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고음이온차 대사성산증에서 요 삼투질농도차와 요증 암모늄 배설의 상관성 ; 요 음이온차와 비교
정용영(Yong Young Jung),한성우(Sung Woo Han),박민숙(Min Sook Park),김권수(Gwan Soo Kim),김근호(Gheun Ho Kim),조윤숙(Yoon Sook Cho),주권욱(Kwon Wook Joo),한진석(Jin Suk Han),김성권(Suhng Gwon Kim),이정상(Jung Sang Lee) 대한내과학회 1997 대한내과학회지 Vol.53 No.1
N/A Objectives: Urine anion gap(UAG) and urine osmolal gap(UOG) were proposed as indirect measures of urine ammonium(NF4+). While the former is known to have its usefulness limited to hyperchloremic metabolic acidosis, the latter is reported to have its correlation with urine NE4+ in ketoacidosis. This study was undertaken to evaluate the correlation of urine NH with IJOG in high anion gap metabolic acidosis(AGMA) and to compare it with UAG. Methods: We measured urine NH' by enzymatic determination, UOG(=0.5×[urine osmolality-{2×(Na++K+)+urea+glucose)]), and UAG(=Na++K+-Cl-) in 18 patients(serum AG=24.4±1.6mmol/L ) with AGMA. Results: When they were grouped into those with acute disorders(n=11) and those with chronic disorder(n=7), urine Nk4+ concentration was higher (p<0.05) in the acute(35.6±7.7mmol/L) than in the chronic(3.8±0.9mmol/L) group. The UOG was higher (p<0.05) in the acute(73.2±18.9mmol/L) than in the chronic(6.3±8.7mmol/L) group, but the UAG had no difference between the two groups. When both groups of the patients were considered together, urine NH concentration correlated with the UOG (r=0.90, p<0.01), but not with the UAG. While the patients with lower urine NH4+ excretion(<30mmol/d) had the UOG<40mmol/L, those with higher urine NH' excretion(>40mmol/d) had the UOG>40mmol/L. Conclusion: In contrast to the UAG, the UOG has a significant correlation with urine NH4+ in AGMA.
간경변증 환자의 나트륨대사에 있어서 혈장 Renin 및 교감신경활동도의 역할
이진(Jin Lee),최용석(Young Suk Choi),강승식(Seung Sik Kang),정용영(Yong Young Jung),윤석부(Seok Boo Yoon),계세협(Sea Hyub Kae),곽상택(Sang Taek Kwak),주상언(Sang Aun Joo),김호중(Ho Jung Kim),기춘석(Choon Suhk Kee) 대한내과학회 1995 대한내과학회지 Vol.49 No.1
N/A Objectives: We studied to determine the changes of sodium metabolism and to evaluate the role of plasma renin and sympathetic activities in liver cirrhosis with hyponatremia. Methods: We performed measurement of serum sodium, serum albumin and other blood biochemistries, creatinine and creatinine clearance, daily urinary sodium excretion, plasma renin and aldosterone, and plasma norephinephrine level for sympathetic activity in 24 cirrhotic patients with (n;8) and without ascites(n; 16) on day 1 after admisson. We checked body weight, serum sodium and creatinine clearance again on day 10 after admission. Results: 1) The serum sodium level of the ascitic group was lower than that of the non-ascitic group(136±1.0 vs. 138±2.4 mEq/L, p<0.01). There were also significant lower values of serum albumin, creatinine clearance and 24hr urinary sodium excreation in the ascitic group as compared with non-ascitic group. 2) The plasma renin activity and norepinephrine level of the ascitic group were higher than that of the non-ascitic group(renin=3.8±1.1 vs. 557±50 pg/ mL, p<0.05). 3) On day 10 after admission, the serum sodium concentration was decreased more prominently to 132±2.6 mEq/L along with significant reduction of body weight and creatinine clearance in the ascitic group, whereas there was no change of serum sodium level in the non-ascitic group, 4) In total 24 patients, a significant positive correlation between serum sodium and albumin concentration(R=0.6, p=0.004) as well as a significant negative correlation between serum sodium concentration and plasma renin activity(R=0.7, p=0.001). Conclusion: These results suggest that changes of serum sodium concentration in cirrhotic pathents correlate closely with changes of renal function related to the presence or absence of ascites, serum albumin level, changes of body weight, increased plasma renin activity and sympathetic activity, and with alteration of sodium and water delivery to the diluting segment of renal tubules.