Wallia R, Greenberg A, Piraino B, Mitro R, Puschett J B
Am J Kidney Dis. 1986 Aug;8(2):98-104. doi: 10.1016/s0272-6386(86)80119-6.
The charts of 70 successive patients presenting for dialysis therapy for end-stage renal disease (ESRD) were evaluated for their serum electrolyte values. The "classical" pattern of low total CO2 (tCO2), elevated anion gap ("delta"), and normal chloride was found in a minority of patients (14 of 70, or 20%). Hyperchloremia was noted in 46%; in 21 patients (30%), this was associated with a normal delta and in 11 (16%), hyperchloremia was accompanied by an elevated delta. Fourteen patients (20%), most with diabetic nephropathy, had normal serum electrolytes. Patients with chronic glomerulonephritis had a hyperchloremic pattern as often as not, and two of four patients with interstitial nephritis demonstrated hyperchloremia without an elevated delta. We conclude that the previously held thesis that hyperchloremia is a rare or absent finding by the time renal failure progresses to ESRD is no longer tenable. Furthermore, a significant minority of ESRD patients may require the initiation of dialysis at a time when their serum electrolytes are still normal.
对70例终末期肾病（ESRD）患者接受透析治疗的病历进行血清电解质值评估。少数患者（70例中的14例，占20%）呈现出低总二氧化碳（tCO2）、阴离子间隙升高（“delta”）和氯化物正常的“经典”模式。46%的患者存在高氯血症；21例患者（30%）伴有正常的delta，11例患者（16%）高氯血症伴有delta升高。14例患者（20%），大多数患有糖尿病肾病，血清电解质正常。慢性肾小球肾炎患者高氯血症的情况同样常见，4例间质性肾炎患者中有2例表现为高氯血症且delta未升高。我们得出结论，先前认为高氯血症在肾衰竭进展至ESRD时罕见或不存在的观点不再成立。此外，相当一部分ESRD患者在血清电解质仍正常时可能就需要开始透析。
