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Urinary net charge in hyperchloremic metabolic acidosis

S Kumar1, M Vaswani, R N Srivastava

  • 1Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi.

Indian Pediatrics
|August 26, 1998
PubMed
Summary

Urinary net charge helps evaluate hyperchloremic metabolic acidosis in children. This method distinguishes between diarrhea, distal RTA, and proximal RTA, aiding in diagnosis and characterizing distal RTA defects.

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Area of Science:

  • Pediatric Nephrology
  • Acid-Base Balance
  • Electrolyte Disorders

Background:

  • Hyperchloremic metabolic acidosis is a complex condition with various causes in children.
  • Distinguishing between diarrhea, distal renal tubular acidosis (RTA), and proximal RTA is crucial for appropriate management.
  • Urinary parameters are often used to investigate the underlying cause of metabolic acidosis.

Purpose of the Study:

  • To assess the utility of urinary net charge (UNa + UK - UCl) in diagnosing hyperchloremic metabolic acidosis.
  • To differentiate between acidosis caused by diarrhea, distal RTA, and proximal RTA.
  • To characterize the specific defect in distal RTA.

Main Methods:

  • A study involving 34 children with hyperchloremic metabolic acidosis (diarrhea, distal RTA, proximal RTA) and 10 healthy controls.

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  • Urine and blood samples were collected for measurement of electrolytes (Na, K, Cl), pH, and pCO2.
  • Urinary net charge was calculated as (urinary sodium + urinary potassium - urinary chloride).

    • Main Results:

    • Patients with proximal and distal RTA exhibited a positive urinary net charge.
    • Patients with diarrhea and induced acidosis showed a negative urinary net charge.
    • All distal RTA cases demonstrated a secretory defect, and some diarrhea cases showed high urine pH despite acidosis.

    Conclusions:

    • Urinary net charge measurement is a valuable tool for the initial evaluation of hyperchloremic metabolic acidosis in pediatric patients.
    • This parameter aids in differentiating common causes of this condition.
    • The study successfully characterized distal RTA as secretory in all evaluated patients.