Shichiri M, Hirata Y
Second Department of Internal Medicine, Tokyo Medical and Dental University.
Rinsho Byori. 1999 May;47(5):417-23.
Changes in renal urate clearance may reflect altered glomerular dynamics more precisely than other commonly used indices. Extracellular fluid volume expansion is known to be correlated with uricosuria, while volume depletion is associated with decreased urate excretion. The diagnostic usefulness of measuring serum urate levels and fractional excretions of urate in SIADH, incipient diabetic nephropathy, and prerenal azotemia have been reviewed. In SIADH, profound hypouricemia and markedly increased fractional excretion of urate (FEUA) accompany the extracellular fluid volume expansion. In prerenal azotemia, decreased FEUA may represent a reliable indicator of prerenal azotemia in the differential diagnosis of acute renal failure. In incipient diabetic nephropathy, glomerular hyperfiltration may increase renal urate clearance and lower the serum uric acid level. Hypouricemia may also predict the future progression of incipient nephropathy in type II diabetes.
与其他常用指标相比，肾脏尿酸清除率的变化可能更准确地反映肾小球动力学的改变。已知细胞外液量增加与尿酸尿相关，而容量减少与尿酸排泄减少有关。血清尿酸水平和尿酸排泄分数测定在抗利尿激素分泌异常综合征（SIADH）、早期糖尿病肾病和肾前性氮质血症中的诊断价值已得到综述。在SIADH中，细胞外液量增加伴随严重低尿酸血症和显著增加的尿酸排泄分数（FEUA）。在肾前性氮质血症中，降低的FEUA可能是急性肾衰竭鉴别诊断中肾前性氮质血症的可靠指标。在早期糖尿病肾病中，肾小球高滤过可能增加肾脏尿酸清除率并降低血清尿酸水平。低尿酸血症也可能预测II型糖尿病早期肾病的未来进展。
