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- 저자 : 임춘수(Choon Soo Lim) (검색결과 2 건)
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만성 대사성 산증에서 요 음이온차를 이용한 요 산성화능의 평가
한진석(Jin Suk Han),주권욱(Kwon Wook Joo),정윤철(Yoon Chul Jung),임춘수(Choon Soo Lim),김연수(Yon Su Kim),안규리(Cu Rie Ahn),김성권(Suhng Gwon Kim),이정상(Jung Sang Lee),김근호(Gheun Ho Kim) 대한내과학회 1993 대한내과학회지 Vol.45 No.4
N/A Objectives : The clinical usefulness of the urine anion gap as an indirect index of theammonium excretion was reported only in patients with hyperchloremic metabolic acidosis. And the significance of the urine anion gap and its relation with other indices of urine acidification are not clearly defined yet. We are aimed to evaluate the clinical usefulness of the urine anion gap and its relations with other indices of urine acidification in normal and high anion gap metabolic acidosis. Methods : We measured the urine acidification indices (ammonium, titratable acid, net acid) and the urine anion gap in 24 patients with chronic renal failure, 7 patients with dista1 renal tubular acidosis, and 8 healthy adults with acid loading (normal controls), whose arterial blood bicarbonate concentrations were 14.0 mmol/ L (7.0 to 20.0 mmol/L)(median;range), 18.1 mmol/L(15.0 to 20.0 mmol/L), 19.5 mmol/L(16.8 to 22.D mmol/L), respectively. Results: The urinary excretion of ammonium in chronic renal failure(4.5 mmol/day; 1.6 to 11.8 mmol/ day) and renal tubular acidosis (19.8 mmol/day; 6.9 to 27.2 mmol/day) were lower than in normal controls (52. 5mmol/day; 37.3 to 69.4mmol/day)(p<0.05). The urinary excretion of titratable acid in chronic renal failure (4.9 mmol/day; 0.1 to 19.7 mmol/day) and renal tubular acidosis (2.8 mmol/day; 0.1 to 20.2 mmol/day) were lower than in normal controls (6.2 mmol/day; 20.6 to 36.9mmol/day)(p<0.05) The urinary excretion of net acid in chronic renal failure(8.8 mmol/day; 0.1 to 28.2 mmol/day) and renal tubular acidosis (12.9 mmol/day; 0. 1 to 33.6 mmol/day) were also lower than in normal controls (77.9mmol/day; 62.7 to 98.9 mmol/day)(p<0. 05). The urine anion gap in chronic renal failure (22.9 mmol/L; 13.0 to 43.2 mmol/L) and renal tubular acidosis (36.0 mmol/L; 7.0 to 82.0 mmol/L) were higher than in normal controls (-14.6 mmol/L; 40.7 to 2.2 mmol/ L) (p<0.05), and had inverse relation with urine ammonium (r=-0.71, p<0.01), titratable acid (r=-0.76, p<0.01), and had inverse relation with urine ammonium (r=-0.83, p <0.01), respectively. The urine anion gap in chronic renal failure and renal tubular acidosis were all above 5.0 mmol/L. Conclusion : We concluded that the urine anion gap in chronic metabolic acidosis would be a good clinical index of the impairment of urine acidification in the distal nephron, and reflect not only urine ammmonium excretion but also urinary excretion of net acid.
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