[Amoniuria, urinary gap and osmolal in patients with moderate renal insufficiency]

The chronic metabolic acidosis induces increase in the urinary ammonium production (NH4+u) like equalizer, reflected in major or measured minor, if the process is chronic or acute. The objective of the present work was to study the capacity of urinary acidification in patients with Failure Renal Chronic (FRC), stage II and III measuring NH4+u and to compare results with GAP urinary (GAPu), GAP urinary modified (GAPu mod), GAP Osmolal (GAPosm) and GAP Osmolal modified (GAPosm modif.) like indirect indices of amoniuria. Samples Venous/arterial blood and a draft fresh urine of 34 patients were analyzed. Statistically significant correlation was obtained (p < 0,003) between NH4+u ug/min/1.73m2 versus GAPu mmol/l (r = -0,4979) and GAPu mod mmol/l (- 0.5032), improving when NH4+u normatizó by creatinine (r = - 0.6793 and 0.6087 respectively, p < 0,0001). The GAPosm and GAPosm modif did not show significance at the time of evaluating NH4+u, contrary GAPu and GAPu mod would offer an indirect measurement of excretion of NH4+u, having given this last protein nutritional information. A value of p < 0.05 was considered statistically significant.

Obstructive uropathy as the only manifestation of flare in a patient with systemic lupus erythematosus and anti-phospholipid syndrome

Chronic interstitial cystitis and ureteral stenosis has occasionally been reported in systemic lupus erythematosus, mostly associated with gastrointestinal symptoms. We report a case of obstructive uropathy associated to chronic interstitial cystitis as the only manifestation of lupus flare in a patient with SLE and anti-phospholipid syndrome (APS) who had been in remission for many years. The development of chronic interstitial cystitis in patients with SLE and APS has not been previously reported. Histopathological study of her urinary bladder and ureteral meatus showed chronic inflammatory infiltrate in the subepithelium. Lack of significant lower urinary tract symptoms and gastrointestinal involvement were some of the factors that could have prevented an earlier diagnosis. Obstructive uropathy and renal insufficiency initially improved with immunosuppressive treatment and endoureteral protheses, but poor compliance to the therapy led to ominous ending.