Proximal Tubular Malfunction as a Mechanism for Diuresis after Renal Homotransplantation

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Abstract
Four patients who received renal homografts were studied during the first 24 hours after operation to determine the mechanisms of the post-transplantation diuresis. The marked diuresis was associated with decreased tubular reabsorption of sodium and glucose. Fractional excretion of filtered sodium reached values as high as 0.12 to 0.21, and fractional excretion of glucose achieved values as high as 0.10 at normal plasma glucose levels. The marked natriuresis and glycosuria subsided or improved spontaneously despite meticulous replacement of all renal and extrarenal fluid and electrolyte losses. In two subjects who excreted a hypotonic urine, free water excretion during the natriuresis rose to values as high as 12 to 20 percent of the glomerular filtration rate. Excreted potassium exceeded filtered potassium in two subjects.