尿の滴定曲線による分析と臨床的応用

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  • 長沢 脩一
    福島県立医科大単付属中央研究所公害医学研究室 福島県立医科大学第3内科学教室

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タイトル別名
  • Titration-curve analysis of urine and its clinical application
  • ニョウ ノ テキテイ キョクセン ニヨル ブンセキ ト リンショウテキ オウヨ
  • III Titration curve of urine and pattern of acid excretion in patients on chronic hemodialysis and with renal tubular acidosis
  • 第3報　慢性血液透析および尿細管性アシドーシス患者における尿滴定曲線と酸排泄状態について

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This paper reports the pattern of acid excretion in patients on chronic hemodialysis and with renal tubular acidosis examined by the method for qualitative and quantitative analysis of urinary acids which was reported in a previous paper. The specimens were early-morning urine and the titration curve with alkali was drawn by the automatic recording titrator. (1) Chronic hemodialysis cases In 10 cases, there were 1 of JJJ-type, 6 of JJ-type and 3 of J-type. Every case showed an abnorml type of titration curve, i. e. A(±) or A(-) type. Especially in the A(-) type, H2PO4-showed a pH-jump, i. e. the type was J-P. There was no significant relation between the type and the duration of dialysis. Urine pH was high, except in 1, with a mean of 7.00. This is presumably due to the excretion of HC03- caused by an increase of its concentration in the blood by importation from dialysate. TA and NH4.+ concentrations were markedly reduced. In 5 cases examined for HCO3-excretion, it was found in every case. (2) Cases of renal tubular acidosis In all the 3 cases studied, the titration curve was of JJ-P⋅AB type, but the proximal RTA case represented JJJ-type in an advanced stage. Urine pH was over 6.00 in spite of the presence of metabolic acidosis, with a mean of 6. 79, TA concentration was reduced in every case. NH4+ concentration was reduced in two cases with distal RTA, but within the normal range in the case with proximal RTA. HC03- was detected in every case. But in an advanced stage of acidosis in the proximal RTA case, TA and NH4+ concencentions markedly increased and HC03- disappeared. The causes of this are discussed.

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