Functional Impairment in Chronic Renal Disease

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Abstract
(1) The present study has attempted to characterize the acidifying defect in chronic renal disease and to delineate differences which may exist between glomerular and tubular disorders. (2) The ability to excrete an acid load was examined in 45 patients (30 tubular and 15 glomerular disorders) and ten normal controls, employing the short acid-loading test of Wrong and Davies (1959). Urine samples were assayed for pH, ammonia, titratable acid and phosphate and the results examined both in absolute terms and in relation to glomerular filtration rate (as a measure of residual nephron mass). (3) Total acid excretion was significantly reduced in both groups of patients, the reduction in acid excretion correlating well with the degree of reduction of renal mass. Ammonia excretion was reduced to a greater degree than titratable acid excretion and the impairment in ammonia excretion was more closely correlated with renal mass. (4) No differences between the two patient populations were discernible in these parameters of acid excretion. (5) On the other hand, minimum urine pH was significantly elevated above the normal only in the tubular disease group. (6) The increment in titratable acid excretion was highly correlated with the increment in phosphate excretion. (7) Following phosphate infusion in eight patients, there was a linear rise in titratable acid excretion, indicating that hydrogen ion secretion was not a limiting factor in these patients.

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