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慢性肾功能衰竭(肾衰)是慢性代谢性酸中毒的最常见的原因之一。尿毒症酸中毒被认为仅在渐进性肾病的晚期,当血清肌酐浓度>4mg/dl时发生。Widmer指出,血清肌酐浓度在2～4mg/dl时,在慢性肾衰早期出现血清氯化物浓度有轻微但颇为重要的升高(4 mEq/L),而血清碳酸氢盐浓度降低(6 mEq/L),阴离子隙(AG)不变。与一些作者所持的“临床印象”相反,这种无AG改变的高血氯性代谢性酸中毒(与原发性肾小球疾病相比),不是肾小管间质性疾病的标志。作者作了进一步研究后发现,在11例患者(血
Chronic renal failure (renal failure) is one of the most common causes of chronic metabolic acidosis. Uremic acidosis is thought to occur only in the advanced stages of progressive nephropathy when serum creatinine concentrations> 4 mg / dl. Widmer noted a slight but significant increase in serum chloride concentrations (4 mEq / L) and a lower serum bicarbonate concentration (6 mEq) at 2 to 4 mg / dL in the early stages of chronic renal failure / L), anion gap (AG) unchanged. In contrast to the “clinical impression” held by some authors, this absence of AG changes in hyperglycemic metabolic acidosis (compared with primary glomerular disease) is not a hallmark of tubulointerstitial disease. The authors made further studies and found that in 11 patients (blood