The Management of Uremia by Perfusion of an Isolated Jejunal Segment: With Observations of the Dynamics of Water and Electrolyte Exchange in the Human Jejunum1

Abstract

A patient with advanced uremia has been managed by 50 perfusions of the isolated proximal half of the small intestine in the hospital and by 24 perfusions at home. With decreasing renal function and progressive oliguria, the patient remained clinically and biochemically essentially stable until anuria developed. Total renal function was not achieved because of failure to remove adequate amounts of phosphate, uric acid, and probably other larger accumulated metabolites. Studies of the exchange and transfer rates of water, electrolytes and other crystalloids permitted the compilation of a perfusate solution which would produce either no change or predictable transfers of these substances at perfusion flow rates of 2 I/hour. Urea nitrogen was removed at a rate of 0.8 [plus or minus] 0.3 g/hour, and urea clearance was 13.4 ml/minute or 18% of normal renal clearance. Deuterium indicated a water clearance of 19.5 ml/minute by the isolated jejunal segment. Blood pressure was correlated with perfusate sodium balance until cortisone was given. Isolated jejunal segment perfusion was a useful adjunct in maintaining water, electrolyte, and nitrogen homeostasis in this patient.