏϤ˜ ÊÔÚ¤˜ ÙËÓ Ë̤ڷ, ·˘ÛÙË-
Úfi ÂÚÈÔÚÈÛÌfi Ù˘ ÚfiÛÏ˄˘ NaCl Î·È Û˘Ó‰˘·-
ÛÌÔ‡˜ Ì ¿ÏÏ· ‰ÈÔ˘ÚËÙÈο19.
∏ ¯Ú‹ÛË ÙˆÓ ‰ÈÔ˘ÚËÙÈÎÒÓ Ù˘ ·Á·Ï˘ ÛÙË ıÂ-
Ú·›· Ù˘ ·ÓÂ›ÏÂÎÙ˘ ˘¤ÚÙ·Û˘ Û˘ÛÙ‹ÓÂÙ·È ÛÂ
ÌÈÎÚfiÙÂÚÔ ‚·ıÌfi, ΢ڛˆ˜ ÂÍ·ÈÙ›·˜ Ù˘ ÌÈÎÚ‹˜ ‰È¿Ú-
ÎÂÈ·˜ ‰Ú¿Û˘ ÙÔ˘˜ Û ۯ¤ÛË Ì ÙȘ ıÂÈ·˙›‰Â˜. ¶ÚÔË-
ÁÔ‡ÌÂÓ˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ¯ÔÚ‹-
ÁËÛË ÊÔ˘ÚÔÛÂÌ›‰Ë˜ ·ÎfiÌË Î·È ‰‡Ô ÊÔÚ¤˜ ËÌÂÚË-
154 AÚÙËÚȷ΋ Y¤ÚÙ·ÛË, 18, 2-3

¶›Ó·Î·˜ 2. º·ÚÌ·ÎÔÏÔÁÈο Î·È Ê·ÚÌ·ÎÔÎÈÓËÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ‰ÈÔ˘ÚËÙÈÎÒÓ (ΔÚÔÔÔÈË̤ÓÔ˜ ·fi Brater et al.1, Kaplan NM 4
Î·È Shah et al.62)

¢ÈÔ˘ÚËÙÈÎÔ› ÃËÌÈ΋ ª¤ÁÈÛÙ‹ ‰Ú¿ÛË ÃÚfiÓÔ˜ ËÌ›ÛÂÈ·˜ ¢È¿ÚÎÂÈ· ∏ÌÂÚ‹ÛÈ· ∂ÌÔÚÈ΋

·Ú¿ÁÔÓÙ˜ ηÙËÁÔÚ›· (% ÔÛÔÛÙfi ÙÔ˘ ˙ˆ‹˜ (ÒÚ˜) ‰Ú¿Û˘ ‰ÔÛÔÏÔÁ›· ÔÓÔÌ·Û›· –
‰ÈËıË̤ÓÔ˘ ÊÔÚ- (ÒÚ˜) (‰ÔÛÔÏÔÁÈÎfi ™Î‡·ÛÌ·(Ù·)
Ù›Ô˘ Ó·ÙÚ›Ô˘) Û¯‹Ì·) ÛÙËÓ ∂ÏÏ¿‰·

∞Ó·ÛÙÔÏ›˜ Ù˘
ηڂÔÓÈ΋˜
·Ó˘‰Ú¿Û˘

∞ÎÂÙ·˙ÔÏ·Ì›‰Ë ™Ô˘ÏÊÔÓ·- 3-5 13 16 250-1000 mg -Acetazolamide

ÌȉÈÎfi (·Ú·ÙÂٷ̤ÓÔ˜ (‰‡Ô ÊÔÚ¤˜ tab 250 mg
·Ú¿ÁˆÁÔ ÛÙÔ ÙÂÏÈÎfi ËÌÂÚËÛ›ˆ˜) -Diamox
ÛÙ¿‰ÈÔ Ã¡∞) 500 mg/vial
øÛ̈ÙÈÎÒ˜
‰ÚÒÓÙ·
‰ÈÔ˘ÚËÙÈο

ª·ÓÓÈÙfiÏË ™¿Î¯·ÚÔ 20-25 1 (¤ˆ˜ & 36 ÒÚ˜ 2 50-200 g (Û˘Ó¯‹˜ -Mannitol 20%
ÛÙÔ ÙÂÏÈÎfi ÂÓ‰ÔÊϤ‚È· solution
ÛÙ¿‰ÈÔ Ã¡∞) ¤Á¯˘ÛË ‹ ÂÓ‰Ô-
ÊϤ‚È· ¤Á¯˘ÛË
‰È·Ï‡Ì·ÙÔ˜ 20%
οı 3-4 ÒÚ˜)

¢ÈÔ˘ÚËÙÈο ¶·Ú¿ÁˆÁ· 20-25

Ù˘ ·Á·Ï˘ ÛÔ˘ÏÊÔÓ·Ì›‰Ë˜

ºÔ˘ÚÔÛÂÌ›‰Ë 1,5-2 4-6 20-480 mg (‰‡Ô ‹ Lasix,

(·Ú·ÙÂٷ̤ÓÔ˜ ÙÚÂȘ ÊÔÚ¤˜ Hydroflux
ÛÙÔ ÙÂÏÈÎfi ËÌÂÚËÛ›ˆ˜) tab 40 mg, inj.
ÛÙ¿‰ÈÔ Ã¡∞) sol 20 mg/2 ml
Lasix tab 500 mg

ΔÔÚÛÂÌ›‰Ë 3-4 (∞ÌÂÙ¿‚ÏËÙÔ˜ 12 5-40 mg (Ì›· ‹

ÛÙÔ ÙÂÏÈÎfi ‰‡Ô ÊÔÚ¤˜
ÛÙ¿‰ÈÔ Ã¡∞) ËÌÂÚËÛ›ˆ˜)

μÔ˘ÌÂÙ·Ó›‰Ë 0,3-1,5 4-6 0,5-5 mg (‰‡Ô ‹

∞ÌÂÙ¿‚ÏËÙÔ˜ ÙÚÂȘ ÊÔÚ¤˜
ÛÙÔ ÙÂÏÈÎfi ËÌÂÚËÛ›ˆ˜)
ÛÙ¿‰ÈÔ Ã¡∞)

∂ı·ÎÚÈÓÈÎfi Ô͇ — 12 25-100 (Ì›· ÊÔÚ¿

ËÌÂÚËÛ›ˆ˜)

£ÂÈ·˙›‰Â˜ Î·È ¶·Ú¿ÁˆÁ· 5-8

ıÂÈ·˙ȉÈο ÛÔ˘ÏÊÔÓ·Ì›‰Ë˜
·Ó¿ÏÔÁ·

£ÂÈ·˙›‰Â˜

À‰ÚԯψÚÔ- 3-10 12-18 12.5-50 mg (Ì›· ªfiÓÔ Û ‰È¿ÊÔ-

ıÂÈ·˙›‰Ë ÊÔÚ¿ ËÌÂÚËÛ›ˆ˜) ÚÔ˘˜ Û˘Ó‰˘·ÛÌÔ‡˜
Ì ·ª∂∞, AΔ1
·ÔÎÏÂÈÛÙ¤˜ (12,5 ηÈ
25 mg) Î·È Û˘Ó‰˘·-
ÛÌfi Ì ·ÌÈÏÔÚ›‰Ë
(Moduretic, Tiaden
tab 50+5 mg)
 AÚÙËÚȷ΋ Y¤ÚÙ·ÛË, 18, 2-3 155

¶›Ó·Î·˜ 2 (Û˘Ó¤¯ÂÈ·)

¢ÈÔ˘ÚËÙÈÎÔ› ÃËÌÈ΋ ª¤ÁÈÛÙ‹ ‰Ú¿ÛË ÃÚfiÓÔ˜ ËÌ›ÛÂÈ·˜ ¢È¿ÚÎÂÈ· ∏ÌÂÚ‹ÛÈ· ∂ÌÔÚÈ΋

·Ú¿ÁÔÓÙ˜ ηÙËÁÔÚ›· (% ÔÛÔÛÙfi ÙÔ˘ ˙ˆ‹˜ (ÒÚ˜) ‰Ú¿Û˘ ‰ÔÛÔÏÔÁ›· ÔÓÔÌ·Û›· –
‰ÈËıË̤ÓÔ˘ ÊÔÚ- (ÒÚ˜) (‰ÔÛÔÏÔÁÈÎfi ™Î‡·ÛÌ·(Ù·)
Ù›Ô˘ Ó·ÙÚ›Ô˘) Û¯‹Ì·) ÛÙËÓ ∂ÏÏ¿‰·

ÃψÚÔıÂÈ·˙›‰Ë 15-25 6-12 125-500 mg (Ì›·

‹ ‰‡Ô ÊÔÚ¤˜
ËÌÂÚËÛ›ˆ˜

‚ÂÓ‰ÚÔÊÏÔ˘ÌÂ- 2.5-5 18 2.5-5 mg (Ì›·

ıÂÈ·˙›‰Ë ÊÔÚ¿ ËÌÂÚËÛ›ˆ˜)

ΔÚȯψÚÌÂ- 1-4 24 1-4 mg (Ì›·

ıÂÈ·˙›‰Ë ÊÔÚ¿ ËÌÂÚËÛ›ˆ˜)

£ÂÈ·˙ȉÈο
·Ó¿ÏÔÁ·

ÃψÚÔı·ÏȉfiÓË 24-55 24-72 12.5-50 mg (Ì›· Hygroton tab 50 mg

ÊÔÚ¿ ËÌÂÚËÛ›ˆ˜
‹ οı ‰Â‡ÙÂÚË
Ë̤ڷ)

πÓ‰··Ì›‰Ë 6-15 24-36 1.25-2.5 mg (Ì›· Fludex tab 2.5 mg

ÊÔÚ¿ ËÌÂÚËÛ›ˆ˜)

ªÂÙÔÓ·˙fiÓË — 24 0.25-2.5 mg (Ì›·

ÊÔÚ¿ ËÌÂÚËÛ›ˆ˜)

∫Ô˘ÈÓÂı·˙fiÓË 10 18-24 25-100 mg (Ì›·

ÊÔÚ¿ ËÌÂÚËÛ›ˆ˜)

∫·ÏÈÔÛ˘ÓÙË-
ÚËÙÈο
‰ÈÔ˘ÚËÙÈο

¶·Ú¿ÁˆÁ· Ù˘ ¶·Ú¿ÁˆÁ· Ù˘ 2-3

ÙÂÚȉ›Ó˘ ÙÂÚȉ›Ó˘

∞ÌÈÏÔÚ›‰Ë 17 24 5-10 mg (Ì›· ªfiÓÔ ÛÂ Û˘Ó‰˘·ÛÌfi

(·Ú·ÙÂٷ̤ÓÔ˜ ÊÔÚ¿ ËÌÂÚËÛ›ˆ˜) Ì ˘‰ÚԯψÚÔıÂÈ·-
ÛÙÔ ÙÂÏÈÎfi ˙›‰Ë (Moduretic,
Tiaden tab 5+50 mg)
Î·È ÊÔ˘ÚÔÛÂÌ›‰Ë
(Frumil 5+40 mg)

ΔÚÈ·ÌÙÂÚ¤ÓË 3 (ÂÓÂÚÁfi˜ 12 50-150 mg (Ì›·

ÌÂÙ·‚ÔÏ›Ù˘=3) ÊÔÚ¿ ËÌÂÚËÛ›ˆ˜)
(·Ú·ÙÂٷ̤ÓÔ˜
ÛÙÔ ÙÂÏÈÎfi
ÛÙ¿‰ÈÔ Ã¡∞)

∞ÓÙ·ÁˆÓÈÛÙ¤˜ ∞Ó¿ÏÔÁ· 2-3

Ù˘ ·Ï‰ÔÛÙÂ- ·Ï·ÙÔÎÔÚÙÈ-
ÚfiÓ˘ ÎÔÂȉÒÓ

™ÈÚÔÓÔÏ·ÎÙfiÓË 1,5 (ÂÓÂÚÁÔ› 8-12 25-100 mg (Ì›· Aldactone tab 25,

ÌÂÙ·‚Ôϛ٘=15) ÊÔÚ¿ ËÌÂÚËÛ›ˆ˜) 100 mg

∂ÏÂÚÂÓfiÓË 3-4 12 25-100 mg (Ì›· Inspra tab 25, 50 mg

ÊÔÚ¿ ËÌÂÚËÛ›ˆ˜)

™˘ÓÙÔÌÔÁڷʛ˜: á∞= ÃÚfiÓÈ· ÓÂÊÚÈο ·ÓÂ¿ÚÎÂÈ·, ·-ª∂∞= ·Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘,
156 AÚÙËÚȷ΋ Y¤ÚÙ·ÛË, 18, 2-3
Û›ˆ˜ Â›Ó·È ÏÈÁfiÙÂÚÔ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·fi ÙËÓ ˘‰ÚÔ-
¯ÏˆÚÔıÂÈ·˙›‰Ë42,43, ÂÓÒ ÚÔηÏ› Û fiÌÔÈÔ ‚·ıÌfi
˘ÂÚÔ˘Úȯ·ÈÌ›· Î·È ˘ÔηÏÈ·ÈÌ›·. ∏ ÙÔÚÛÂÌ›‰Ë,
¤¯ÔÓÙ·˜ ÌÂÁ·Ï‡ÙÂÚË ‰È¿ÚÎÂÈ· ‰Ú¿Û˘, ›Ûˆ˜ Â›Ó·È ÈÔ
·ÔÙÂÏÂÛÌ·ÙÈ΋ Û·Ó ·ÓÙÈ˘ÂÚÙ·ÛÈÎfi Ê¿ÚÌ·ÎÔ44.
∫·ıÒ˜ Ù· ‰ÈÔ˘ÚËÙÈο Ù˘ ·Á·Ï˘ ÚÔηÏÔ‡Ó ·Ô-
‚ÔÏ‹ ·Û‚ÂÛÙ›Ô˘ ÛÙ· Ô‡Ú·, ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈ-
ËıÔ‡Ó ÛÙË ıÂÚ·›· Ù˘ ˘ÂÚ·Û‚ÂÛÙÈ·ÈÌ›·˜, ·ÏÏ¿
ÌfiÓÔ ·ÊfiÙÔ˘ ‰ÈÔÚıˆı› Ë ˘ÔÔÁηÈÌ›· Ô˘ Û¯ÂÙ›-
˙ÂÙ·È Ì ÙËÓ ˘ÂÚ·Û‚ÂÛÙÈ·ÈÌ›·, ηıÒ˜ Ë ·Ôηٿ-
ÛÙ·ÛË ÙÔ˘ fiÁÎÔ˘ ÌÔÚ› Ó· Â·ÚΛ ÁÈ· ÙËÓ ‰ÈfiÚ-
ıˆÛË Ù˘ ‰È·Ù·Ú·¯‹˜45,46. ∞ÎfiÌË, Ù· ‰ÈÔ˘ÚËÙÈο Ù˘
·Á·Ï˘ ÌÔÚÔ‡Ó Ó· Ê·ÓÔ‡Ó ¯Ú‹ÛÈÌ· ÛÙË ıÂÚ·›·
Ù˘ ˘ÔÓ·ÙÚÈ·ÈÌ›·˜, ηıÒ˜ ÚÔηÏÔ‡Ó ·Ô‚ÔÏ‹ ÓÂ-
ÚÔ‡ Û ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi ·fi fiÙÈ Ó·ÙÚ›Ô˘. °È· Ó·
Û˘Ì‚Â› ·˘Ùfi, ı· Ú¤ÂÈ ÔÈ ÚÔηÏÔ‡ÌÂÓ˜ ·fi Ù·
‰ÈÔ˘ÚËÙÈο ·ÒÏÂȘ ˘ÁÚÒÓ Ó· ·ÓÙÈηı›ÛÙ·ÓÙ·È ÌÂ
ÈÛfiÙÔÓ· ‹ ˘¤ÚÙÔÓ· ‰È·Ï‡Ì·Ù·, ·Ó¿ÏÔÁ· Ì ÙËÓ ÂÈ-
ı˘ÌËÙ‹ Ù·¯‡ÙËÙ· ‰ÈfiÚıˆÛ˘ Ù˘ ˘ÔÓ·ÙÚÈ·ÈÌ›·˜47.
Δ¤ÏÔ˜, Û ÔÚÈṲ̂ÓÔ˘˜ ·ÛıÂÓ›˜ Ì ÓÂÊÚÈ΋ ÛˆÏË-
Ó·Úȷ΋ ÔͤˆÛË Ù‡Ô˘ π Ô˘ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ‰È·-
ÙËÚ‹ÛÔ˘Ó ¤Ó· Â·ÚΤ˜ Û˘ÛÙËÌ·ÙÈÎfi PH Ì ÙË Û˘-
ÓÙËÚËÙÈ΋ ıÂÚ·›·, Ù· ‰ÈÔ˘ÚËÙÈο Ù˘ ·Á·Ï˘ ı·
ÌÔÚÔ‡Û·Ó Ó· ‚ÔËı‹ÛÔ˘Ó ÛÙË ‰ÈfiÚıˆÛË Ù˘ ÌÂÙ·-
‚ÔÏÈ΋˜ ÔͤˆÛ˘, ÂÈÙÚ¤ÔÓÙ·˜ ÙËÓ ·Ô‚ÔÏ‹ fiÍÈÓˆÓ
Ô‡ÚˆÓ1, ̤ۈ ·˘ÍË̤Ó˘ ¤ÎÎÚÈÛ˘ H+ ÛÙÔÓ ¿ˆ ÓÂ-
ÊÚÒÓ·48.
£ÂÈ·˙ȉÈο ‰ÈÔ˘ÚËÙÈο
OÈ ıÂÈ·˙›‰Â˜ ·Ó·Ù‡¯ıËÎ·Ó ·fi ¯ËÌÈΤ˜ ÙÚÔ-
ÔÔÈ‹ÛÂȘ ÙÔ˘ ÛÔ˘ÏÊÔÓ·ÌȉÈÎÔ‡ ˘Ú‹Ó· Ù˘ ·ÎÂ-
Ù·˙ÔÏ·Ì›‰Ë˜ Û ÌÈ· ÚÔÛ¿ıÂÈ· ÁÈ· ÙËÓ ‰ËÌÈÔ˘Ú-
Á›· ÂÓfi˜ ‰ÈÔ˘ÚËÙÈÎÔ‡ Ô˘ ÚÔηÏ› ·ÒÏÂÈ· NaCl
Î·È fi¯È NaHCO3 ÛÙ· Ô‡Ú·49. ∏ ¯ÏˆÚÔıÂÈ·˙›‰Ë
‹Ù·Ó Ë ÚÒÙË ıÂÈ·˙ȉÈ΋ ¤ÓˆÛË Ô˘ ·Ó·Î·Ï‡ÊıË-
ÎÂ, Î·È ·ÎÔÏÔ‡ıËÛ·Ó ¿ÏÏ· Ê¿Ú̷η Ì fiÌÔÈ· Ê·Ú-
Ì·ÎÔÏÔÁ›·, ·ÏÏ¿ Ì ‰È·ÊÔÚÂÙÈ΋ Ê·ÚÌ·ÎÔÎÈÓËÙÈ΋.
ÕÏϘ ÙÚÔÔÔÈ‹ÛÂȘ ÙÔ˘ ÛÔ˘ÏÊÔÓ·ÌȉÈÎÔ‡ ˘Ú‹-
Ó· Ô‰‹ÁËÛ·Ó ÛÙËÓ ÎÔ˘˚ÓÂı·˙fiÓË, ÙË ÌÂÙÔÏ·˙fiÓË,
ÙË ¯ÏˆÚÔı·ÏȉfiÓË Î·È ÙËÓ ÈÓ‰··Ì›‰Ë, ÔÈ Ôԛ˜
¤¯Ô˘Ó fiÌÔȘ Ê·ÚÌ·ÎÔÏÔÁÈΤ˜ ‰Ú¿ÛÂȘ Ì ÙËÓ ÔÌ¿-
‰· ÙˆÓ ıÂÈ·˙›‰ˆÓ, ·ÏÏ¿ ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ÌÈ· ‰È·-
ÊÔÚÂÙÈ΋ ¯ËÌÈ΋ ηÙËÁÔÚ›·1. Ÿˆ˜ Î·È Ù· ‰ÈÔ˘ÚË-
ÙÈο Ù˘ ·Á·Ï˘, Ù· ·Ú·¿Óˆ Ê¿Ú̷η ΢ÎÏÔ-
ÊÔÚÔ‡Ó ÛÙÔ ·›Ì· Û˘Ó‰Â‰Â̤ӷ Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi
Ì ÙË ÏÂ˘ÎˆÌ·Ù›ÓË Î·È ÂÎÎÚ›ÓÔÓÙ·È ÂÓÂÚÁËÙÈο ÛÙÔ
ÂÁÁ‡˜ ÛˆÏËÓ¿ÚÈÔ Ì¤Ûˆ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÙˆÓ ÔÚÁ·-
ÓÈÎÒÓ ·ÓÈfiÓÙˆÓ1,2. OÈ ıÂÈ·˙›‰Â˜ Î·È Ù· Û˘ÁÁÂÓ‹
ÛÔ˘ÏÊ·Ó·ÌȉÈο ·Ú¿ÁˆÁ· ‰ÚÔ˘Ó Î˘Ú›ˆ˜ ÛÙÔ ¿ˆ
ÂÛÂÈڷ̤ÓÔ ÛˆÏËÓ¿ÚÈÔ, fiÔ˘ Â·Ó·ÚÚÔÊ¿Ù·È Â-
Ú›Ô˘ ÙÔ 5-10% ÙÔ˘ ‰ÈËıË̤ÓÔ˘ NaCl17. ™Â ·˘Ùfi ÙÔ
ÙÌ‹Ì· ÙÔ˘ ÓÂÊÚÒÓ·, Ù· ÈfiÓÙ· Na+ Î·È Cl– ÂÈÛ¤Ú¯Ô-
ÓÙ·È ÛÙÔ Î‡ÙÙ·ÚÔ Ì¤Ûˆ Ù˘ ·˘ÏÈ΋˜ ÌÂÌ‚Ú¿Ó˘
̤ۈ ÌÈ· ËÏÂÎÙÚÈο Ô˘‰¤ÙÂÚ˘ Ô‰Ô‡ Û˘ÌÌÂÙ·ÊÔ-
Ú¿˜ NaCl (NCC, ÁÔÓȉȷÎfi ۇ̂ÔÏÔ SLC12A3)2,18.
∞˘Ù‹ Ë Ô‰fi˜ Û˘ÌÌÂÙ·ÊÔÚ¿˜ ·ÔÎÏ›ÂÙ·È ·fi ÙȘ
ıÂÈ·˙›‰Â˜ Î·È Ù· ıÂÈ·˙ȉÈο ·Ó¿ÏÔÁ·, ÚÔηÏÒÓÙ·˜
‰È·Ù·Ú·¯‹ ÛÙËÓ Â·Ó·ÚÚfiÊËÛË Na+ Î·È Cl–. ∞Í›-
˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ë Û˘ÌÌÂÙ·ÊÔÚ¿ ·˘Ù‹ Â›Ó·È ÁÂ-
ÓÂÙÈο ·ÓÂÓÂÚÁfi˜ ÛÙÔ Û‡Ó‰ÚÔÌÔ Gitelman, Ô Ê·È-
ÓfiÙ˘Ô˜ ÙÔ˘ ÔÔ›Ô˘ ÌÔÈ¿˙ÂÈ Ôχ Ì ÙÔ ·ÔÙ¤ÏÂÛÌ·
Ù˘ ‰Ú¿Û˘ ÙˆÓ ıÂÈ·˙›‰ˆÓ50,51. ∂Í·ÈÙ›·˜ Ù˘ ·˘ÍË-
̤Ó˘ ÚÔÛÊÔÚ¿˜ Na+ ÛÙ· ·ıÚÔÈÛÙÈο ÛˆÏËÓ¿ÚÈ·,
·˘Í¿ÓÂÙ·È Ë ÂΛ ·ÓÙ·ÏÏ·Á‹ Na+ Ì ∫+, Ì ·ÔÙ¤-
ÏÂÛÌ· ·ÒÏÂÈ· ∫+ ÛÙ· Ô‡Ú·. ∫·ıÒ˜ ÙÔ ¿ˆ ÛˆÏË-
Ó¿ÚÈÔ Â›Ó·È Û¯ÂÙÈο ·‰È·¤Ú·ÛÙÔ ÁÈ· ÙÔ ÓÂÚfi Î·È Ë
Ê˘ÛÈÔÏÔÁÈ΋ Â·Ó·ÚÚfiÊËÛË NaCl ÂΛ Û˘ÓÂÈÛʤÚÂÈ
ÛÙËÓ ·Ú·›ˆÛË ÙÔ˘ ÛˆÏËÓ·ÚÈ·ÎÔ‡ ˘ÁÚÔ‡, ÔÈ ıÂÈ·˙›-
‰Â˜ ‰È·Ù·Ú¿ÛÛÔ˘Ó ÙËÓ ·Ú·ÈˆÙÈ΋ ÈηÓfiÙËÙ· ÙÔ˘ ÓÂ-
ÊÚÔ‡, ·ÏÏ¿ ‰ÂÓ ¤¯Ô˘Ó η̛· Â›‰Ú·ÛË ÛÙË Û˘Ì˘-
ÎÓˆÙÈ΋ ÙÔ˘ ÈηÓfiÙËÙ·1-3. ∂ÈϤÔÓ, ·˘Ù¿ Ù· Ê¿Ú-
̷η ‰È·Ù·Ú¿ÛÛÔ˘Ó ÙËÓ Â·Ó·ÚÚfiÊËÛË Mg++, ·ÏÏ¿
Û ·ÓÙ›ıÂÛË Ì ٷ ‰ÈÔ˘ÚËÙÈο Ù˘ ·Á·Ï˘ ‰ÈÂÁ›-
ÚÔ˘Ó ÙËÓ Â·Ó·ÚÚfiÊËÛË Ca++. ∞˘Ùfi ÌÔÚ› Ó· ›-
Ó·È Û˘Ó¤ÂÈ· ›Ù Ù˘ ·˘ÍË̤Ó˘ Â·Ó·ÚÚfiÊËÛ˘
Na+ Î·È Ca++ ÛÙÔ ÂÁÁ‡˜ ÛˆÏËÓ¿ÚÈÔ ÂÍ·ÈÙ›·˜ Ù˘
ÚÔηÏÔ‡ÌÂÓ˘ ·fi ÙË ıÂÈ·˙›‰Ë Ì›ˆÛ˘ ÙÔ˘ Â͈-
΢ÙÙ¿ÚÈÔ˘ fiÁÎÔ˘, ›Ù Ù˘ ·˘ÍË̤Ó˘ Â·Ó·ÚÚfiÊË-
Û˘ Ca++ ÛÙÔ ¿ˆ ÛˆÏËÓ¿ÚÈÔ ÂÍ·ÈÙ›·˜ ‰È·ÊfiÚˆÓ
·Ú·ÁfiÓÙˆÓ (fiˆ˜ Ë ‰È¿ÓÔÈÍË ÂÍ·ÚÙÒÌÂÓˆÓ ·fi ÙÔ
‰˘Ó·ÌÈÎfi ‰È·‡ÏˆÓ ηÙÈfiÓÙˆÓ ÏfiÁˆ ·ÚÓËÙÈÎÔ‡ ËÏÂ-
ÎÙÚÈÎÔ‡ ÊÔÚÙ›Ô˘ ÛÙÔ ÂÛˆÙÂÚÈÎfi ÙˆÓ ÛˆÏËÓ·ÚÈ·ÎÒÓ
΢ÙÙ¿ÚˆÓ ÚÔηÏÔ‡ÌÂÓÔ ·fi ÙËÓ Â·Ó›ÛÔ‰Ô Cl–
·fi ÙÔ ‰È·ÌÂÛÔÛˆÏËÓ·ÚÈ·Îfi ¯ÒÚÔ ‹ Ë ·˘ÍË̤ÓË
·ÓÙ·ÏÏ·Á‹ 3Na+-Ca++ ÛÙË ‚·ÛÂÔÏ¢ÚÈ΋ ÌÂÌ‚Ú¿-
ÓË Ô˘ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ù˘ ÚÔηÏÔ‡ÌÂÓ˘ ·fi ÙË
ıÂÈ·˙›‰Ë Ì›ˆÛ˘ ÙÔ˘ ÂÓ‰Ô΢ÙÙ¿ÚÈÔ˘ Na+ 2,52).
∏ ÈÔ Û˘¯Ó‹ ıÂÚ·¢ÙÈ΋ ¯Ú‹ÛË ÙˆÓ ıÂÈ·˙ȉÈ-
ÎÒÓ ‰ÈÔ˘ÚËÙÈÎÒÓ ·ÊÔÚ¿ ÛÙËÓ È‰ÈÔ·ı‹ ˘¤ÚÙ·ÛË.
¶ÔÏ˘¿ÚÈı̘ ÎÏÈÓÈΤ˜ ‰ÔÎÈ̤˜ ¤‰ÂÈÍ·Ó ÙËÓ ÎÏÈÓÈ΋
·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ·˘ÙÒÓ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÛÙËÓ
ÙÒÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, fiˆ˜ Î·È ÛÙË Ì›ˆ-
ÛË Ù˘ ηډȷÁÁÂȷ΋˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfi-
ÙËÙ·˜ ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù˘ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋˜ ÙÔ˘˜
‰Ú¿Û˘. ∫·Ù¿ Û˘Ó¤ÂÈ·, ÔÈ ıÂÈ·˙›‰Â˜ Û˘ÛÙ‹ÓÔÓÙ·È
Û‹ÌÂÚ· ˆ˜ ÚÒÙ˘ ÁÚ·ÌÌ‹˜ ÂÈÏÔÁ‹ ÛÙË ıÂÚ·›·
Ù˘ ȉÈÔ·ıÔ‡˜ ˘¤ÚÙ·Û˘ ˆ˜ ÌÔÓÔıÂÚ·›· ‹ ÛÂ
Û˘Ó‰˘·ÛÌfi Ì ¿ÏÏ· ·ÓÙÈ˘ÂÚÙ·ÛÈο Ê¿Ú̷η53,54.
OÈ ·Ú¯ÈΤ˜ ‰fiÛÂȘ ÌÈ·˜ ıÂÈ·˙›‰Ë˜ ÚÔηÏÔ‡Ó Ì›-
ˆÛË ÙÔ˘ ÂÍˆÎ˘ÙÙ¿ÚÈÔ˘ fiÁÎÔ˘ Î·È Û˘ÓÂÒ˜ ÙÒÛË
Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘. ™˘ÛÙËÌ·ÙÈÎÔ› Î·È ÂÓ‰ÔÓÂ-
 AÚÙËÚȷ΋ Y¤ÚÙ·ÛË, 18, 2-3 157

¶›Ó·Î·˜ 3. ∫·Ù·ÛÙ¿ÛÂȘ ÌÂȈ̤Ó˘ ·ÓÙ·fiÎÚÈÛ˘ ÛÙ· ‰ÈÔ˘ÚËÙÈο Ù˘ ·Á·Ï˘ Î·È ·ÓÙ›ÛÙÔȯ˜ ̤ÁÈÛÙ˜ ‰fiÛÂȘ (ΔÚÔÔ-
ÔÈË̤ÓÔ˜ ·fi Brater et al.1, Wilcox et al.34, Î·È Shankar et al.20).

∫ÏÈÓÈ΋ ηٿÛÙ·ÛË ¡ÂÊÚÈ΋ ∞ÓÂ¿ÚÎÂÈ· ¡ÂÊÚˆÛÈÎfi ∏·ÙÈ΋ ∫›ÚÚˆÛË* ∫·Ú‰È·Î‹

Û‡Ó‰ÚÔÌÔ* ∞ÓÂ¿ÚÎÂÈ·*
ª¤ÙÚÈ· μ·ÚÈ¿
(CrCl 20-50 (CrCl <20
ml/min) ml/min)
ªË¯·ÓÈÛÌfi˜ ªÂȈ̤ÓË ÌÂÙ·ÊÔÚ¿ ªÂȈ̤ÓË ÓÂÊÚÈ΋ ªÂȈ̤ÓË ÓÂÊÚÈ΋ ªÂȈ̤ÓË ÓÂÊÚÈ΋
Ù˘ ÌÂȈ̤Ó˘ ÛÙÔ ÛËÌÂ›Ô ‰Ú¿Û˘ ·ÓÙ·fiÎÚÈÛË ·ÓÙ·fiÎÚÈÛË ·ÓÙ·fiÎÚÈÛË
·ÓÙ·fiÎÚÈÛ˘ ™‡Ó‰ÂÛË ÙÔ˘
ÛÙ· ‰ÈÔ˘ÚËÙÈο ‰ÈÔ˘ÚËÙÈÎÔ‡ ÌÂ
ÙË ÏÂ˘ÎˆÌ·Ù›ÓË
ÙˆÓ Ô‡ÚˆÓ
£ÂÚ·¢ÙÈÎÔ› ∞˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ∞˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ∞˘ÍË̤ÓË ∞˘ÍË̤ÓË
¯ÂÈÚÈÛÌÔ› ÁÈ· ¯ÔÚ‹ÁËÛ˘ ·ÔÙÂÏÂÛÌ·- ¯ÔÚ‹ÁËÛ˘ ·ÔÙÂÏÂ- Û˘¯ÓfiÙËÙ· Û˘¯ÓfiÙËÙ·
Â›Ù¢ÍË ÙÈÎÒÓ ‰fiÛÂˆÓ ÛÌ·ÙÈÎÒÓ ‰fiÛÂˆÓ ¯ÔÚ‹ÁËÛ˘ ·Ô- ¯ÔÚ‹ÁËÛ˘ ·Ô-
·ÓÙ·fiÎÚÈÛ˘ ¢fiÛË ÈηӋ ÁÈ· ÙËÓ Â›- ¢fiÛË ÈηӋ ÁÈ· ÙËÓ ÙÂÏÂÛÌ·ÙÈÎÒÓ ÙÂÏÂÛÌ·ÙÈÎÒÓ
Ù¢ÍË ·ÔÙÂÏÂÛÌ·ÙÈÎÔ‡ Â›Ù¢ÍË ·ÔÙÂÏÂ- ‰fiÛÂˆÓ ‰fiÛˆÓ
ÔÛÔ‡ ‰ÈÔ˘ÚËÙÈÎÔ‡ ÛÌ·ÙÈÎÔ‡ ÔÛÔ‡
ÛÙÔ ÛËÌÂ›Ô ‰Ú¿Û˘ ‰ÈÔ˘ÚËÙÈÎÔ‡
ÛÙÔ ÛËÌÂ›Ô ‰Ú¿Û˘
ª¤ÁÈÛÙ˜ ‰fiÛÂȘ
(mg)
ºÔ˘ÚÔÛÂÌ›‰Ë IV 80-160 200 120 40 40-80
ºÔ˘ÚÔÛÂÌ›‰Ë PO 160 400 240 80 80-160
μÔ˘ÌÂÙ·Ó›‰Ë IV+PO 6 10 3 1 1-2
∂ı·ÎÚÈÓÈÎfi Ô͇
IV+PO 100 250 150 50 50-100
ΔÔÚÛÂÌ›‰Ë IV+PO 50 100 50 20 20-40
*Ì ‰È·ÙËÚË̤ÓË ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›·
™˘ÓÙÔÌÔÁڷʛ˜: CrCl: οı·ÚÛË ÎÚ·ÙÈÓ›Ó˘, IV: ÂÓ‰ÔÊÏ‚›ˆ˜, PO: per os

ÊÚÈÎÔ› ÔÌÔÈÔÛÙ·ÙÈÎÔ› Ì˯·ÓÈÛÌÔ›, fiˆ˜ Ë ÂÓÂÚÁÔ-
Ô›ËÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÚÂÓ›Ó˘-·ÁÁÂÈÔÙÂÓÛ›Ó˘
(™ƒ∞) Î·È ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜
(™¡™), ÚÔηÏÔ‡Ó ·˘ÍË̤ÓË Â·Ó·ÚÚfiÊËÛË Na+
ÛÙÔ ÂÁÁ‡˜ ÛˆÏËÓ¿ÚÈÔ Î·È Â·Ó·Ê¤ÚÔ˘Ó ÙËÓ ÈÛÔÚ-
ÚÔ›· ·Ó¿ÌÂÛ· ÛÙËÓ ÚfiÛÏË„Ë Î·È ÙËÓ ·Ô‚ÔÏ‹
Ó·ÙÚ›Ô˘ ÂÓÙfi˜ 3-9 ËÌÂÚÒÓ, ÂÓÒ Û ¯ÚfiÓÈ· ¯ÔÚ‹ÁË-
ÛË ıÂÈ·˙›‰ˆÓ Ô ÂÍˆÎ˘ÙÙ¿ÚÈÔ˜ fiÁÎÔ˜ ÂÈÛÙÚ¤ÊÂÈ ÌÂ-
ÚÈÎÒ˜ ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi55. øÛÙfiÛÔ, Ë ·ÓÙÈ˘ÂÚÙ·ÛÈ-
΋ ‰Ú¿ÛË ‰È·ÙËÚÂ›Ù·È ÂÍ·ÈÙ›·˜ ¯ÚfiÓÈ·˜ Ì›ˆÛ˘ ÙˆÓ
ÂÚÈÊÂÚÈÎÒÓ ·ÁÁÂÈ·ÎÒÓ ·ÓÙÈÛÙ¿ÛˆÓ56,57. ∏ Û¯ÂÙÈ-
˙fiÌÂÓË Ì ÙȘ ıÂÈ·˙›‰Â˜ ·˘ÍË̤ÓË Â·Ó·ÚÚfiÊËÛË
Ca++ Â›Ó·È ÌÈ· ¯Ú‹ÛÈÌË È‰ÈfiÙËÙ· Û ·ÛıÂÓ›˜ ÌÂ
ÓÂÊÚÔÏÈı›·ÛË Î·È È‰ÈÔ·ı‹ ˘ÂÚ·Û‚ÂÛÙÈÔ˘Ú›·, η-
ıÒ˜ ÌÂÈÒÓÂÈ ÙËÓ ·Ô‚ÔÏ‹ Ca++ ÛÙ· Ô‡Ú· ηٿ 40-
50% Î·È Û˘ÓÂÒ˜ ÌÂÈÒÓÂÈ ÙÔ Û¯ËÌ·ÙÈÛÌfi ÓÂÊÚÈÎÒÓ
Ï›ıˆÓ58, Ì ÌfiÓÔ ÎfiÛÙÔ˜ ÌÈ· ÌÈÎÚ‹ ·‡ÍËÛË ÛÙ· Â›-
‰· ÙÔ˘ Ca++ ÙÔ˘ ÔÚÔ‡5. ∂ÈϤÔÓ, Ë ‰È·Ù·Ú·¯‹
Ù˘ ̤ÁÈÛÙ˘ ÓÂÊÚÈ΋˜ ·Ú·ÈˆÙÈ΋˜ ÈηÓfiÙËÙ·˜ ·fi
ÙȘ ıÂÈ·˙›‰Â˜ Â›Ó·È ¯Ú‹ÛÈÌË Û ·ÛıÂÓ›˜ Ì ÎÂÓÙÚÈ-
Îfi ¿ÔÈÔ ‰È·‚‹ÙË, ÛÙÔÓ ÔÔ›Ô ÔÈ ıÂÈ·˙›‰Â˜ ÌÔÚÔ‡Ó
Ó· ÌÂÈÒÛÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ Ô‡ÚˆÓ ¤ˆ˜ Î·È 50%.
¶·ÚfiÙÈ Ë Ó·ÙÚÈÔ˘ÚËÙÈ΋ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ
ıÂÈ·˙›‰ˆÓ Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË Û ۯ¤ÛË Ì ٷ ‰È-
Ô˘ÚËÙÈο Ù˘ ·Á·Ï˘, ÌÔÚ› Ó· Â›Ó·È Â·Ú΋˜ ÛÂ
‹Ș ÔȉËÌ·ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, ÂÎÙfi˜ ·Ó Ô ·ÛıÂÓ‹˜
¤¯ÂÈ Î·È ¯·ÌËÏfi GFR1,2. OÈ ıÂÈ·˙›‰Â˜ ÌÔÚ› Ó· ›-
Ó·È Â›Û˘ ¯Ú‹ÛÈ̘ Û ·ÛıÂÓ›˜ ˘fi ·ÁˆÁ‹ Ì ‰È-
Ô˘ÚËÙÈο Ù˘ ·Á·Ï˘ ÔÈ ÔÔ›ÔÈ ·Ó·Ù‡ÛÛÔ˘Ó ÛÔ-
‚·Ú‹ ·ÓÙÔ¯‹. ™Â ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ë ÌÂÙ·ÊÔÚ¿
NaCl ÛÙÔ ¿ˆ ÂÛÂÈڷ̤ÓÔ ÛˆÏËÓ¿ÚÈÔ, ÙÔ ÙÌ‹Ì·
ÙÔ˘ ÓÂÊÚÒÓ· Ô˘ Â›Ó·È Â˘·›ÛıËÙÔ ÛÙȘ ıÂÈ·˙›‰Â˜,
Â›Ó·È ·˘ÍË̤ÓË. ∂ÈϤÔÓ, Û ¯ÚfiÓÈ· ıÂÚ·›· ÌÂ
‰ÈÔ˘ÚËÙÈο Ù˘ ·Á·Ï˘, Ë ·˘ÍË̤ÓË ÌÂÙ·ÊÔÚ¿ ‰È·-
Ï˘ÙÒÓ Ô˘ÛÈÒÓ ÛÙÔ ¿ˆ ÛˆÏËÓ¿ÚÈÔ ÚÔηÏ› ˘ÂÚ-
ÙÚÔÊ›· ÙˆÓ ÂÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ·˘Í¿ÓÂÈ ÙËÓ
¤ÎÊÚ·ÛË ÚˆÙÂ˚ÓÒÓ ÌÂÙ·ÊÔÚ¿˜ Î·È ¿Ú· ÙËÓ Èη-
ÓfiÙËÙ· ÌÂÙ·ÊÔÚ¿˜ Na+ Û ·˘Ùfi ÙÔ ÙÌ‹Ì· ÙÔ˘ ÓÂ-
158 AÚÙËÚȷ΋ Y¤ÚÙ·ÛË, 18, 2-3
ÊÚÒÓ·. ™˘ÓÂÒ˜, Û ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ Ë Ó·-
ÙÚÈÔ˘ÚËÙÈ΋ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ ıÂÈ·˙›‰ˆÓ ›-
Ó·È ·˘ÍË̤ÓË Î·È Ë ÚÔÛı‹ÎË ÙÔ˘˜ ÛÙÔ ıÂÚ·¢ÙÈ-
Îfi Û¯‹Ì· ÌÔÚ› Ó· ·Ú¤¯ÂÈ ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÛÙË
‰ÈÔ‡ÚËÛË2,59,60.
ŒÓ· ÛËÌ·ÓÙÈÎfi ÏÂÔÓ¤ÎÙËÌ· ÙˆÓ ÈÔ Û˘¯Ó¿
¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓˆÓ ıÂÈ·˙›‰ˆÓ Î·È Û˘ÁÁÂÓÒÓ Ô˘-
ÛÈÒÓ (˘‰ÚԯψÚÔıÂÈ·˙›‰Ë, ¯ÏˆÚÔı·ÏȉfiÓË, ÈÓ‰·-
·Ì›‰Ë) Â›Ó·È Ë ÌÂÁ¿ÏË ‰È¿ÚÎÂÈ· ‰Ú¿Û˘. ¶Ú¤ÂÈ
Ó· ÛËÌÂȈı› fiÙÈ Ë ‰È¿ÚÎÂÈ· Ù˘ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋˜
ÙÔ˘˜ ‰Ú¿Û˘ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ·fi ÙË ‰È¿ÚÎÂÈ· Ù˘
‰ÈÔ˘ÚËÙÈ΋˜ ‰Ú¿Û˘61, Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙÔÓ ›-
ӷη 2, οÙÈ Ô˘ ηıÈÛÙ¿ ‰˘Ó·Ù‹ ÙË ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜
Ì›· ÊÔÚ¿ ÙËÓ Ë̤ڷ. Δ· ıÂÈ·˙ȉÈο ‰ÈÔ˘ÚËÙÈο ÂÌ-
Ê·Ó›˙Ô˘Ó Ôχ «Ú˯‹» ηÌ‡ÏË ‰fiÛ˘-·ÓÙ·fiÎÚÈ-
Û˘, οÙÈ Ô˘ ÛËÌ·›ÓÂÈ fiÙÈ ˘¿Ú¯ÂÈ Ôχ ÌÈÎÚ‹ ‰È·-
ÊÔÚ¿ ÌÂٷ͇ Ù˘ ¯·ÌËÏfiÙÂÚ˘ Î·È Ù˘ ̤ÁÈÛÙ˘
·ÔÙÂÏÂÛÌ·ÙÈ΋˜ ‰fiÛ˘, fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ›Ó·-
η 31,62. ∫ÏÈÓÈο ‰Â‰Ô̤ӷ ˘ÔÛÙËÚ›˙Ô˘Ó Û¯Â‰fiÓ
·ÚfiÌÔÈ· ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÌÂ-
ٷ͇ ÌÈÎÚÒÓ Î·È ÌÂÁ¿ÏˆÓ ‰fiÛÂˆÓ (.¯. 12,5 mg
˘‰ÚԯψÚÔıÂÈ·˙›‰Ë˜ ¤Ó·ÓÙÈ 25 mg ‹ 50 mg), Ì ¯·-
ÌËÏfiÙÂÚ· ÔÛÔÛÙ¿ ÂÈÏÔÎÒÓ ÛÙȘ ÌÈÎÚfiÙÂÚ˜ ‰fi-
ÛÂȘ4,63. ŒÙÛÈ, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ˘¿Ú¯ÂÈ ÌÈ·
ÛÙÚÔÊ‹ ÚÔ˜ ¯ÚËÛÈÌÔÔ›ËÛË ÌÈÎÚfiÙÂÚˆÓ ‰fiÛˆÓ
·˘ÙÒÓ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÛÙË ıÂÚ·›· Ù˘ ˘¤ÚÙ·Û˘.
ŸÙ·Ó ÔÈ ıÂÈ·˙›‰Â˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÂ Û˘Ó‰˘·-
Ṳ̂ÓË ıÂÚ·›·, ·ÎfiÌË Î·È ¯·ÌËÏfiÙÂÚ˜ ‰fiÛÂȘ
(.¯. ˘‰ÚԯψÚÔıÂÈ·˙›‰Ë 6,25 mg) ÌÔÚ› Ó· ›ӷÈ
·ÚÎÂÙ¿ ·ÔÙÂÏÂÛÌ·ÙÈΤ˜, ÏfiÁˆ Û˘ÓÂÚÁÈ΋˜ ‰Ú¿Û˘
Ì ÙȘ ¿ÏϘ ηÙËÁÔڛ˜ ÙˆÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ53,54.
ΔÔ ÈÔ ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· ÛÙËÓ ÎÏÈÓÈ΋ ¯Ú‹ÛË
·˘ÙÒÓ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Â›Ó·È fiÙÈ Ë Ó·ÙÚÈÔ˘ÚËÙÈ΋
ÙÔ˘˜ Â›‰Ú·ÛË Î·Ù·ÚÁÂ›Ù·È fiÙ·Ó Ô GFR ÌÂÈÒÓÂÙ·È
οو ·fi Ù· 40 ml/min/1.73 m2 1,62,64, Ì ÂÍ·›ÚÂÛË
ÙËÓ ÌÂÙÔÏ·˙fiÓË Ë ÔÔ›· Â›Ó·È ‰Ú·ÛÙÈ΋ ¤ˆ˜ Î·È Ù·
20 ml/min/1.73 m2,65. ∞˘Ùfi ÔÊ›ÏÂÙ·È ÛÙÔ fiÙÈ ÛÙË
á¡ ÌÂÈÒÓÂÙ·È ÚÔԉ¢ÙÈο Ë ÂÓÂÚÁËÙÈ΋ ¤ÎÎÚÈ-
ÛË ÙˆÓ ıÂÈ·˙ȉÈÎÒÓ ‰ÈÔ˘ÚËÙÈÎÒÓ ÛÙÔÓ ·˘Ïfi ÙÔ˘ Ô˘-
ÚÔÊfiÚÔ˘ ÛˆÏËÓ·Ú›Ô˘ ̤ۈ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÙˆÓ ÔÚ-
Á·ÓÈÎÒÓ ÔͤˆÓ, ÂÍ·ÈÙ›·˜ Ù˘ Û˘ÛÛÒÚ¢Û˘ ÂÓ‰ÔÁÂ-
ÓÒ˜ ·Ú·ÁfiÌÂÓˆÓ ÔÚÁ·ÓÈÎÒÓ ÔͤˆÓ Ù· ÔÔ›· ·ÓÙ·-
ÁˆÓ›˙ÔÓÙ·È ÙȘ ıÂÈ·˙›‰Â˜ ÁÈ· ·˘Ù‹ ÙË ÌÂÙ·ÊÔÚ¿4,66.
∂¿Ó ÔÈ ıÂÈ·˙›‰Â˜ ‰ÔıÔ‡Ó Û ·ÛıÂÓ›˜ Ì á¡ ÛÂ
Â·ÚÎÒ˜ ˘„ËϤ˜ ‰fiÛÂȘ, Èı·ÓfiÓ Ó· Â›Ó·È ‰Ú·ÛÙÈΤ˜,
Ë ÛÙÚ·ÙËÁÈ΋ ·˘Ù‹ fï˜ ‰Â Û˘ÛÙ‹ÓÂÙ·È, ‰Â‰Ô̤Ó˘
Ù˘ ÌÈÎÚfiÙÂÚ˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙˆÓ ıÂÈ·˙›‰ˆÓ
Û ۇÁÎÚÈÛË Ì ٷ ‰ÈÔ˘ÚËÙÈο Ù˘ ·Á·Ï˘ Î·È ÙÔ˘
·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÌÂÙ·‚ÔÏÈΤ˜ ·ÓÂÈı‡ÌËÙ˜
ÂÓ¤ÚÁÂȘ Ì ÙȘ ˘„ËϤ˜ ‰fiÛÂȘ66. ∏ ÌfiÓË Èı·Ó‹ ¤Ó-
‰ÂÈÍË ÙˆÓ ıÂÈ·˙›‰ˆÓ Î·È ÙˆÓ Û˘Ó·ÊÒÓ ‰ÈÔ˘ÚËÙÈÎÒÓ
ÛÙË Ã¡¡ Â›Ó·È Ë Û˘Ó‰˘·Ṳ̂ÓË ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜ Ì ‰È-
Ô˘ÚËÙÈο Ù˘ ·Á·Ï˘ Û ·ÛıÂÓ›˜ Ì ÛÔ‚·Ú‹ ·ÓÙ›-
ÛÙ·ÛË ÛÙ· ‰ÈÔ˘ÚËÙÈο Ù˘ ·Á·Ï˘, fiˆ˜ ·Ó·Ê¤Ú-
ıËÎÂ ·Ú·¿Óˆ.
∫·ÏÈÔÛ˘ÓÙËÚËÙÈο ‰ÈÔ˘ÚËÙÈο
Δ· ηÏÈÔÛ˘ÓÙËÚËÙÈο ‰ÈÔ˘ÚËÙÈο ÌÔÚÔ‡Ó Ó·
‰È·ÎÚÈıÔ‡Ó Û ‰‡Ô ˘Ô-ηÙËÁÔڛ˜: ·˘Ù¿ Ô˘ ·Ó·-
ÛÙ¤ÏÏÔ˘Ó ÙÔÓ ÂÈıËÏÈ·Îfi ‰›·˘ÏÔ Na+ ÙÔ˘ ·ıÚÔÈ-
ÛÙÈÎÔ‡ ÛˆÏËÓ·Ú›Ô˘ (·ÌÈÏÔÚ›‰Ë, ÙÚÈ·ÌÙÂÚ¤ÓË), Ô˘
Â›Ó·È ·Ó¿ÏÔÁ· Ù˘ ÙÂÚȉ›Ó˘, Î·È ·˘Ù¿ Ô˘ ·Ô-
ÎÏÂ›Ô˘Ó ÙÔ˘˜ ˘ԉԯ›˜ Ù˘ ·Ï‰ÔÛÙÂÚfiÓ˘ (ÛÈÚÔ-
ÓÔÏ·ÎÙfiÓË Î·È ÂÏÂÚÂÓfiÓË). Δ· Ê¿Ú̷η Î·È ÙˆÓ
‰‡Ô ηÙËÁÔÚÈÒÓ ‰ÚÔ˘Ó Î˘Ú›ˆ˜ ÛÙÔ ÊÏÔÈ҉˜ ÙÌ‹-
Ì· ÙˆÓ ·ıÚÔÈÛÙÈÎÒÓ ÛˆÏËÓ·Ú›ˆÓ (Î·È Û ÌÈÎÚfiÙÂ-
ÚÔ ‚·ıÌfi ÛÙÔ ÙÂÏÈÎfi ÙÌ‹Ì· ÙÔ˘ ¿ˆ ÂÛÂÈڷ̤ÓÔ˘
ÛˆÏËÓ·Ú›Ô˘ Î·È ÙÔ˘ Û˘Ó‰ÂÙÈÎÔ‡ ÛˆÏËÓ·Ú›Ô˘) fiÔ˘
Â·Ó·ÚÚÔÊ¿Ù·È ÌfiÓÔ ÂÚ› ÙÔ 3% ÙÔ˘ ‰ÈËıË̤ÓÔ˘
ÊÔÚÙ›Ô˘ Na+1-3. °È· Ó· ÂΉËÏÒÛÔ˘Ó ÙȘ ‰Ú¿ÛÂȘ
ÙÔ˘˜, Ë ·ÌÈÏÔÚ›‰Ë Î·È Ë ÙÚÈ·ÌÙÂÚ¤ÓË ÂÎÎÚ›ÓÔÓÙ·È
ÂÓÂÚÁËÙÈο ÛÙÔÓ ·˘Ïfi ÙÔ˘ ÂÁÁ‡˜ ÛˆÏËÓ·Ú›Ô˘ ̤ۈ
ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÙˆÓ ÔÚÁ·ÓÈÎÒÓ ‚¿ÛˆÓ. ∞ÓÙ›ıÂÙ·,
Ë ÛÈÚÔÓÔÏ·ÎÙfiÓË Î·È Ë ÂÏÂÚÂÓfiÓË Â›Ó·È Ù· ÌfiÓ·
‰ÈÔ˘ÚËÙÈο Ô˘ ‰ÂÓ ÂÈÛ¤Ú¯ÔÓÙ·È ÛÙÔÓ ÛˆÏËÓ·ÚÈ·-
Îfi ·˘Ïfi, ηıÒ˜ ‰ÚÔ˘Ó ÛÙÔ Î˘ÙfiÏ·ÛÌ· ÙˆÓ ıÂ̤-
ÏÈˆÓ Î‡ÙÙ·ÚˆÓ ÙˆÓ ·ıÚÔÈÛÙÈÎÒÓ ÛˆÏËÓ·Ú›ˆÓ. ™Â
·˘Ùfi ÙÔ ÙÌ‹Ì· ÙÔ˘ ÓÂÊÚÒÓ·, ÙÔ Na+ ÌÂÙ·ÎÈÓ›ٷÈ
ÂÓÙfi˜ ÙˆÓ Î˘Ú›ˆÓ (principal) ΢ÙÙ¿ÚˆÓ ·fi ÙËÓ ÎÔ-
Ú˘Ê·›· ÌÂÌ‚Ú¿ÓË Ì¤Ûˆ ¤ÓÔ˜ ÂÈıËÏÈ·ÎÔ‡ ‰È·‡ÏÔ˘
Na+ (epithelial Na+ channel, ENaC) ·ÎÔÏÔ˘ıÒÓÙ·˜
ÙËÓ ËÏÂÎÙÚÔ¯ËÌÈ΋ ‚·ıÌ›‰ˆÛË Ô˘ ‰ËÌÈÔ˘ÚÁ›ٷÈ
·fi ÙË ÏÂÈÙÔ˘ÚÁ›· Ù˘ Na+-K+-ATP¿Û˘ Ù˘ ‚·-
ÛÂÔÏ¢ÚÈ΋˜ ÂÈÊ¿ÓÂÈ·˜1,2,67. ∏ ÌÂٷΛÓËÛË Na+
̤ۈ Ù˘ ÎÔÚ˘Ê·›·˜ ÌÂÌ‚Ú¿Ó˘ Â›Ó·È ËÏÂÎÙÚÔ-ÁÂÓ-
ÓËÙÈ΋, ‰ËÌÈÔ˘ÚÁÒÓÙ·˜ ÌÈ· ‰È·ÊÔÚ¿ ‰˘Ó·ÌÈÎÔ‡
ηٿ Ì‹ÎÔ˜ ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙÔ˘ ÛˆÏËÓ·Ú›Ô˘, Ì ÙÔÓ
·˘Ïfi Ó· Â›Ó·È ·ÚÓËÙÈο ÊÔÚÙÈṲ̂ÓÔ˜ Û ۯ¤ÛË ÌÂ
ÙÔ ‰È·ÌÂÛÔÛˆÏËÓ·ÚÈ·Îfi ¯ÒÚÔ. ∞˘Ù‹ Ë ‰È·ÊÔÚ¿
‰˘Ó·ÌÈÎÔ‡ Â›Ó·È ˘‡ı˘ÓË ÁÈ· ÙË ÌÂٷΛÓËÛË ÙÔ˘
∫+ ·fi Ù· ÂÈıËÏȷο ·ÙÙ·Ú· ÛÙÔ ·˘Ïfi, ̤ۈ ÈÔ-
ÓÙÈÎÒÓ ‰È·‡ÏˆÓ, ÔÈ ÔÔ›ÔÈ ‰ÂÓ ¤¯Ô˘Ó ‰È¢ÎÚÈÓÈÛı›
Ï‹Úˆ˜1,2. ∂ÈÚfiÛıÂÙ·, ·˘Ù‹ Ë ‰È·ÊÔÚ¿ ‰˘Ó·ÌÈ-
ÎÔ‡ ÚÔ¿ÁÂÈ ÙËÓ ¤ÎÎÚÈÛË ∏+ ÛÙÔÓ ÛˆÏËÓ·ÚÈ·Îfi
·˘Ïfi. ™˘ÓÂÒ˜, ·Ú¿ÁÔÓÙ˜ Ô˘ ‰ÈÂÁ›ÚÔ˘Ó ÙËÓ
Â·Ó·ÚÚfiÊËÛË Na+ ¤ÌÌÂÛ· ÚÔ¿ÁÔ˘Ó ÙËÓ ·Ú·-
ÁˆÁ‹ fiÍÈÓˆÓ Ô‡ÚˆÓ. ª¤Ûˆ ·˘Ù‹˜ Ù˘ ‰È·‰Èηۛ·˜
Ù· ·ÚÈ· ·ÙÙ·Ú· η٤¯Ô˘Ó ¤Ó·Ó ¤ÌÌÂÛÔ ÚfiÏÔ ÛÙË
ÌÂÙ·ÊÔÚ¿ ÔͤˆÓ-‚¿ÛÂˆÓ ÛÙÔ ¿ˆ ÓÂÊÚÒÓ·, Ë
ÔÔ›· ÂϤÁ¯ÂÙ·È ·fi Ù· ÁÂÈÙÔÓÈο «·ÚÂÌ‚·ÏÏfi-
ÌÂÓ·» (intercalated) ·ÙÙ·Ú· ÙÔ˘ ·ıÚÔÈÛÙÈÎÔ‡ Ûˆ-
 AÚÙËÚȷ΋ Y¤ÚÙ·ÛË, 18, 2-3
ÏËÓ·Ú›Ô˘ ̤ۈ ÂÚ›ÏÔÎˆÓ Ì˯·ÓÈÛÌÒÓ48,68. ∏ ·ÌÈ-
ÏÔÚ›‰Ë Î·È Ë ÙÚÈ·ÌÙÂÚ¤ÓË ·ÔÎÏÂ›Ô˘Ó ÂÎÏÂÎÙÈο
ÙËÓ Â›ÛÔ‰Ô Na+ ̤ۈ ÙˆÓ E¡aC. ∏ ÛÈÚÔÓÔÏ·-
ÎÙfiÓË Î·È Ë ÂÏÂÚÂÓfiÓË ·ÔÎÏÂ›Ô˘Ó ·ÓÙ·ÁˆÓÈÛÙÈ-
ο ÙÔ˘˜ ·Ï·ÙÔÎÔÚÙÈÎÔÂȉÈÎÔ‡˜ ˘ԉԯ›˜ Ù˘ ·Ï-
‰ÔÛÙÂÚfiÓ˘ ÛÙÔ Î˘ÙÙ·ÚfiÏ·ÛÌ· ÙˆÓ Î˘Ú›ˆÓ ΢Ù-
Ù¿ÚˆÓ, ·Ó·ÛÙ¤ÏÏÔÓÙ·˜ ¤ÙÛÈ ÙË ‰Ú¿ÛË Ù˘ ·Ï‰ÔÛÙÂ-
ÚfiÓ˘1,2. º˘ÛÈÔÏÔÁÈο, ÌÂÙ¿ ·fi ÙË Û‡Ó‰ÂÛË Ù˘
·Ï‰ÔÛÙÂÚfiÓ˘ Ì ÙÔÓ ˘Ô‰Ô¯¤· Ù˘, ÙÔ Û‡ÌÏÔÎÔ
ÔÚÌfiÓË-˘Ô‰Ô¯¤·˜ ÌÂٷʤÚÂÙ·È ÛÙÔÓ ˘Ú‹Ó· ÙÔ˘
΢ÙÙ¿ÚÔ˘, fiÔ˘ ÂÓÂÚÁÔÔÈ› ÙËÓ ¤ÎÊÚ·ÛË ÁÔÓȉ›ˆÓ
Î·È ÙËÓ ·Ú·ÁˆÁ‹ ÚˆÙÂ˚ÓÈÎÒÓ ÙÌËÌ¿ÙˆÓ ÙˆÓ Î˘Ù-
Ù·ÚÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ ÌÂÙ·ÊÔÚ¿˜ Na+ (.¯. ˘ÔÌÔ-
Ó¿‰ˆÓ ÙÔ˘ ÌÔÚ›Ô˘ Ù˘ Na+-K+-ATP¿Û˘ Î·È ÙÔ˘
E¡aC)69. ΔÔ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· Ù˘ ‰Ú¿Û˘ ·ÌÊfi-
ÙÂÚˆÓ ·˘ÙÒÓ ÙˆÓ ÔÌ¿‰ˆÓ Ê·ÚÌ¿ÎˆÓ Â›Ó·È Ë ‰È·-
Ù·Ú·¯‹ Ù˘ Â·Ó·ÚÚfiÊËÛ˘ Na+ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ
·‡ÍËÛË Ù˘ ¤ÎÎÚÈÛ˘ ∫+ Î·È ∏+ ÛÙÔ ·ıÚÔÈÛÙÈÎfi
ÛˆÏËÓ¿ÚÈÔ.
∫·ıÒ˜ ÌfiÓÔ ÌÈ· ÌÈÎÚ‹ ÔÛfiÙËÙ· Na+ Â·-
Ó·ÚÚÔÊ¿Ù·È ÛÙÔ ·ıÚÔÈÛÙÈÎfi ÛˆÏËÓ¿ÚÈÔ, Ù· ηÏÈÔ-
Û˘ÓÙËÚËÙÈο ‰ÈÔ˘ÚËÙÈο ‰ÂÓ Â›Ó·È Ôχ ÈÛ¯˘ÚÔ› ‰È-
Ô˘ÚËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜. ∫·Ù¿ Û˘Ó¤ÂÈ·, Ë ·ÌÈÏÔÚ›-
‰Ë Î·È Ë ÙÚÈ·ÌÙÂÚ¤ÓË ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Î˘Ú›ˆ˜ ÛÂ
Û˘Ó‰˘·ÛÌfi Ì ¿ÏÏ· Ê¿Ú̷η ÛÙË ıÂÚ·›· Ù˘
˘¤ÚÙ·Û˘, ÁÈ· Ó· ‰ÈÔÚıÒÛÔ˘Ó ÙËÓ ·ÒÏÂÈ· ηϛ-
Ô˘ Û ·ÛıÂÓ›˜ ¯ˆÚ›˜ ÂÚ›ÛÛÂÈ· ·Ï·ÙÔÎÔÚÙÈÎÔÂÈ-
‰ÒÓ. Δ· Ê¿Ú̷η ·˘Ù¿ ¤¯Ô˘Ó Â›Û˘ ¯ÚËÛÈÌÔÔÈ-
Ëı› ÁÈ· ÙË ‰ÈfiÚıˆÛË Ù˘ ·ÒÏÂÈ·˜ Ì·ÁÓËÛ›Ô˘ ηٿ
ÙË ıÂÚ·›· Ù˘ ˘¤ÚÙ·Û˘ ·Ú¿ ÙÔ fiÙÈ ÔÈ ·ÎÚȂ›˜
Ì˯·ÓÈÛÌÔ› ÁÈ· ·˘Ù‹Ó ÙË ‰Ú¿ÛË ·Ú·Ì¤ÓÔ˘Ó ¿ÁÓˆ-
ÛÙÔÈ1,4. OÈ ÛÙ·ıÂÚÔ› Û˘Ó‰˘·ÛÌÔ› ·ÌÈÏÔÚ›‰Ë˜ ‹
ÙÚÈ·ÌÙÂÚ¤Ó˘ Ì ıÂÈ·˙ȉÈο ‰ÈÔ˘ÚËÙÈο ¯ÚËÛÈÌÔ-
ÔÈÔ‡ÓÙ·È Â˘Ú¤ˆ˜ Û ÔÏϤ˜ ¯ÒÚ˜. £· Ú¤ÂÈ Ó·
ÛËÌÂȈı›, ˆÛÙfiÛÔ, fiÙÈ ·˘ÙÔ› ÔÈ Û˘Ó‰˘·ÛÌÔ› ‰Â Û˘-
ÛÙ‹ÓÔÓÙ·È ÁÈ· ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ ÛÙËÓ ˘-
¤ÚÙ·ÛË, ηıÒ˜ ÌfiÓÔ ¤Ó· 5% ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ο-
ÓÔ˘Ó ¯Ú‹ÛË ÙˆÓ ıÂÈ·˙ȉÈÎÒÓ ‰ÈÔ˘ÚËÙÈÎÒÓ ·Ó·-
Ù‡ÛÛÔ˘Ó ¤ÏÏÂÈÌÌ· Î·Ï›Ô˘ Ô˘ ··ÈÙ› ÚÔÛı‹ÎË
ÂÓfi˜ ηÏÈÔÛ˘ÓÙËÚËÙÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘. ∏ Û˘ÓÙ·ÁÔ-
ÁÚ¿ÊËÛË Ù¤ÙÔÈˆÓ Û˘Ó‰˘·ÛÌÒÓ ˆ˜ ÚÔʇϷÍË ¤Ó·-
ÓÙÈ Ù˘ ˘ÔηÏÈ·ÈÌ›·˜ ÂÎı¤ÙÂÈ ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜
·fi ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ÛÙÔÓ Î›Ó‰˘ÓÔ Ù˘ ˘ÂÚ-
ηÏÈ·ÈÌ›·˜, Ë ÔÔ›· Â›Ó·È ÈÔ ·ÂÈÏËÙÈ΋ ÁÈ· ÙË ˙ˆ‹
·fi ÙËÓ ˘ÔηÏÈ·ÈÌ›·1,70. ∏ ·ÌÈÏÔÚ›‰Ë Î·È Ë ÙÚÈ·Ì-
ÙÂÚ¤ÓË Â›Ó·È Ù· Ê¿Ú̷η ÂÎÏÔÁ‹˜ Û ·ÛıÂÓ›˜ ÌÂ
Ï‹Ú˜ Û‡Ó‰ÚÔÌÔ Liddle, ηıÒ˜ Ô Ì˯·ÓÈÛÌfi˜ ‰Ú¿-
Û˘ ÙÔ˘˜ ·ÓÙÈÛÙ·ıÌ›˙ÂÈ Â·ÎÚÈ‚Ò˜ ÙÔ ÁÂÓÂÙÈÎfi ¤Ï-
ÏÂÈÌÌ· Ù˘ ÓfiÛÔ˘. ∞ÓÙ›ıÂÙ·, ÔÈ ·ÓÙ·ÁˆÓÈÛÙ¤˜ Ù˘ ·Ï-
‰ÔÛÙÂÚfiÓ˘ ‰ÂÓ Â›Ó·È ¯Ú‹ÛÈÌÔÈ ÛÙÔ Û‡Ó‰ÚÔÌÔ Liddle,
ηıÒ˜ ÙÔ ™ƒ∞ Û ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Â›Ó·È Î·ÙÂ-
159
ÛÙ·Ï̤ÓÔ4,71. °È· Ó· ·Û΋ÛÂÈ ÙË ‰Ú¿ÛË Ù˘, Ë ÙÚÈ·Ì-
ÙÂÚ¤ÓË Ú¤ÂÈ Ó· ÌÂÙ·ÙÚ·› ·fi ÙÔ ‹·Ú ÛÙÔÓ
ÂÓÂÚÁfi Ù˘ ÌÂÙ·‚ÔÏ›ÙË, ¤Ó·Ó ıÂÈÈÎfi ÂÛÙ¤Ú·, ÌÈ· ‰ÈÂÚ-
Á·Û›· Ô˘ ÌÔÚ› Ó· Â›Ó·È ‰È·Ù·Ú·Á̤ÓË Û ·ÛıÂ-
Ó›˜ Ì Ë·ÙÈ΋ ÓfiÛÔ, ηıÈÛÙÒÓÙ·˜ ÙÔ Ê¿ÚÌ·ÎÔ ÌË
‰Ú·ÛÙÈÎfi. ∂Ô̤ӈ˜, Û ·ÛıÂÓ›˜ Ì Ë·ÙÈ΋ ÓfiÛÔ
ı· Ú¤ÂÈ Ó· ÚÔÙÈÌ¿Ù·È Ë ·ÌÈÏÔÚ›‰Ë. ∂ÈϤÔÓ, Ë
·ÌÈÏÔÚ›‰Ë ¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚÔ ¯ÚfiÓÔ ËÌ›ÛÈ·˜ ˙ˆ‹˜ ÛÂ
Û¯¤ÛË Ì ÙËÓ ÙÚÈ·ÌÙÂÚ¤ÓË1.
∏ ÛÈÚÔÓÔÏ·ÎÙfiÓË ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙË ıÂÚ·-
›· Ù˘ ˘¤ÚÙ·Û˘ ÁÈ· ÔÏÏ¿ ¯ÚfiÓÈ·72 Î·È Ë ÂÏÂ-
ÚÂÓfiÓË ¤¯ÂÈ Ê·Ó› fiÙÈ ¤¯ÂÈ fiÌÔÈ· ·ÓÙÈ˘ÂÚÙ·ÛÈ΋
·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ì ·˘Ù‹ ÙˆÓ Û˘Ó‹ıˆÓ ·ÓÙÈ˘-
ÂÚÙ·ÛÈÎÒÓ Ê·Ú̿ΈÓ73. øÛÙfiÛÔ, Ù· Ê¿Ú̷η
·˘Ù¿ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙË ıÂÚ·›· Ù˘ ˘¤ÚÙ·-
Û˘ ΢ڛˆ˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ¿ÏÏ· ‰ÈÔ˘ÚËÙÈο ÁÈ·
ÙËÓ ·ÔÊ˘Á‹ Ù˘ ˘ÔηÏÈ·ÈÌ›·˜4. ∞ÓÙ›ıÂÙ·, Ô ·Ô-
ÎÏÂÈÛÌfi˜ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘ ·Ï‰ÔÛÙÂÚfiÓ˘ ηıÈ-
ÛÙ¿ ÙË ÛÈÚÔÓÔÏ·ÎÙfiÓË Î·È ÙËÓ ÂÏÂÚÂÓfiÓË Ê¿Ú-
̷η ÂÎÏÔÁ‹˜ Û ·ÛıÂÓ›˜ Ì ÂÚ›ÛÛÂÈ· ·Ï·ÙÔ-
ÎÔÚÙÈÎÔÂȉÒÓ. ∏ ÛÈÚÔÓÔÏ·ÎÙfiÓË Â›Ó·È Ë Î‡ÚÈ· ıÂ-
Ú·›· Û ·ÛıÂÓ›˜ Ì ÚˆÙÔ·ı‹ ˘ÂڷωÔÛÙÂ-
ÚÔÓÈÛÌfi Ô˘ ÔÊ›ÏÂÙ·È Û ·ÌÊÔÙÂÚfiÏ¢ÚË ˘-
ÂÚÏ·Û›· ÙÔ˘ ÊÏÔÈÔ‡ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ, Î·È ÛÂ
·ÛıÂÓ›˜ Ì ÂÈÓÂÊÚȉÈο ·‰ÂÓÒÌ·Ù· Ô˘ ˘ÂÚ-
·Ú¿ÁÔ˘Ó ·Ï‰ÔÛÙÂÚfiÓË (Û‡Ó‰ÚÔÌÔ Cohn) ¤ˆ˜ ÙË
¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË ÙÔ˘ fiÁÎÔ˘, Û ·˘ÙÔ‡˜ Ô˘ ›-
Ó·È ·Úfiı˘ÌÔÈ ‹ ¤¯Ô˘Ó ·ÓÙÂӉ›ÍÂȘ ÁÈ· Ó· ˘Ô-
‚ÏËıÔ‡Ó Û ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË Î·È Û fiÛÔ˘˜
·Ú·Ì¤ÓÔ˘Ó ˘ÂÚÙ·ÛÈÎÔ› ÌÂÙ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ Â-
Í·›ÚÂÛË ÙÔ˘ fiÁÎÔ˘74. ∏ ÂÏÂÚÂÓfiÓË Â›Ó·È ÈÔ ÂȉÈ-
Îfi˜ ·ÔÎÏÂÈÛÙ‹˜ ÙˆÓ ·Ï·ÙÔÎÔÚÙÈÎÔÂȉÈÎÒÓ ˘Ô‰Ô-
¯¤ˆÓ, ¯ˆÚ›˜ ÙȘ ÔÈÛÙÚÔÁÔÓÈΤ˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤Ú-
ÁÂȘ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È Ì ÙȘ ˘„ËϤ˜ ‰fiÛÂȘ ÛÈ-
ÚÔÓÔÏ·ÎÙfiÓ˘ ÂÍ·ÈÙ›·˜ Ù˘ ‰È¤ÁÂÚÛ˘ ÙˆÓ ÔÈÛÙÚÔ-
ÁÔÓÈÎÒÓ ˘Ô‰Ô¯¤ˆÓ75. ∞ÎfiÌË, ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ
fiÙÈ Ë ÛÈÚÔÓÔÏ·ÎÙfiÓË Â›Ó·È ÎÏÈÓÈο ÂˆÊÂÏ‹˜ ÛÂ
·ÛıÂÓ›˜ Ì ‰Â˘ÙÂÚÔ·ı‹ ˘ÂڷωÔÛÙÂÚÔÓÈÛÌfi. ∏
ÈÔ ÎÔÈÓ‹ ÎÏÈÓÈ΋ ηٿÛÙ·ÛË ·˘Ù‹˜ Ù˘ ηÙËÁÔÚ›·˜
Â›Ó·È ·ÛıÂÓ›˜ Ì Ë·ÙÈ΋ ΛÚÚˆÛË Î·È ·ÛΛÙË,
fiÔ˘ Ë ÛÈÚÔÓÔÏ·ÎÙfiÓË ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı›
ÛÂ Û˘Ó‰˘·ÛÌfi Ì ‰ÈÔ˘ÚËÙÈο Ù˘ ·Á·Ï˘, ‹ Î·È ˆ˜
ÌÔÓÔıÂÚ·›·, ηıÒ˜ ÚfiÛÊ·Ù˜ ÛÙÔȯ›· Û˘ÓË-
ÁÔÚÔ‡Ó ÛÙÔ fiÙÈ Ë ÛÈÚÔÓÔÏ·ÎÙfiÓË Â›Ó·È ÈÔ ·ÔÙÂ-
ÏÂÛÌ·ÙÈ΋ ·fi Ù· ‰ÈÔ˘ÚËÙÈο Ù˘ ·Á·Ï˘ Û ·˘-
ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜2. ¶·Ú¿ ÙÔ fiÙÈ Ë ÛÈÚÔÓÔÏ·ÎÙfi-
ÓË ¤¯ÂÈ ÌÈÎÚfi ¯ÚfiÓÔ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜, Ê·›ÓÂÙ·È fiÙÈ Ë
‰Ú·ÛÙÈÎfiÙËÙ¿ Ù˘ ·Ô‰›‰ÂÙ·È Û ·ÚÎÂÙÔ‡˜ ÂÓÂÚ-
ÁÔ‡˜ ÌÂÙ·‚Ôϛ٘ Ù˘, ÔÈ ÔÔ›ÔÈ ¤¯Ô˘Ó ¯ÚfiÓÔ ËÌ›-
ÛÂÈ·˜ ˙ˆ‹˜ ÂÚ›Ô˘ 15 ÒÚ˜. ŒÙÛÈ, Ë Û˘ÓÔÏÈ΋
‰È¿ÚÎÂÈ· ‰Ú¿Û˘ Ù˘ ÛÈÚÔÓÔÏ·ÎÙfiÓ˘ Â›Ó·È ÌÂÁ·-
160 AÚÙËÚȷ΋ Y¤ÚÙ·ÛË, 18, 2-3
χÙÂÚË ·fi Ì›· Ë̤ڷ Î·È ÌÔÚ› Ó· ¯ÔÚËÁËı›
¿·Í ËÌÂÚËÛ›ˆ˜1,2.
§·Ì‚¿ÓÔÓÙ·˜ ˘fi„Ë ÙËÓ ÏËıÒÚ· ÙˆÓ ‰Â‰Ô-
Ì¤ÓˆÓ Ô˘ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë ·Ï‰ÔÛÙÂÚfiÓË ‰È·-
‰Ú·Ì·Ù›˙ÂÈ ‚·ÛÈÎfi ÚfiÏÔ ÛÙË ‚Ï¿‚Ë ÙˆÓ ÔÚÁ¿ÓˆÓ-
ÛÙfi¯ˆÓ Î·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù· Â›‰· Ù˘ ·Ï‰ÔÛÙÂ-
ÚfiÓ˘ ‰È·Ê‡ÁÔ˘Ó Ù˘ ηٷÛÙÔÏ‹˜ ηٿ ÙË ‰È¿ÚÎÂÈ·
Ì·ÎÚÔ¯ÚfiÓÈ·˜ ıÂÚ·›·˜ Ì ·Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·-
ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ (·ª∂∞) ‹
·ÔÎÏÂÈÛÙ¤˜ ÙˆÓ ∞Δ-1 ˘Ô‰Ô¯¤ˆÓ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›-
Ó˘76,77, ·ÚÎÂÙ¤˜ ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ÂÍ¤Ù·Û·Ó ÙÔ
ÚfiÏÔ ÙˆÓ ·ÓÙ·ÁˆÓÈÛÙÒÓ Ù˘ ·Ï‰ÔÛÙÂÚfiÓ˘ ÛÙËÓ ÚÔ-
ÛÙ·Û›· Ù˘ ηډȿ˜, ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ÙˆÓ ÓÂÊÚÒÓ Î·È
ÙˆÓ ·ÁÁ›ˆÓ. ¢‡Ô ÚfiÛÊ·Ù˜ ÎÏÈÓÈΤ˜ ‰ÔÎÈ̤˜ ¤‰ÂÈ-
Í·Ó fiÙÈ Ë ÚÔÛı‹ÎË ÛÈÚÔÓÔÏ·ÎÙfiÓ˘ Û ·ÛıÂÓ›˜ ÌÂ
ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·78 ‹ ÂÏÂÚÂÓfiÓ˘ Û ·ÛıÂÓ›˜
Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· ÌÂÙ¿ ·fi ¤ÌÊÚ·ÁÌ· ÙÔ˘
Ì˘Ôηډ›Ô˘79 ÂÈÚfiÛıÂÙ· Ù˘ ÚÔ¸¿Ú¯Ô˘Û·˜
·ÁˆÁ‹˜ Ô˘ ÂÚÈÏ¿Ì‚·Ó ·ª∂∞ ‹ ∞Δ-1 ·ÔÎÏÂÈ-
ÛÙ¤˜ Î·È ‰ÈÔ˘ÚËÙÈο Ì›ˆÛ ÙË Î·Ú‰È·ÁÁÂȷ΋ ÓÔ-
ÛËÚfiÙËÙ· Î·È ıÓËÛÈÌfiÙËÙ·. ∞˘Ùfi Ô‰‹ÁËÛ ÛÂ Û˘-
ÛÙ¿ÛÂȘ Ó· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÔÈ ·ÓÙ·ÁˆÓÈÛÙ¤˜ Ù˘ ·Ï-
‰ÔÛÙÂÚfiÓ˘ ÛÙË ıÂÚ·›· Ù˘ ηډȷ΋˜ ·ÓÂ¿Ú-
ÎÂÈ·˜ ÛÙ·‰›Ô˘ III-IV ηٿ ÙËÓ Ù·ÍÈÓfiÌËÛË Ù˘ New
York Heart Association (NYHA). øÛÙfiÛÔ, ÔÈ ÁÈ·-
ÙÚÔ› ı· Ú¤ÂÈ Ó· ÂȉÂÈÎÓ‡Ô˘Ó È‰È·›ÙÂÚË ÚÔÛÔ¯‹
ÛÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ Î·Ï›Ô˘ fiÙ·Ó
¯ÔÚËÁÔ‡Ó ·˘Ù¿ Ù· Ê¿Ú̷η, ηıÒ˜ Ë ·‡ÍËÛË Ù˘
¯Ú‹Û˘ ÙÔ˘˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Û¯ÂÙ›ÛıËΠ̠ÛË-
Ì·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ ÂÈÛ·ÁˆÁÒÓ Û ÓÔÛÔÎÔÌ›· ÏfiÁˆ
˘ÂÚηÏÈ·ÈÌ›·˜80. ∞ÎfiÌË, ÌÈÎÚfiÙÂÚ˜ ÌÂϤÙ˜ ¤‰ÂÈ-
Í·Ó fiÙÈ ÙfiÛÔ Ë ÛÈÚÔÓÔÏ·ÎÙfiÓË fiÛÔ Î·È Ë ÂÏÂÚÂ-
ÓfiÓË Ì›ˆÛ·Ó ÙËÓ ·Ô‚ÔÏ‹ ÏÂ˘ÎˆÌ·Ù›Ó˘ ÛÙ· Ô‡Ú·
Û ·ÛıÂÓ›˜ Ì ‰È·‚ËÙÈ΋ ÓÂÊÚÔ¿ıÂÈ· ÔÈ ÔÔ›ÔÈ
‹‰Ë ÂÏ¿Ì‚·Ó·Ó ıÂÚ·›· Ì ·ª∂∞ ‹ ∞Δ-1 ·Ô-
ÎÏÂÈÛÙ¤˜81-83, ·ÏÏ¿ Ì·ÎÚÔÚfiıÂÛÌ· ‰Â‰Ô̤ӷ ›ӷÈ
··Ú·›ÙËÙ· ÁÈ· Ó· Û˘ÌÂÚÈÏËÊıÔ‡Ó Ù· Ê¿Ú̷η
·˘Ù¿ ÛÙȘ Û¯ÂÙÈΤ˜ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ÁÈ· ÙË
ıÂÚ·›· Ù˘ ‰È·‚ËÙÈ΋˜ ÓÂÊÚÔ¿ıÂÈ·˜. Δ¤ÏÔ˜, ÌÂ
‚¿ÛË ÚfiÛÊ·Ù˜ ·Ó·ÊÔÚ¤˜ Û¯ÂÙÈο Ì ·˘ÍË̤ÓÔ
ÂÈÔÏ·ÛÌfi ÚˆÙÔ·ıÔ‡˜ ˘ÂڷωÔÛÙÂÚÔÓÈÛÌÔ‡
ÌÂٷ͇ ÙˆÓ ·ÛıÂÓÒÓ Ì ·ÓıÂÎÙÈ΋ ˘¤ÚÙ·ÛË84, Úfi-
ÛÊ·Ù˜ ÌÂϤÙ˜ ÂÍ¤Ù·Û·Ó ÙËÓ Â›‰Ú·ÛË Ù˘ ÚÔ-
Ûı‹Î˘ ·ÓÙ·ÁˆÓÈÛÙÒÓ Ù˘ ·Ï‰ÔÛÙÂÚfiÓ˘ ÛÙËÓ ÚÔ-
¸¿Ú¯Ô˘Û· ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ·ÁˆÁ‹ ·ÛıÂÓÒÓ Ì ·Ó-
ıÂÎÙÈ΋ ˘¤ÚÙ·ÛË, ‰Â›¯ÓÔÓÙ·˜ ÛËÌ·ÓÙÈÎfi ·ÓÙÈ˘ÂÚ-
Ù·ÛÈÎfi fiÊÂÏÔ˜85,86. ∂Ô̤ӈ˜, Ë ÚÔÛı‹ÎË ·˘ÙÒÓ
ÙˆÓ Ê·ÚÌ¿ÎˆÓ Û ·ÛıÂÓ›˜ Ô˘ Ú·ÁÌ·ÙÈο ÂÌ›-
ÙÔ˘Ó ÛÙÔÓ ÔÚÈÛÌfi Ù˘ ·ÓıÂÎÙÈ΋˜ ˘¤ÚÙ·Û˘ ÌÔ-
Ú› Ó· ·ÔÙÂϤÛÂÈ ÛËÌ·ÓÙÈÎfi ‚Ô‹ıËÌ·84,87.
™Àª¶∂ƒ∞™ª∞Δ∞
Δ· ‰ÈÔ˘ÚËÙÈο ·ÔÙÂÏÔ‡Ó ÈÛ¯˘Ú¿ ıÂÚ·¢ÙÈο
ÂÚÁ·Ï›· Î·È Â›Ó·È Ê¿Ú̷η Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È
¢ڤˆ˜ Î·È Ì ÌÂÁ¿ÏË ÂÈÙ˘¯›· ÁÈ· ¿Óˆ ·fi 50
¯ÚfiÓÈ· ÛÙË ıÂÚ·›· ‚·ÛÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ Ù˘ ÂÛˆ-
ÙÂÚÈ΋˜ ·ıÔÏÔÁ›·˜, fiˆ˜ Ë ˘¤ÚÙ·ÛË Î·È ÔÈ Ì›-
˙ÔÓ˜ ÔȉËÌ·ÙÈΤ˜ ηٷÛÙ¿ÛÂȘ (ηډȷ΋ ·ÓÂ-
¿ÚÎÂÈ·, ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ, ΛÚÚˆÛË ÙÔ˘ ‹·-
ÙÔ˜). OÚÈṲ̂ӷ ‰ÈÔ˘ÚËÙÈο ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Â›-
Û˘ ÁÈ· ¯ÚfiÓÈ· ÛÙË ıÂÚ·›· ÈÔ ÂȉÈÎÒÓ Î·Ù·-
ÛÙ¿ÛˆÓ, fiˆ˜ ÙÔ ÁÏ·‡ÎˆÌ·, ÙÔ ÂÁÎÂÊ·ÏÈÎfi Ô›‰Ë-
Ì·, Ë ˘ÂÚ·‚ÂÛÙÈ·ÈÌ›·, Ë ˘ÂÚ·Û‚ÂÛÙÈÔ˘Ú›· Î·È Ô
¿ÔÈÔ˜ ‰È·‚‹Ù˘. ∏ Û˘Ó¯È˙fiÌÂÓË ¤Ú¢ӷ ¿Óˆ ÛÙÔ
·ÓÙÈΛÌÂÓÔ ·Ó·‰ÂÈÎÓ‡ÂÈ Ó¤Â˜ Èı·Ó¤˜ ıÂÚ·¢ÙÈ-
Τ˜ ÂӉ›ÍÂȘ ÁÈ· ÔÚÈṲ̂Ó˜ ηÙËÁÔڛ˜ ‰ÈÔ˘ÚËÙÈ-
ÎÒÓ (.¯. ηډȷ΋ Î·È ÓÂÊÚÈ΋ ÚÔÛÙ·Û›· ÁÈ· ÙÔ˘˜
·ÓÙ·ÁˆÓÈÛÙ¤˜ Ù˘ ·Ï‰ÔÛÙÂÚfiÓ˘). øÛÙfiÛÔ, ÙfiÛÔ ÁÈ·
ÙȘ ηıÈÂڈ̤Ó˜ fiÛÔ Î·È ÁÈ· ÙȘ ·Ó·‰˘fiÌÂÓ˜ ıÂ-
Ú·¢ÙÈΤ˜ ÂӉ›ÍÂȘ ·˘ÙÒÓ ÙˆÓ Ê·Ú̿ΈÓ, Ë ‚·-
ıÂÈ¿ ÁÓÒÛË Ù˘ Ê·ÚÌ·ÎÔÏÔÁÈÎÒÓ È‰ÈÔÙ‹ÙˆÓ Ù˘
οı ηÙËÁÔÚ›·˜ ‰ÈÔ˘ÚËÙÈÎÒÓ ·ÔÙÂÏ› ÙÔ ÎÏÂȉ›
ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÎÏÈÓÈ΋ ÙÔ˘˜ ¯Ú‹ÛË ÚÔ˜
fiÊÂÏÔ˜ ÙˆÓ ·ÛıÂÓÒÓ Ì·˜.
SUMMARY
Georgianos PI, Sarafidis PA, Savidis N. Diuretics
in clinical practice. Part A′: Mechanisms of acti-
on, pharmacologic effects and clinical indications
of diuretic compounds. ∞rterial Hypertension 2009;
18: 146-163.
Diuretics are among the most important drugs of
our therapeutic armamentarium and have been
broadly used for more than 50 years, providing impor-
tant help towards the treatment of several diseases.
Although all diuretics act primarily by impairing
sodium reabsorption in the renal tubules, they differ in
their mechanism and site of action and, therefore, in
their specific pharmacological properties and clinical
indications. Loop diuretics are mainly used for
oedematous disorders (i.e. cardiac failure, nephrotic
syndrome) and for blood pressure and volume control
in renal disease, thiazides and related agents are a-
mong the most prescribed drugs for hypertension
treatment, aldosterone-blockers are traditionally used
for primary or secondary aldosteronism, and other diu-
retic classes have more specific indications. Moreover,
continuous research on the field reveals beneficial
effects of certain diuretics on clinical conditions
distinct from the traditional indications of these drugs
(i.e. heart and renal protection for aldosterone
 AÚÙËÚȷ΋ Y¤ÚÙ·ÛË, 18, 2-3
blockers). In every case, knowledge of the pharma-
cology of diuretic agents is the main prerequisite for
successful choice and effective clinical use of a diuretic
compound. This article discusses the mechanisms of
action and pharmacological effects of the various
diuretic classes aiming to provide insights on the
effective use of these agents in patients with various
medical conditions.
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