尿钾排泄量减少与高血压正常高值期患者发生高血压的关系研究

目的探究尿钾排泄量与高血压前期患者发生高血压的关系。方法本研究选取于2011年1至7月在社区体检时检出的高血压前期患者200例为观察组,同时选取血压正常的志愿者200例进行对照。从早6点开始,于次日6点结束收集入组人员24 h尿液,进行尿钾排泄量测定,同时测量人员血压,数据统计后进行分析,比较两组人员尿钾排泄量的差异及尿钾排泄量与血压的相关关系,随访3年,记录发生高血压的例数,同时测量尿钾排泄量,比较患高血压与未患高血压人群尿钾排泄量的差异。结果观察组患者24 h尿钾排泄量为(29.01±7.30)mmol/L,对照组为(36.40±10.04)mmol/L,两组比较,差异具有统计学意义(P<0.05);对24 h尿钾排泄量与血压的相关关系进行分析,结果提示24 h尿钾排泄量与血压存在负相关(r=-0.79,P<0.05);3年内,高血压前期人群中有74例发展为高血压,24 h尿钾水平为(25.37±5.23)mmol/L,未发展为高血压的126例,24 h尿钾水平为(30.05±7.44)mmol/L,两组比较,差异具有统计学意义(P<0.05)。结论尿钾排泄量与高血压前期患者血压存在负相关,即患者血压越高,尿钾排泄量越低,临床上可以通过尿钾排泄量的测定来及早预防高血压的发生。     

原发性高血压患者血清钠钾比及24 h尿钠钾比与血压节律的关系

目的探讨原发性高血压患者血清钠钾比及24h尿钠钾比与血压节律之间的关系。方法回顾性分析2017年9月至2019年5月原发性高血压患者264例,根据患者24h动态监测血压情况,分为杓型血压组(夜间血压下降率≥10%)159例及非杓型血压组105例(夜间血压下降率10%)。各组血清钠钾比及24h尿钠钾比等指标进行比较分析。结果两组患者的男性占比、年龄、体质量指数(BMI)、同型半胱氨酸、空腹血糖、冠心病患病率比较,差异有统计学意义(P0.05);经患者年龄、性别、BMI校正后,非杓型血压组的血清钠水平、血清钠钾比、24h尿钠钾比、血清钾水平与杓型血压组比较,差异有统计学意义(P0.05)。结论原发性高血压患者应及时调整钠、钾摄入,选择适合的降压药物及给药方法,有助于血压降低。     

新疆汉族、维吾尔族、哈萨克族原发性高血压患者的24小时尿微量白蛋白与尿钾/钠排泄比率的差异性分析

目的研究新疆汉族、维吾尔族、哈萨克族原发性高血压患者24 h尿微量白蛋白、尿钠/钾排泄比率的差异性。方法入选2010年3月至2015年1月在新疆医科大学第一附属医院高血压科就诊,明确诊断、未服药的原发性高血压患者共878例,其中汉族362例,维吾尔族330例,哈萨克族186例。测定24 h尿白蛋白、尿微量白蛋白、尿钠、钾及肾素、血管紧张素、醛固酮水平,比较三个民族间差异性,并分析尿微量白蛋白与尿钠、钾的相关性。结果三个民族间24 h尿微量白蛋白水平比较,维吾尔族>汉族>哈萨克族[(403.2±109.7)mg/24 h vs.(163.5±54.9)mg/24 h vs.(113.1±59.1)mg/24 h,均P<0.05];24 h尿钠水平,维吾尔族低于哈萨克族[(158.1±28.5)mmol/24 h vs.(173.9±70.5)mmol/24 h,P<0.05]。24 h尿钾水平,维吾尔族高于哈萨克族[(42.0±7.4)mmol/24 h vs.(36.7±8.9)mmol/24 h,P<0.05]。24 h尿钠/钾比值,维吾尔族<汉族<哈萨克族(3.36±0.23 vs.4.39±1.16 vs.5.36±1.64,均P<0.05)。哈萨克族患者24 h尿微量白蛋白与24 h尿钠/钾呈负相关(r=-0.204,P<0.05),与24 h尿钾呈正相关(r=0.381,P<0.05)。结论新疆维吾尔族原发性高血压患者尿钾及尿钠/钾水平低于哈萨克族及汉族,24 h尿微量白蛋白水平及阳性率高于哈萨克族及汉族,存在民族差异。     

探讨24h尿中GGT在常见肾疾病中的应用价值

目的探讨24h尿中γ-谷氨酰基转移酶(GGT)活性在常见肾疾病诊断中的应用价值。方法将108例肾脏疾患病例分成不同病例组,在日立7170S全自动生化分析仪上测定其24h尿GGT活性,同时测定30例健康体查者24h尿GGT,将结果进行对照分析,并进行24h尿GGT与24h尿肌酐(Cr)的相关性分析。结果急性和慢性肾炎患者组、重症肾病组、糖尿病和高血压组随机尿GGT与正常对照组比较,分别有显著性差异(P<0.05)、无差异(P>0.05)、有极显著性差异(P<0.01);而正常对照组24h尿GGT分别与3组病例组24h尿GGT比较,结果均有极显著性差异(P<0.01)。24h尿GGT与24h尿肌酐(Cr)具有显著的相关性(r=0.697 1)。结论测定24h尿GGT活性可作为肾脏疾病的重要指标之一。     

24h尿肌酐检测影响因素的探讨

目的 分析尿液不同保存方法和检测方法对24 h尿肌酐(Ucr)的影响,探讨留取24 h尿测定肌酐的适宜保存条件和最佳检测方法.方法 在同一时间收集24 h尿液后,分别在不同时间加入不同防腐剂及采用不同检测方法的条件下,检测初始和保存后的肌酐浓度,采用单因素方差分析探讨时间、防腐剂和检测方法3种因素对Ucr测定值的影响.结果 在室温条件下,Ucr在24 h内均可保持稳定,没有明显变化;加入甲醛会降低Ucr检测值(P<0.05),加入12 mmol/L浓盐酸并调节pH至4.08,也会降低Ucr检测值(P<0.05),而二甲苯对Ucr检测值没有影响(P>0.05);采用肌酐酶法检测的Ucr值低于苦味酸法(P<0.01).结论 测定24 h Ucr只需在室温下放置24 h后,直接采用肌酐酶法进行检测,无需添加任何防腐剂.     

随机尿、晨尿与24 h尿生化指标的相关性分析

目的:研究分别用肌酐和渗透压校正随机尿、晨尿中的常规生化指标与24 h尿中对应指标含量的相关性。方法:收集患者同一天内的24 h尿、晨尿和随机尿,分别测定三种不同类型尿液中的蛋白、电解质(钾、钠、氯)、和尿酸UA的含量,其中晨尿和随机尿的结果分别以肌酐比值和渗透压比值表示,用SPSS11.5软件进行数据处理和秩相关分析。结果:随机尿、晨尿尿蛋白/尿肌酐比值和尿蛋白/尿渗透压比值与24 h尿蛋白定量结果相关性良好(P<0.05),相关系数约为0.8;随机尿、晨尿尿电解质/尿肌酐比值和尿电解质/尿渗透压比值与24 h尿电解质的相关性较差;随机尿、晨尿尿酸校正后没有相关性。结论:晨尿和随机尿尿蛋白/尿肌酐比值代替24 h尿蛋白的测定有标本收集方便易行的优势;用肌酐校正随机尿、晨尿尿电解质的临床评价有待进一步的研究;尿酸的测定仍须采用24 h尿标本。而晨尿、随机尿用渗透压做校正效果与肌酐校正一致。     

血清CysC联合肾小球滤过率、24h尿白蛋白排泄量在早期糖尿病肾病诊断中应用价值

目的探讨血清CysC联合肾小球滤过率、24h尿白蛋白排泄量用于早期糖尿病肾病诊断的可行性。方法选取我院2015年3月~2016年2月收治的60例早期糖尿病肾病患者设为观察组,另选同期60例入院健康检查正常者设为对照组。对两组血清CysC水平、肾小球滤过率、24h尿白蛋白排泄量变化情况进行比较,同时对观察组不同检查方式疾病检出率情况比较。结果观察组血清CysC、肾小球滤过率、24h尿白蛋白排泄量水平分别为0.96±0.36、46.25±8.24、72.86±10.72,对照组为2.85±0.64、85.67±10.38、38.92±7.45,观察组中血清CysC及肾小球滤过率指标水平含量较对照组指标水平低,而24h尿白蛋白排泄量水平含量则较对照组指标水平高(P0.05)。单用血清CysC测定检出率为56.7%,单用肾小球滤过率为51.7%,单用24h尿白蛋白排泄量为53.3%,而三种联合使用检出率为85.0%,三种指标联合检测,检测准确度明显高于单一指标检测(P0.05)。结论临床采用血清CysC联合肾小球滤过率、24h尿白蛋白排泄量用于糖尿病肾病早期检查,能提高疾病检出率。     

血管迷走性晕厥儿童24h尿电解质含量变化

目的 探讨血管迷走性晕厥儿童24 h尿电解质含量变化,对临床补盐补液治疗提供依据.方法 2004-06～2007-04在中南大学湘雅二医院晕厥专科门诊就诊或住院的不明原因晕厥或先兆晕厥儿童79例(晕厥组),男31例,女48例,平均年龄(11.18±2.47)岁.匹配健康儿童11例为对照(对照组).研究对象留取24 h尿,测量尿量后,采用日本HITACHI公司7600-020全自动生化分析仪检测24 h尿电解质(钾、钠、氯、钙、磷、镁)含量.结果 ①晕厥组24 h尿量较对照组减少(P>0.05),24 h尿电解质含量变化不明显(P>0.05),每毫升尿钠和尿钙增加(P<0.01或P<0.05).②晕厥儿童HUTT阳性组24 h尿钠、尿钾较HUTT阴性组明显增加(P<0.05),每毫升尿钠增加(P<0.05).③晕厥儿童24 h尿电解质含量和每毫升尿电解质含量在血管抑制型与心脏抑制型 混合型组、男女性别、<12岁组与≥12岁组、晕厥频次<4次组和晕厥频次≥4次组之间比较差异无统计学意义(P>0.05).结论 24 h尿钠含量增加与VVS发病关系密切,临床治疗VVS要强调健康教育,重视补盐补液方案.     

妊娠高血压患者24h尿微量清蛋白检测的意义

目的通过检测妊娠高血压子痫前期患者24h尿微量清蛋白的含量,探讨其在疾病中的意义。方法采用免疫比浊法在全自动生化分析仪进行178例妊娠高血压子痫前期患者(其中轻度88例,重度90例)24h尿微量蛋白及24h尿微量清蛋白含量的检测,并进行统计学分析。结果轻度子痫前期患者24h尿微量蛋白结果(756.95±1249.26)mg/24h,24h尿清蛋白结果(447.02±1134.58)mg/24h;重度子痫前期患者24h尿微量蛋白结果(2576.09±3153.68)mg/24h,24h尿清蛋白结果(1860.42±2702.37)mg/24h;轻度及重度两组相比差异有统计学意义(P<0.05)。结论妊娠高血压患者肾小球随病情的加重损伤也加重,作为肾小球损伤重要标志的尿微量清蛋白可能在疾病的早期诊断及病情判断上起到一定的作用。     

基于目视管理理论的图示法在老年患者留取24h尿标本中的应用

目的观察目视管理理论的图示法在老年患者留取24h尿标本中的应用效果。方法按实施图示法健康宣教前后进行分组,2017年7月期间(实施口头宣教)收治患者52例为对照组,2017年9月期间(实施图示法宣教)收治患者52例为观察组。对照组用口头讲解辅以文字提示牌进行留取24h尿标本的宣教;观察组采用基于目视管理理论的图示法健康宣教,即制作图示指导册进行留取24h尿标本宣教。统计患者留取24h尿标本的正确率和宣教的时间。结果观察组患者留取24h尿标本的正确率高于对照组,留取尿标本宣教时间短于对照组,经比较,差异有统计学意义(P0.01)。结论基于目视管理理论的图示法有利于提高老年患者留取24h尿标本的正确率,节约宣教的时间。     

Protein-to-creatinine ratio in spot urine samples as a predictor of quantitation of proteinuria

BACKGROUND: Normal individuals usually excrete very small amounts of protein in the urine. Persistently increased protein excretion is usually a marker of kidney damage. Quantifying protein in urine is commonly used in the diagnosis of kidney diseases, detection of treatment effects and evaluation of prognosis. We evaluated the use of the total protein-to-creatinine ratio (P/C) in spot urine specimens as a predictor of urine protein excretion in 24-h collections. METHODS: The correlation between P/C in first morning and random urine specimens and urinary protein excretion in 24-h collections were analyzed. The cutoff value of P/C in first morning urine specimens for screening urinary protein excretion of 1 and 3 g in 24-h collections was determined by receiver operating characteristics (ROC) curve. RESULTS: For patients with Ccr 10 ml/min, the correlation was highly significant. Similar results were obtained for random urine specimens. By ROC curve analysis, the P/C of 0.94 and 2.84 g/gcr in first morning urine specimens represent the best threshold to detect urine protein excretion of 1 and 3 g in 24-h collections, respectively. There is a good correlation between P/C in first morning urine specimens and random urine specimens from inpatients and outpatients. But the P/C in random specimens is significantly higher than that in first morning specimens in outpatients. CONCLUSION: The P/C in spot urine samples could be used as an alternative to urine protein excretion in 24-h collections in patients with Ccr>10 ml/min. The P/C in first morning urine samples is better than that in random specimens, especially for outpatients.     

Estimation of vitamin B1 excretion in 24-hr urine by assay of first-morning urine

Urinary B1 (vitamin B1) excretion is commonly determined in 24-hr urine specimens to obtain an estimate of nutritional status. The aim of our study was to investigate whether B1 in random urine specimens, corrected for the urine creatinine (Cr), can be substituted for B1 in 24-hr urines. Collection of such hour urines is often fraught with errors; an alternative method is described here. All urine specimens voided over 24 hr were collected from 32 healthy adults as were the first-morning urines from 30 healthy Japanese women. The B1 excretion was expressed as the ratio of B1 to Cr. Although the B1 excretion was expressed as the B1/Cr ratio, the B1 excretion varied with the urine volume and the time of urine collection. The B1/Cr ratio in random urine specimens not collected at a fixed time may mislead the evaluation of the nutritional status. We found that the B1/Cr ratio in the first-morning urine correlated significantly with the ratio in 24-hr urines (r=0.970, P<0.001) and also with the concentration of total B1 (B1 plus its phosphate esters) in whole blood (r=0.733, P<0.001). We conclude that the B1/Cr ratio in 24-hr urines could be estimated by measuring the ratio in the first-morning urine.     

防腐剂对24 h尿蛋白定量检测的影响

目的：分析防腐剂对24 h尿蛋白检测结果的影响,探讨留取24 h尿测定尿蛋白加入防腐剂的必要性。方法在同一时间收集健康体检者尿蛋白定性为阴性的尿液后,加入不同量蛋白标准品和大肠杆菌菌液,检测初始和室温保存24 h 后的尿蛋白水平。采用单因素方差分析探讨3种蛋白浓度梯度下,含不同细菌数的尿液室温保存24 h后清蛋白水平变化。结果在保存于室温,不加防腐剂的情况下,不同蛋白浓度且含不同细菌数的尿液蛋白浓度测定值可稳定保持24 h,在24 h内测定值没有明显改变（P＞0．05）。结论用于24 h尿蛋白定量检测的标本可以不加入防腐剂。     

Urinary Sodium-to-Potassium Ratio and Incident Chronic Kidney Disease: Results From the Korean Genome and Epidemiology Study

ObjectiveTo evaluate the association of sodium-potassium intake balance on kidney function.Patients and MethodsData from the Korean Genome and Epidemiology Study were used. The participants were enrolled between June 1, 2001, and January 31, 2003, and were followed-up until December 31, 2016. The 24-hour excretion levels of sodium and potassium were calculated using the Kawasaki formula with spot urinary potassium and sodium measurements. Participants were categorized into tertiles according to the estimated 24-hour urinary sodium-to-potassium (Na/K) ratio. The primary outcome was incident chronic kidney disease (CKD), defined as an estimated glomerular filtration rate of <60 mL/min per 1.73 m² in two or more consecutive measurements during the follow-up period.ResultsThis study included 4088 participants with normal kidney function. The mean age was 52.4±8.9 years, and 1747 (42.7%) were men. The median estimated 24-hour urinary sodium excretion level, potassium excretion level, and Na/K ratio (inter quartile range) were 4.9 (4.1-5.8) g/d, 2.1 (1.8-2.5) g/d, and 2.3 (1.9-2.7) g/d, respectively. During 37,950 person-years of follow-up (median, 11.5 years), 532 participants developed CKD, and the corresponding incidence rate was 14.0 (95% CI, 12.9-15.3) per 1000 person-years. Multivariable Cox hazard analysis revealed that the risk of incident CKD was significantly lower in the lowest tertile than in the highest tertile (HR, 0.78; 95% CI, 0.63-0.97). However, no significant association was found with incident CKD risk when urinary excretion levels of sodium or potassium were evaluated individually.ConclusionA low urinary Na/K ratio may relate with lower CKD development risk in adults with preserved kidney function.     

Is the renal kallikrein system relevant to sodium sensitivity in patients with essential hypertension

In twenty-five outpatients with essential hypertension, the relevance of renal kallikrein excretion for inter-individual differences in the blood pressure response to changes in dietary sodium intake was investigated. The patients were studied during 2 weeks of high (300 mmol) and 2 weeks of low (50-100 mmol) sodium intake. In addition there were two control periods of normal sodium intake, one lasting 4 weeks at the beginning and one lasting 2 weeks at the end of the study. Blood pressure, body weight and 24 h urinary sodium and kallikrein excretion were measured at the end of all periods. At the end of the first control period, 1 mg furosemide per kg body weight was administered intravenously, and the urinary excretion of kallikrein and sodium were measured 30 and 120 min later. The difference in mean arterial pressure (delta MAP) between high and low sodium intake ranged from + 18 to -8 mmHg. The eight patients with a delta MAP greater than 10 mmHg were regarded as salt-sensitive. They were older and had a higher initial blood pressure than salt-insensitive patients. For all patients, urinary kallikrein excretion at the end of the low sodium period (123(SEM 20.3) micrograms 24 h-1) was significantly higher than at the end of the first control period (96(SEM 16.3) micrograms 24 h-1, P less than 0.01) and at the end of the high sodium period (96(SEM 23.7) micrograms 24(-1), P less than 0.01). When compared with salt-insensitive patients, salt-sensitives had lower levels of urinary kallikrein excretion and a blunted kallikrein response to dietary sodium restriction and furosemide.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparative quantitative clinico-chemical analysis of the characteristics of 24-hour urine and morning urine

Ten clinical chemical parameters were used to investigate the relationship between morning urine and 24-hour urine in 80 healthy probands. During the period of the investigation there were no dietary restrictions. A period of at least 4 hours was required between the previous micturation and the collection of morning urine. The following parameters were determined: sodium, potassium, chloride, creatinine, urea, uric acid, glucose, calcium, inorganic phosphorus and total protein. Every parameter, with the exception of total protein, was determined without prior manual dilution, by a fully mechanized procedure, using a multichannel analyser SMA 12/60 (Technicon) adapted for routine purposes. The data showed: The scatter of the excretory values is generally lower in 24-hour urine than in morning urine, but collectively the reference intervals are relatively wide. Almost without exception, there is a significant correlation between excretion in the 24-hour and morning urines, but the average correlation coefficient is only 0.5. The determined reference intervals (10/90 percentile) for the concentrations of the parameters in 24-hour and morning urines are largely in agreement. It is concluded from the data that the composition of morning urine of apparently healthy probands adequately reflects excretion of 24 hours. It remains to be seen whether this is also true for pathological states.     

Hepcidin on 24-hour urine collection: preanalytical aspects and correlation with ferritin levels

Background: Urine hepcidin measurement is a potential non-invasive tool for assessing iron stores. However, hepcidin, due to its amphipathic structure, tends to aggregate and to adhere to surfaces in a protein-poor environment. In this study, we assessed the effect of solid bovine serum albumin (BSA) at different final concentrations (0, 2.5 or 5?g/L) in limiting the loss of hepcidin in spot urine samples. We also explored how hepcidin measured on plasma, spot or 24-hour urine collections can identify iron deficiency.Methods: Hepcidin levels were quantified on plasma, spot (with or without BSA) or 24-h urine collections for 33 volunteers. Hematological and iron status parameters were measured for each individual. The ability to detect iron deficiency (defined as a ferritin level <30?μg/L) based on plasma, spot or 24-h urine collections hepcidin levels was assessed by the means of receiver operator curves analysis.Results: The addition of BSA into urine prior to sample collection prevented hepcidin loss by 13.3% (mean) in spot urine samples whatever the amount. The areas under the receiver operator curves obtained for detecting iron deficiency were respectively 0.94 and 0.93 for hepcidin levels obtained on plasma and 24-h urine collections.Conclusion: In this study, we showed that the addition of solid BSA into urine sample collection containers could prevent aggregation of hepcidin and that 24-h urine hepcidin levels could be as efficient as plasma concentrations for identifying iron deficiency.     

Simple method for monitoring 24-hour urinary urea nitrogen excretion

The urine urea nitrogen/urine creatinine excretion ratio (UUN/UCr) of a "spot" urine specimen obtained approximately 5 hours after the last meal of the day can be used to accurately calculate the urinary urea excretion for the previous 24-hour period. Because UUN excretion is largely determined by dietary intake of protein nitrogen, this method can be used to estimate dietary protein intake for the previous 24-hour period. Strategies for using this simple method for inexpensively and continuously monitoring dietary protein intake are discussed.     

Evaluation of the individual effects of a health education program for sodium restriction by a simple method for measuring 24-hour urinary sodium excretion

A simple method for measuring 24-hr urinary sodium excretion was applied to the evaluation of the individual effects of a health education program for sodium restriction in a rural community in Japan. Eighteen subjects (6 males and 12 females) between 35 and 72 years of age were advised to reduce their sodium intake. Twenty-four-hour urinary sodium, potassium excretion, and sodium/potassium ratio were measured using the simple method for seven consecutive days in three periods which were before the sodium restriction, 6 months after the sodium restriction, and 6 months after the end of the program. Mean sodium excretion of 18 subjects significantly decreased (p less than 0.05) after the end of the program. The reduced level was maintained until six months after the end of the program. Within individual cases, sodium excretion decreased significantly in subjects who had levels higher than 170 mmol at the initial stage. The reduced levels of sodium excretion were maintained until six months after the end of the program except for one subject. The subjects who had an initial level lower than 170 mmol of sodium, which is the upper limit of present recommendation for Japanese adults, did not change their levels.