J Korean Med Sci.  1998 Aug;13(4):389-394. 10.3346/jkms.1998.13.4.389.

Metabolic acidosis and urinary acidification defect during the course of hemorrhagic fever with renal syndrome

• Han JS
• Kim GH
• Earm J
• Joo KW
• Huh W
• Jeon US
• Ahn C
• Kim S
• Lee JS

• KMID: 1038166
• DOI: http://doi.org/10.3346/jkms.1998.13.4.389

Abstract

To evaluate urinary acidification defect and its contribution to metabolic acidosis (MA) during hemorrhagic fever with renal syndrome (HFRS), we serially analyzed acid-base balance and urinary acidification indices in 10 HFRS patients. Data of the patients were compared with those of 8 normal volunteers (NC). MA was observed in 6 of 8 patients in the oliguric phase, 5 of 7 in the early diuretic phase, 8 of 10 in the late diuretic phase and 2 of 9 in the convalescent phase. HFRS patients with MA had a higher plasma anion gap in the oliguric and early diuretic phases than NC and a higher plasma Cl/Na ratio in the late diuretic phase than NC. As compared with acid-loaded NC, HFRS patients had a higher urine pH in the oliguric, early diuretic and late diuretic phases, a higher urine anion gap (UAG) in the oliguric and early diuretic phases and a lower urinary NH4+ excretory rate in the oliguric, early diuretic and late diuretic phases. Overt distal acidification defect was observed in 6 of 8 patients in the oliguric phase, 3 of 7 in the early diuretic phase, 5 of 10 in the late diuretic phase and none of 9 in the convalescent phase. None of the convalescent patients had latent acidification defect. In conclusion, urinary acidification defect is marked in the oliguric and diuretic phases of severe HFRS and may play a role in the development of a high anion gap (AG) metabolic acidosis in the earlier phase and hyperchloremic MA in the later phase, but rapidly recovers in the convalescent phase.

MeSH Terms

Acidosis, Renal Tubular/urine
Acidosis, Renal Tubular/metabolism*
Hemorrhagic Fever with Renal Syndrome/urine
Hemorrhagic Fever with Renal Syndrome/metabolism*
Human