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Cited by 49Electrolyte and hormonal disordersRenal function and acid-base balanceClinical Laboratory Practices and Quality Control

Use of Urine Electrolytes and Urine Osmolality in the Clinical Diagnosis of Fluid, Electrolytes, and Acid-Base Disorders

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Kamel, Kamel S., Halperin, Mitchell L.·2021·Kidney International Reports
DOI 10.1016/j.ekir.2021.02.003PMC PMC8116912
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Abstract

We discuss the use of urine electrolytes and urine osmolality in the clinical diagnosis of patients with fluid, electrolytes, and acid-base disorders, emphasizing their physiological basis, their utility, and the caveats and limitations in their use. While our focus is on information obtained from measurements in the urine, clinical diagnosis in these patients must integrate information obtained from the history, the physical examination, and other laboratory data.

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  • Serum osmolarity and electrolytes evaluate hydration status.

    “Serum Osmolarity (275-295 mOsm/kg) Electrolytes: Sodium (135-145 mEq/L).Potassium (3.5-5.0 mEq/L) Chlorine (96-106 mEq/L) Calcium (8.5-10.5 mg/dL) Evaluates hydration status.”

    From The Seven Methods for the Evaluation of Nutritional Status—ABCDEFG: Narrative Review (2026) · cites this paper as [24]

    The Patients With Acute Dysnatremia section relates plasma sodium to water and electrolyte balance and describes plasma tonicity in terms of sodium and potassium concentrations. It does not give the cited serum reference ranges or say that the listed serum osmolality and electrolyte panel, including chloride and calcium, evaluates hydration status. (LLM, conf=0.83)

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  1. [1]Kamel K.S. Ethier J.H. Richardson R.M. Bear R.A. Halperin M.L. Urine electrolytes and osmolality: when and how to use them Am J Nephrol 10 1990 89 102 2190469
  2. [2]Kamel K.S. Halperin M.L. Interpretation of electrolytes and acid base parameters in blood and urine Skorecki K. Chertow G.M. Marsden P.A. Brenner and Rector’s The Kidney 11th ed. 2019 Elsevier Philadelphia, PA 758 795
  3. [3]Kamel K.S. Halperin M.L. Fluid, Electrolytes and Acid-Base Physiology: A Problem Based Approach 2017 Elsevier Philadelphia, PA
  4. [4]Huth E.J. Squires R.D. Elkinton J.R. Experimental potassium depletion in normal human subjects. II. Renal and hormonal factors in the development of extracellular alkalosis during depletion J Clin Invest 38 1959 1149 1165 13664790 PMC293262
  5. [5]Womersley R.A. Darragh J.H. Potassium and sodium restriction in the normal human J Clin Invest 34 1955 456 461 14354016 PMC438650
  6. [7]Brunner H.R. Baer L. Sealey J.E. The influence of potassium administration and of potassium deprivation on plasma renin in normal and hypertensive subjects J Clin Invest 49 1970 2128 2138 4319970 PMC535788
  7. [8]West M.L. Marsden P.A. Richardson R.M. New clinical approach to evaluate disorders of potassium excretion Miner Electrolyte Metab 12 1986 234 238 3762510
  8. [9]Ethier J.H. Kamel K.S. Magner P.O. The transtubular potassium concentration in patients with hypokalemia and hyperkalemia Am J Kidney Dis 15 1990 309 315 2321642
  9. [10]Fenton R.A. Yang B. Urea transporter knockout mice and their renal phenotypes Subcell Biochem 73 2014 137 152 25298343
  10. [11]Yang B. Bankir L. Urea and urine concentrating ability: new insights from studies in mice Am J Physiol Renal Physiol 288 2005 F881 F896 15821253
  11. [12]Lassiter W.E. Gottschalk C.W. Mylle M. Micropuncture study of net transtubular movement of water and urea in nondiuretic mammalian kidney Am J Physiol 200 1961 1139 1147 13759324
  12. [13]Kamel K.S. Halperin M.L. Intrarenal urea recycling leads to a higher rate of renal excretion of potassium: an hypothesis with clinical implications Curr Opin Nephrol Hypertens 20 2011 547 554 21788894
  13. [14]Murdaugh H.V. Jr. Schmidt-Nielsen B. Doyle E.M. O’Dell R. Renal tubular regulation of urea excretion in man J Appl Physiol 13 1958 263 268 13575341
  14. [15]Bankir L.T. Trinh-Trang-Tan M.M. Renal urea transporters. Direct and indirect regulation by vasopressin Exp Physiol 85 2000 Spec No:243S–252S 10795928
  15. [16]Kato A. Klein J.D. Zhang C. Sands J.M. Angiotensin II increases vasopressin-stimulated facilitated urea permeability in rat terminal IMCDs Am J Physiol. Renal Physiol 279 2000 F835 F840 11053043
  16. [17]Gertner R.A. Klein J.D. Bailey J.L. Aldosterone decreases UT-A1 urea transporter expression via the mineralocorticoid receptor J Am Soc Nephrol 15 2004 558 565 14978157
  17. [18]Schmidt C. Hocherl K. Bucher M. Cytokine-mediated regulation of urea transporters during experimental endotoxemia Am J Physiol. Renal Physiol 292 2007 F1479 F1489 17229673
  18. [19]Lim S.W. Li C. Sun B.K. Long-term treatment with cyclosporine decreases aquaporins and urea transporters in the rat kidney Am J Physiol. Renal Physiol 287 2004 F139 F151 14871880
  19. [20]Trinh-Trang-Tan M.M. Geelen G. Teillet L. Corman B. Urea transporter expression in aging kidney and brain during dehydration Am J Physiol Regul Integr Comp Physiol 285 2003 R1355 R1365 12933359
  20. [21]Hu M.C. Bankir L. Michelet S. Massive reduction of urea transporters in remnant kidney and brain of uremic rats Kidney Int 58 2000 1202 1210 10972682
  21. [24]Blanchard A. Bockenhauer D. Bolignano D. Gitelman syndrome: consensus and guidance from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference Kidney Int 91 2017 24 33 28003083
  22. [26]Palmer B.F. Clegg D.J. The use of selected urine chemistries in the diagnosis of kidney disorders Clin J Am Soc Nephrol 14 2019 306 316 30626576 PMC6390907
  23. [27]Gennari F.J. Weise W.J. Acid-base disturbances in gastrointestinal disease Clin J Am Soc Nephrol 3 2008 1861 1868 18922984
  24. [28]Groeneveld J.H. Sijpkens Y.W. Lin S.H. An approach to the patient with severe hypokalaemia: the potassium quiz QJM 98 2005 305 316 15760922
  25. [30]Kamel K.S. Ethier J. Levin A. Halperin M.L. Hypokalemia in the “beautiful people.” Am J Med 88 1990 534 536 2186627
  26. [31]Wu K.L. Cheng C.J. Sung C.C. Identification of the causes for chronic hypokalemia: importance of urinary sodium and chloride excretion Am J Med 130 2017 846 855 28213045
  27. [32]Lin S.H. Halperin M.L. Hypokalemia: a practical approach to diagnosis and its genetic basis Curr Med Chem 14 2007 1551 1565 17584063
  28. [33]Huang C.L. Kuo E. Mechanism of hypokalemia in magnesium deficiency J Am Soc Nephrol 18 2007 2649 2652 17804670
  29. [34]Wang T. Egbert A.L. Jr. Aronson P.S. Giebisch G. Effect of metabolic acidosis on NaCl transport in the proximal tubule Am J Physiol 274 1998 F1015 F1019 9841491
  30. [35]Kassirer J.P. Schwartz W.B. The response of normal man to selective depletion of hydrochloric acid. Factors in the genesis of persistent gastric alkalosis Am J Med 40 1966 10 18 5901147
  31. [36]Alexandridis G. Elisaf M. Renal potassium handling in a patient with surreptitious vomiting Nephrol Dial Transplant 16 2001 2275 11682688
  32. [37]Carlisle E.J. Donnelly S.M. Ethier J.H. Modulation of the secretion of potassium by accompanying anions in humans Kidney Int 39 1991 1206 1212 1895674
  33. [38]Kamel K.S. Schreiber M. Halperin M.L. Renal potassium physiology: integration of the renal response to dietary potassium depletion Kidney Int 93 2018 41 53 29102372
  34. [39]Simon D.B. Lifton R.P. Ion transporter mutations in Gitelman’s and Bartter’s syndromes Curr Opin Nephrol Hypertens 7 1998 43 47 9442362
  35. [40]Shaer A.J. Inherited primary renal tubular hypokalemic alkalosis: a review of Gitelman and Bartter syndromes Am J Med. Sci 322 2001 316 332 11780689
  36. [41]Chen Y.S. Fang H.C. Chou K.J. Gentamicin-induced Bartter-like syndrome Am J Kidney Dis 54 2009 1158 1161 19765870
  37. [42]Chrispal A. Boorugu H. Prabhakar A.T. Moses V. Amikacin-induced type 5 Bartter-like syndrome with severe hypocalcemia J Postgrad Med 55 2009 208 2010 19884751
  38. [43]Oronsky B. Caroen S. Oronsky A. Electrolyte disorders with platinum-based chemotherapy: mechanisms, manifestations and management Cancer Chemother Pharmacol 80 2017 895 907 28730291 PMC5676816
  39. [44]Casatta L. Ferraccioli G.F. Bartoli E. Hypokalaemic alkalosis, acquired Gitelman’s and Bartter’s syndrome in chronic sialoadenitis Br J Rheumatol 36 1997 1125 1128 9374934
  40. [45]Barathidasan G.S. Krishnamurthy S. Karunakar P. Systemic lupus erythematosus complicated by a Gitelman-like syndrome in an 8-year-old girl CEN Case Rep 9 2020 129 132 31853802 PMC7148407
  41. [46]Kim Y.K. Song H.C. Kim Y.S. Choi E.J. Acquired Gitelman syndrome Electrolyte Blood Press 7 2009 5 8 21468178 PMC3041481
  42. [47]Bettinelli A. Bianchetti M.G. Girardin E. Use of calcium excretion values to distinguish two forms of primary renal tubular hypokalemic alkalosis: Bartter and Gitelman syndromes J Pediatr 120 1992 38 43 1731022
  43. [48]Ellison D.H. Divalent cation transport by the distal nephron: insights from Bartter’s and Gitelman’s syndromes Am J Physiol Renal Physiol 279 2000 F616 F625 10997911
  44. [49]Cheng C.J. Lin C.S. Chang L.W. Lin S.H. Perplexing hyperkalaemia Nephrol Dial Transplant 21 2006 3320 3323 16968727
  45. [50]DuBose T.D. Jr. Hyperkalemic hyperchloremic metabolic acidosis: pathophysiologic insights Kidney Int 51 1997 591 602 9027745
  46. [51]Kamel K.S. Schreiber M. Halperin M.L. Integration of the response to a dietary potassium load: a Paleolithic perspective Nephrol Dial Transplant 29 2014 982 989 24789504
  47. [52]Bhasin B. Velez J.C. Evaluation of Polyuria: The roles of solute loading and water diuresis Am J Kidney Dis 67 2016 507 511 26687922
  48. [53]Christ-Crain M. Bichet D.G. Fenske W.K. Diabetes insipidus Nat Rev Dis Primers 5 2019 54 31395885
  49. [54]Verbalis J.G. Disorders of body water homeostasis Best Pract Res Clin Endocrinol Metab 17 2003 471 503 14687585
  50. [55]Kamel K.S. Bichet D.G. Halperin M.L. A patient with partial central diabetes insipidus: clarifying pathophysiology and designing treatment Am J Kidney Dis 37 2001 1290 1293 11382701
  51. [56]Fenske W. Allolio B. Clinical review: current state and future perspectives in the diagnosis of diabetes insipidus: a clinical review J Clin Endocrinol Metab 97 2012 3426 3437 22855338
  52. [57]Miller M. Dalakos T. Moses A.M. Recognition of partial defects in antidiuretic hormone secretion Ann Intern Med 73 1970 721 729 5476203
  53. [58]De Wardener H.E. Herxheimer A. The effect of a high water intake on the kidney’s ability to concentrate the urine in man J Physiol 139 1957 42 52 13481895 PMC1358676
  54. [59]Epstein F.H. Kleeman C.R. Hendrikx A. The influence of bodily hydration on the renal concentrating process J Clin Invest 36 1957 629 634 13428850 PMC441729
  55. [60]Harrington A.R. Valtin H. Impaired urinary concentration after vasopressin and its gradual correction in hypothalamic diabetes insipidus J Clin Invest 47 1968 502 510 5637139 PMC297196
  56. [61]Kiil F. Aukland K. Renal tubular localization of water and sodium reabsorption in antidiuresis and water diuresis Scand J Clin Lab Invest 12 1960 277 289 14409026
  57. [62]Jamison R.L. Buerkert J. Lacy F. A micropuncture study of collecting tubule function in rats with hereditary diabetes insipidus J Clin Invest 50 1971 2444 2452 5096527 PMC292187
  58. [63]Levitin H. Goodman A. Pigeon G. Epstein F.H. Composition of the renal medulla during water diuresis J Clin Invest 41 1962 1145 1151 14464700 PMC291022
  59. [64]Zimmerhackl B.L. Robertson C.R. Jamison R.L. The medullary microcirculation Kidney Int 31 1987 641 647 3550235
  60. [65]Zerbe R.L. Robertson G.L. A comparison of plasma vasopressin measurements with a standard indirect test in the differential diagnosis of polyuria N Engl J Med 305 1981 1539 1546 7311993
  61. [66]Milles J.J. Spruce B. Baylis P.H. A comparison of diagnostic methods to differentiate diabetes insipidus from primary polyuria: a review of 21 patients Acta Endocrinol (Copenh) 104 1983 410 416 6659843
  62. [67]Fenske W. Quinkler M. Lorenz D. Copeptin in the differential diagnosis of the polydipsia-polyuria syndrome—revisiting the direct and indirect water deprivation tests J Clin Endocrinol Metab 96 2011 1506 1515 21367924
  63. [68]Ray J.G. DDAVP use during pregnancy: an analysis of its safety for mother and child Obstet Gynecol Surv 53 1998 450 455 9662731
  64. [69]Rose B.D. New approach to disturbances in the plasma sodium concentration Am J Med 81 1986 1033 1040 3799631
  65. [70]Mallie J.P. Bichet D.G. Halperin M.L. Effective water clearance and tonicity balance: the excretion of water revisited Clin Invest Med 20 1997 16 24 9013040
  66. [71]Carlotti A.P. Bohn D. Mallie J.P. Halperin M.L. Tonicity balance, and not electrolyte-free water calculations, more accurately guides therapy for acute changes in natremia Intensive Care Med 27 2001 921 924 11430551
  67. [72]Mallie J.P. Hypernatraemia and tonicity balance Nephrol Dial Transplant 14 1999 1332 1333 10344396
  68. [73]Kamel K.S. Magner P.O. Ethier J.H. Halperin M.L. Urine electrolytes in the assessment of extracellular fluid volume contraction Am J Nephrol 9 1989 344 347 2554732
  69. [74]Adrogue H.J. Madias N.E. Hyponatremia N Engl J Med 342 2000 1581 1589 10824078
  70. [75]Ellison D.H. Berl T. Clinical practice. The syndrome of inappropriate antidiuresis N Engl J Med 356 2007 2064 2072 17507705
  71. [76]Goldsmith S.R. Francis G.S. Cowley A.W. Cohn J.N. Response of vasopressin and norepinephrine to lower body negative pressure in humans Am J Physiol 243 1982 H970 H973 7149050
  72. [77]Robertson G.L. Vasopressin Seldin D.W. Giebisch G. The Kidney: Physiology and Pathophysiology 2000 Lippincott Philadelphia, PA 1132 1152
  73. [78]Thaler S.M. Teitelbaum I. Berl T. “Beer potomania” in non-beer drinkers: effect of low dietary solute intake Am J Kidney Dis 31 1998 1028 1031 9631849
  74. [79]Filippone E.J. Ruzieh M. Foy A. Thiazide-associated hyponatremia: clinical manifestations and pathophysiology Am J Kidney Dis 75 2020 256 264 31606239
  75. [80]Kamel K.S. Halperin M.L. The importance of distal delivery of filtrate and residual water permeability in the pathophysiology of hyponatremia Nephrol Dial Transplant 27 2012 872 875 22379181
  76. [81]Ware J.S. Wain L.V. Channavajjhala S.K. Phenotypic and pharmacogenetic evaluation of patients with thiazide-induced hyponatremia J Clin Invest 127 2017 3367 3374 28783044 PMC5669583
  77. [83]Chung H.M. Kluge R. Schrier R.W. Anderson R.J. Clinical assessment of extracellular fluid volume in hyponatremia Am J Med 83 1987 905 908 3674097
  78. [84]Musch W. Thimpont J. Vandervelde D. Combined fractional excretion of sodium and urea better predicts response to saline in hyponatremia than do usual clinical and biochemical parameters Am J Med 99 1995 348 355 7573088
  79. [85]Decaux G. Musch W. Clinical laboratory evaluation of the syndrome of inappropriate secretion of antidiuretic hormone Clin J Am Soc Nephrol 3 2008 1175 1184 18434618
  80. [86]Musch W. Decaux G. Utility and limitations of biochemical parameters in the evaluation of hyponatremia in the elderly Int Urol Nephrol 32 2001 475 493 11583374
  81. [87]Beck L.H. Changes in renal function with aging Clin Geriatr Med 14 1998 199 209 9536101
  82. [89]Fenske W.K. Christ-Crain M. Horning A. A copeptin-based classification of the osmoregulatory defects in the syndrome of inappropriate antidiuresis J Am Soc Nephrol 25 2014 2376 2383 27156760
  83. [90]Beck L.H. Hypouricemia in the syndrome of inappropriate secretion of antidiuretic hormone N Engl J Med 301 1979 528 530 460306
  84. [91]Dorhout Mees E.J. Blom van Assendelft P. Nieuwenhuis M.G. Elevation of uric acid clearance caused by inappropriate antidiuretic hormone secretion Acta Med Scand 189 1971 69 72 5121533
  85. [92]Sonnenblick M. Rosin A. Increased uric acid clearance in the syndrome of inappropriate secretion of antidiuretic hormone Isr J Med Sci 24 1988 20 23 3346144
  86. [93]Decaux G. Namias B. Gulbis B. Soupart A. Evidence in hyponatremia related to inappropriate secretion of ADH that V1 receptor stimulation contributes to the increase in renal uric acid clearance J Am Soc Nephrol 7 1996 805 810 8738818
  87. [94]Decaux G. Prospert F. Soupart A. Musch W. Evidence that chronicity of hyponatremia contributes to the high urate clearance observed in the syndrome of inappropriate antidiuretic hormone secretion Am J Kidney Dis 36 2000 745 751 11007676
  88. [95]Weinberger A. Santo M. Solomon F. Abnormality in renal urate handling in the syndrome of inappropriate secretion of antidiuretic hormone Isr J Med Sci 18 1982 711 713 7107209
  89. [96]Oh M.S. Carroll H.J. Cerebral salt-wasting syndrome. We need better proof of its existence Nephron 82 1999 110 114 10364701
  90. [97]Singh S. Bohn D. Carlotti A.P. Cusimano M. Cerebral salt wasting: truths, fallacies, theories, and challenges Crit Care Med 30 2002 2575 2579 12441772
  91. [98]Verbalis J.G. The curious story of cerebral salt wasting: fact or fiction? Clin J Am Soc Nephrol 15 2020 1666 1668 32611661 PMC7646250
  92. [99]Maesaka J.K. Imbriano L.J. Miyawaki N. Determining fractional urate excretion rates in hyponatremic conditions and improved methods to distinguish cerebral/renal salt wasting from the syndrome of inappropriate secretion of antidiuretic hormone Front Med (Lausanne) 5 2018 319 30560127 PMC6284366
  93. [100]Imbriano L.J. Mattana J. Drakakis J. Maesaka J.K. Identifying different causes of hyponatremia with fractional excretion of uric acid Am J Med. Sci 352 2016 385 390 27776720
  94. [101]Maesaka J.K. Imbriano L.J. Miyawaki N. High prevalence of renal salt wasting without cerebral disease as cause of hyponatremia in general medical wards Am J Med. Sci 356 2018 15 22 30049325
  95. [102]Bitew S. Imbriano L. Miyawaki N. More on renal salt wasting without cerebral disease: response to saline infusion Clin J Am Soc Nephrol 4 2009 309 315 19201917 PMC2637602
  96. [103]Maesaka J.K. Imbriano L.J. Miyawaki N. Evolution and evolving resolution of controversy over existence and prevalence of cerebral/renal salt wasting Curr Opin Nephrol Hypertens 29 2020 213 220 31904619
  97. [104]Carlisle E.J. Donnelly S.M. Vasuvattakul S. Glue-sniffing and distal renal tubular acidosis: sticking to the facts J Am Soc Nephrol 1 1991 1019 1027 1912400
  98. [105]Brenes L.G. Sanchez M.I. Impaired urinary ammonium excretion in patients with isolated proximal renal tubular acidosis J Am Soc Nephrol 4 1993 1073 1078 8286715
  99. [106]Halperin M.L. Kamel K.S. Ethier J.H. Magner P.O. What is the underlying defect in patients with isolated, proximal renal tubular acidosis? Am J Nephrol 9 1989 265 268 2817016
  100. [107]Kamel K.S. Briceno L.F. Sanchez M.I. A new classification for renal defects in net acid excretion Am J Kidney Dis 29 1997 136 146 9002543
  101. [108]Richardson R.M. Halperin M.L. The urine pH: a potentially misleading diagnostic test in patients with hyperchloremic metabolic acidosis Am J Kidney Dis 10 1987 140 143 3605091
  102. [109]Carlisle E.J. Donnelly S.M. Halperin M.L. Renal tubular acidosis (RTA): recognize the ammonium defect and pH or get the urine pH Pediatr Nephrol 5 1991 242 248 2031845
  103. [110]Simpson D.P. Control of hydrogen ion homeostasis and renal acidosis Medicine (Baltimore) 50 1971 503 541 4942419
  104. [111]Madison L.L. Seldin D.W. Ammonia excretion and renal enzymatic adaptation in human subjects, as disclosed by administration of precursor amino acids J Clin Invest 37 1958 1615 1627 13587671 PMC1062844
  105. [112]Goldstein M.B. Bear R. Richardson R.M. The urine anion gap: a clinically useful index of ammonium excretion Am J Med. Sci 292 1986 198 202 3752165
  106. [113]Oh M. Carroll H.J. Value and determinants of urine anion gap Nephron 90 2002 252 255 11867944
  107. [114]Batlle D.C. Hizon M. Cohen E. The use of the urinary anion gap in the diagnosis of hyperchloremic metabolic acidosis N Engl J Med 318 1988 594 599 3344005
  108. [115]Dyck R.F. Asthana S. Kalra J. A modification of the urine osmolal gap: an improved method for estimating urine ammonium Am J Nephrol 10 1990 359 362 2080786
  109. [116]Halperin M.L. Margolis B.L. Robinson L.A. The urine osmolal gap: a clue to estimate urine ammonium in “hybrid” types of metabolic acidosis Clin Invest Med 11 1988 198 202 3135965
  110. [117]Kamel K.S. Halperin M.L. An improved approach to the patient with metabolic acidosis: a need for four amendments J Nephrol 19 suppl 9 2006 S76 S85 16736445
  111. [118]Halperin M.L. Kamel K.S. Some observations on the clinical approach to metabolic acidosis J Am Soc Nephrol 21 2010 894 897 20488948
  112. [119]Meregalli P. Luthy C. Oetliker O.H. Bianchetti M.G. Modified urine osmolal gap: an accurate method for estimating the urinary ammonium concentration? Nephron 69 1995 98 101 7891811
  113. [120]Raphael K.L. Ix J.H. Correlation of urine ammonium and urine osmolal gap in kidney transplant recipients Clin J Am Soc Nephrol 13 2018 638 640 29519951 PMC5969467
  114. [121]Weiner I.D. Verlander J.W. Renal ammonia metabolism and transport Compr Physiol 3 2013 201 220 23720285 PMC4319187
  115. [122]Kurtz I. Renal tubular acidosis: H(+)/base and ammonia transport abnormalities and clinical syndromes Adv Chronic Kidney Dis 25 2018 334 350 30139460 PMC6128697
  116. [123]Haque S.K. Ariceta G. Batlle D. Proximal renal tubular acidosis: a not so rare disorder of multiple etiologies Nephrol Dial Transplant 27 2012 4273 4287 23235953 PMC3616759
  117. [124]Simpson D.P. Citrate excretion: a window on renal metabolism Am J Physiol 244 1983 F223 F234 6338740
  118. [125]Hamm L.L. Renal handling of citrate Kidney Int 38 1990 728 735 2232510
  119. [126]Hering-Smith K.S. Hamm L.L. Acidosis and citrate: provocative interactions Ann Transl Med 6 2018 374 30370301 PMC6186559
  120. [127]Dedmon R.E. Wrong O. The excretion of organic anion in renal tubular acidosis with particular reference to citrate Clin Sci 22 1962 19 32 13884802
  121. [128]Wrong O. Davies H.E. The excretion of acid in renal disease Q J Med 28 1959 259 313 13658353
  122. [129]Norman M.E. Feldman N.I. Cohn R.M. Urinary citrate excretion in the diagnosis of distal renal tubular acidosis J Pediatr 92 1978 394 400 632978
  123. [130]Nagai R. Kooh S.W. Balfe J.W. Renal tubular acidosis and osteopetrosis with carbonic anhydrase II deficiency: pathogenesis of impaired acidification Pediatr Nephrol 11 1997 633 636 9323296
  124. [131]Ohlsson A. Cumming W.A. Paul A. Sly W.S. Carbonic anhydrase II deficiency syndrome: recessive osteopetrosis with renal tubular acidosis and cerebral calcification Pediatrics 77 1986 371 381 3081869
  125. [132]Halperin M.L. Goldstein M.B. Haig A. Studies on the pathogenesis of type I (distal) renal tubular acidosis as revealed by the urinary PCO2 tensions J Clin Invest 53 1974 669 677 4812435 PMC333046
  126. [133]DuBose T.D. Jr. Hydrogen ion secretion by the collecting duct as a determinant of the urine to blood PCO2 gradient in alkaline urine J Clin Invest 69 1982 145 156 6274913 PMC371178
  127. [134]DuBose T.D. Jr. Caflisch C.R. Validation of the difference in urine and blood carbon dioxide tension during bicarbonate loading as an index of distal nephron acidification in experimental models of distal renal tubular acidosis J Clin Invest 75 1985 1116 1123 3921566 PMC425434
  128. [135]Roscoe J.M. Goldstein M.B. Halperin M.L. Effect of amphotercin B on urine acidification in rats: implications for the pathogenesis of distal renal tubular acidosis J Lab Clin Med 89 1977 463 470 839105
  129. [136]Kaitwatcharachai C. Vasuvattakul S. Yenchitsomanus P. Distal renal tubular acidosis and high urine carbon dioxide tension in a patient with southeast Asian ovalocytosis Am J Kidney Dis 33 1999 1147 1152 10352205
  130. [137]Jarolim P. Shayakul C. Prabakaran D. Autosomal dominant distal renal tubular acidosis is associated in three families with heterozygosity for the R589H mutation in the AE1 (band 3) Cl–/HCO3– exchanger J Biol Chem 273 1998 6380 6388 9497368
  131. [138]Elkinton J.R. The kidney and hydrogen ion metabolism Bibl Paediatr 74 1960 99 123 13819957

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Authors
Kamel, K. S., & Halperin, M. L.
Affiliations
St. Michael's Hospital (CA)
Corresponding author
Kamel, Kamel S.
Venue
Kidney International Reports
Publisher
Elsevier BV
Published
2021-05
Volume
6
Issue
5
Pages
1211-1224
ISSN
2468-0249 (ISSN-L)
DOI
10.1016/j.ekir.2021.02.003
PMC
PMC8116912
OpenAlex
W3132498669
Cited by
49
References
3
Citations by year
2026: 9 · 2025: 13 · 2024: 9 · 2023: 8 · 2022: 9 · 2021: 1
FWCI
1.17
Type
journal article
Language
en
Open access
Licence
Locations
  • Kidney International Reports (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
  • Health Sciences › Medicine › Nephrology › Renal function and acid-base balance
  • Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
Keywords
urinary electrolytes, urine osmolality, fluid and electrolyte disorders, acid-base disorders, diagnosis, renal physiology, diagnostic limitations

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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