评价低钠血症时尿电解质和尿酸部分排泄率的研究。

Study of Urinary Electrolytes and Fractional Excretion of Uric Acid in Evaluating Hyponatremia.

机构信息

Associate Professor, Department of Medicine, Murshidabad Medical College and Hospital, Berhampore, West Bengal, India, Corresponding Author.

Senior Resident, Department of Medicine, Nil Ratan Sircar Medical College and Hospital, West Bengal, India.

出版信息

J Assoc Physicians India. 2024 Sep;72(9):58-63. doi: 10.59556/japi.72.0682.

DOI:10.59556/japi.72.0682

PMID:39291518

Abstract

INTRODUCTION

Serum sodium levels <135 mmol/L are known as hyponatremia. The syndrome of inappropriate antidiuresis (SIAD), which is described by a drop in the effective arterial blood volume (EABV), is the most common cause of hyponatremia. This study was carried out to categorize hyponatremia based on volume status and on parameters like fractional excretion of uric acid (FE-UA), fractional excretion of sodium (FE-Na), urine uric acid (U-UA), and serum uric acid (SR-UA) values.

MATERIALS AND METHODS

Sixty-one patients admitted to the Department of Medicine at Rajendra Institute of Medical Sciences (RIMS), Ranchi, with hyponatremia were included in the study by applying random sampling. Routine urine and blood samples were collected for biochemical tests. Institutional ethical clearance was obtained for this study. Data were analyzed using Statistical Package for the Social Sciences (SPSS) (version 21). Frequency, central tendency, receiver operating characteristic (ROC), and nonparametric Mann-Whitney test analysis tools were utilized for analysis.

RESULTS

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) was found in nearly 50.82% of hyponatremic patients. Approximately, 70% of non-SIADH patients were hypovolemic. When compared to the non-SIADH group, patients in the SIADH group had significantly higher systolic blood pressure (SBP) and diastolic blood pressure (DBP), lower pulse rates, and lower urine creatinine levels and urine creatinine to serum creatinine ratio. The non-SIADH group had significantly higher SR-UA levels ( < 0.0001), but the SIADH group had significantly higher U-UA levels and significantly lower SR-UA levels. Among the studied parameters, FE-UA was the most accurate in diagnosing SIADH. FE-UA (>12%) is a better diagnostic marker for distinguishing SIADH patients from non-SIADH patients.

CONCLUSION

FE-uric acid was found to be the most superior in diagnosing SIADH, followed by FE-Na.

摘要

简介

血清钠水平<135mmol/L 被称为低钠血症。综合征性抗利尿激素不适当分泌（SIAD）是低钠血症最常见的原因，其特征为有效动脉血容量（EABV）下降。本研究旨在根据容量状态以及尿酸排泄分数（FE-UA）、钠排泄分数（FE-Na）、尿尿酸（U-UA）和血清尿酸（SR-UA）等参数对低钠血症进行分类。

材料与方法

本研究采用随机抽样法，选取了在印度拉金德拉医学科学研究所（RIMS）内科就诊的 61 例低钠血症患者。收集了常规尿液和血液样本进行生化检测。本研究获得了机构伦理委员会的批准。使用社会科学统计软件包（SPSS）（版本 21）进行数据分析。使用频率、集中趋势、接收者操作特征（ROC）和非参数曼-惠特尼检验分析工具进行分析。

结果

近 50.82%的低钠血症患者被诊断为抗利尿激素分泌不当综合征（SIADH）。大约 70%的非 SIADH 患者为低血容量。与非 SIADH 组相比，SIADH 组的收缩压（SBP）和舒张压（DBP）明显较高，脉搏率明显较低，尿肌酐水平和尿肌酐/血清肌酐比值明显较低。非 SIADH 组的 SR-UA 水平明显较高（<0.0001），但 SIADH 组的 U-UA 水平明显较高，SR-UA 水平明显较低。在所研究的参数中，FE-UA 对诊断 SIADH 最准确。FE-UA（>12%）是区分 SIADH 患者和非 SIADH 患者的更好诊断标志物。