Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: Bench-to-bedside review: Lactate and the kidney. | Critical Care August 2002 Vol 6 No 4 Bellomo Review Bench-to-bedside review Lactate and the kidney Rinaldo Bellomo Department of Intensive Care and Department of Medicine Austin Repatriation Medical Centre Heidelberg Melbourne Victoria 3084 Australia Correspondence Rinaldo Bellomo Published online 7 June 2002 Critical Care 2002 6 322-326 This article is online at http content 6 4 322 2002 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X This article is based on a presentation at the Lactate Satellite Meeting held during the 8th Indonesian-International Symposium on Shock Critical Care Bali Indonesia 24 August 2001. Abstract The native kidney has a major role in lactate metabolism. The renal cortex appears to be the major lactate-consuming organ in the body after the liver. Under conditions of exogenous hyperlactatemia the kidney is responsible for the removal of 25-30 of all infused lactate. Most of such removal is through lactate metabolism rather than excretion although under conditions of marked hyperlactatemia such excretion can account for approximately 10-12 of renal lactate disposal. Indeed nephrectomy results in an approximately 30 decrease in exogenous lactate removal. Importantly and differently from the liver however the kidney s ability to remove lactate is increased by acidosis. While acidosis inhibits hepatic lactate metabolism it increases lactate uptake and utilization via gluconeogenesis by stimulating the activity of phospho-enolpyruvate carboxykinase. The kidney remains an effective lactate-removing organ even during endotoxemic shock. The artificial kidney also has a profound effect on lactate balance. If lactate-buffered fluids are used in patients who require continuous hemofiltration and who have pretreatment hyperlactatemia the serum lactate levels can significantly increase. In some cases this increase can result in an exacerbation of metabolic acidosis. If bicarbonate-buffered .
