Györy A Z, Edwards K D, Stewart J H, Whyte H M
J Clin Pathol. 1974 May;27(5):382-91. doi: 10.1136/jcp.27.5.382.
A comprehensive one-day renal function test consisting of a single outpatient visit lasting nine hours, with a minimum of time off work or away from home, is described in detail. Although a large number of laboratory tests are performed in one day, patients usually appreciate thoroughness, and the cost is more than offset by the saving in occupancy of hospital beds and by the early and precise diagnosis of reversible aspects of renal disease. Some aspects of improved methodology, such as the sequential determination of minimum urinary pH, bicarbonate, titratable acid, ammonium, and total acid on a single sample using an automatic titrator, are given in detail. Clinical application of the comprehensive nine-hour renal function testing system is illustrated by the result sheet of a patient with analgesic nephropathy, who was shown in one day to have secondary severe renal failure (glomerular filtration rate 20% of normal for age and surface area), renal tubular acidosis of the distal gradient type (minimum urinary pH 6.20), increased urinary white cell excretion rate, hyaline casts, and absence of red cell casts, consistent with a diagnosis of analgesic nephropathy and urinary tract inflammation. Normal values with 95% range for this laboratory are also given. This testing system has been found to be very useful in investigating patients with analgesic nephropathy, renal tubular acidosis, and after renal transplantation.
本文详细描述了一项为期一天的综合肾功能测试，该测试只需患者门诊就诊一次，持续9小时，且对工作或离家时间的影响降至最低。尽管一天内要进行大量实验室检测，但患者通常认可这种全面性，而且该测试节省了医院病床占用，能早期精确诊断肾病可逆方面，足以抵消其成本。文中还详细介绍了改进方法的一些方面，比如使用自动滴定仪对单个样本依次测定最低尿pH值、碳酸氢盐、可滴定酸、铵和总酸。文中通过一名镇痛剂肾病患者的检测结果单展示了综合9小时肾功能检测系统的临床应用情况，该患者在一天内被诊断为继发性严重肾衰竭（肾小球滤过率为同年龄和体表面积正常人的20%）、远端梯度型肾小管酸中毒（最低尿pH值为6.20）、尿白细胞排泄率增加、出现透明管型且无红细胞管型，符合镇痛剂肾病和泌尿系统炎症的诊断。文中还给出了该实验室的正常参考值及95%范围。现已发现该检测系统在研究镇痛剂肾病、肾小管酸中毒患者以及肾移植后患者方面非常有用。
