Anderson R J, Gabow P A, Gross P A
Miner Electrolyte Metab. 1984;10(2):92-7.
The present prospective study was undertaken to evaluate the usefulness of urinary chloride concentration in determining the cause of an abrupt decline in renal function. 99 patients from diverse clinical settings with multiple causes of acute renal failure were evaluated. Urinary chloride concentrations of less than 20 mEq/l were observed in most cases of reversible prerenal azotemia (20 of 21 cases) and were observed in more frequently than urinary sodium concentration of less than 20 mEq/l (13 of 21 cases, p less than 0.01). Only prerenal azotemia accompanying diuretic use was associated with high urinary chloride concentrations (57 +/- 7 mEq/l). When prerenal azotemia occurred in the setting of metabolic alkalosis with bicarbonaturia, urinary chloride was low (4.0 +/- 1.0 mEq/l) while urinary sodium was high (65.0 +/- 19.0 mEq/l). In patients with oliguric and nonoliguric acute tubular necrosis, and in patients with acute exacerbations of chronic renal failure, mean urinary chloride concentration ranged from 40 to 67 mEq/l and mean fractional excretions of chloride ranged from 7.2 to 8.4%. Only 11% of patients with oliguric and nonoliguric acute tubular necrosis had urinary chloride concentrations of less than 20 mEq/l. Urinary chloride concentrations exhibited greater sensitivity and equivalent specificity as urinary sodium concentrations in differentiating patients with reversible prerenal azotemia from those with oliguric and nonoliguric acute tubular necrosis.
本前瞻性研究旨在评估尿氯浓度在确定肾功能急剧下降原因方面的作用。对99例来自不同临床背景、有多种急性肾衰竭病因的患者进行了评估。在大多数可逆性肾前性氮质血症病例（21例中的20例）中观察到尿氯浓度低于20 mEq/l，且其出现频率高于尿钠浓度低于20 mEq/l的情况（21例中的13例，p<0.01）。仅利尿剂使用所致的肾前性氮质血症与高尿氯浓度相关（57±7 mEq/l）。当肾前性氮质血症发生于伴有碳酸氢盐尿的代谢性碱中毒时，尿氯低（4.0±1.0 mEq/l）而尿钠高（65.0±19.0 mEq/l）。在少尿型和非少尿型急性肾小管坏死患者以及慢性肾衰竭急性加重患者中，尿氯平均浓度为40至67 mEq/l，氯的平均排泄分数为7.2%至8.4%。少尿型和非少尿型急性肾小管坏死患者中只有11%的尿氯浓度低于20 mEq/l。在区分可逆性肾前性氮质血症患者与少尿型和非少尿型急性肾小管坏死患者时，尿氯浓度与尿钠浓度相比表现出更高的敏感性和相当的特异性。
