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2017 ; 21
(5
): 866-876
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Acid-base disturbances in nephrotic syndrome: analysis using the CO(2)/HCO(3)
method (traditional Boston model) and the physicochemical method (Stewart model)
#MMPMID28289910
Kasagi T
; Imai H
; Miura N
; Suzuki K
; Yoshino M
; Nobata H
; Nagai T
; Banno S
Clin Exp Nephrol
2017[Oct]; 21
(5
): 866-876
PMID28289910
show ga
BACKGROUND: The Stewart model for analyzing acid-base disturbances emphasizes
serum albumin levels, which are ignored in the traditional Boston model. We
compared data derived using the Stewart model to those using the Boston model in
patients with nephrotic syndrome. METHODS: Twenty-nine patients with nephrotic
syndrome and six patients without urinary protein or acid-base disturbances
provided blood and urine samples for analysis that included routine biochemical
and arterial blood gas tests, plasma renin activity, and aldosterone. The total
concentration of non-volatile weak acids (A(TOT)), apparent strong ion difference
(SIDa), effective strong ion difference (SIDe), and strong ion gap (SIG) were
calculated according to the formulas of Agrafiotis in the Stewart model. RESULTS:
According to the Boston model, 25 of 29 patients (90%) had alkalemia. Eighteen
patients had respiratory alkalosis, 11 had metabolic alkalosis, and 4 had both
conditions. Only three patients had hyperreninemic hyperaldosteronism. The
Stewart model demonstrated respiratory alkalosis based on decreased PaCO(2),
metabolic alkalosis based on decreased A(TOT), and metabolic acidosis based on
decreased SIDa. We could diagnose metabolic alkalosis or acidosis with a normal
anion gap after comparing delta A(TOT) [(14.09?-?measured A(TOT)) or
(11.77?-?2.64?×?Alb (g/dL))] and delta SIDa [(42.7?-?measured SIDa) or
(42.7?-?(Na?+?K?-?Cl)]). We could also identify metabolic acidosis with an
increased anion gap using SIG?>?7.0 (SIG?=?0.9463?×?corrected anion gap-8.1956).
CONCLUSIONS: Patients with nephrotic syndrome had primary respiratory alkalosis,
decreased A(TOT) due to hypoalbuminemia (power to metabolic alkalosis), and
decreased levels of SIDa (power to metabolic acidosis). We could detect metabolic
acidosis with an increased anion gap by calculating SIG. The Stewart model in
combination with the Boston model facilitates the analysis of complex acid-base
disturbances in nephrotic syndrome.