Abnormal uric acid

Introduction Renal tubular acidosis (RTA) is a group of clinical syndromes of chronic acidosis and imbalance of electrolyte balance due to abnormalities in urinary acid caused by distal renal tubular H+ disorders and vitamin H+ concentrations. Usually, there are few physical activities, poor coordination of the body, sudden increase in exercise, training and running, and the activity time is too long. During the running and jumping process, the foot is repeatedly forced to squat, the long-term communication of the calf muscle is in a state of tension, and the muscles are constantly involved, so that the calf is paralyzed. Periosteal tear injury Periosteal and periosteal vasodilatation congestion and edema, or subperiosteal hemorrhage mechanized periosteal hyperplasia and inflammatory changes and post-traumatic purulent bacterial infection can be caused.

Cause

1. There are few physical activities, poor coordination of the body, sudden increase in exercise, training and running, technical skills are not good, movements are not correct, and in the sports field, the activity time is too long. After exerting force, the long-term communication of the calf muscles is in a state of tension, and the muscles are continuously involved, causing tears in the calf and periosteum to damage the periosteum and periosteal vasodilatation, congestion and edema, or subperiosteal hemorrhage, mesenteric periosteal hyperplasia and inflammatory changes.

2. Causes purulent bacterial infection after trauma.

an examination

Related inspection

Uric acid uric acid

(1) distal renal tubular poisoning: according to the above clinical manifestations and reduction of plasma HCO-3, CO2 binding is reduced, blood K+, Ca2+, PO3-4, Na+ is low, blood Cl- is increased, urine PH>6.0, 24 hours Urinary Na+, K+, Ca2+, and PO3-4 excretion can be confirmed; it is also possible to test the ammonium chloride load. That is, the first day to stop the alkaline drug, the next day after the administration of 0.1 g / kg of ammonium chloride in three orally, for 3 consecutive days, urine pH, such as urine PH can not be reduced to 5.5 or less, that is, diagnostic significance, clinically used Atypical cases, such as urine pH above 6.0, and other symptoms are not obvious, if the patient has liver disease, can not use ammonia chloride, can be replaced by calcium chloride.

(2) proximal tubular toxicity: according to typical clinical symptoms and laboratory tests, blood HCO-3 decreased, carbon dioxide binding decreased, hypokalemia, blood Cl- increased; urine HCO3 content increased, accompanied by amino acid urine, Diabetes and so on. In the case of systemic acidosis, the urine pH can be reduced to 5.5 or less, and the filtered bicarbonate excretion fraction is greater than 15%.

Differential diagnosis

(1) Distal renal tubular acidosis (DRTA): is caused by the secretion of H+ disorder and maintenance of H+ concentration in the distal nephron. Can occur at any age, more women than men, and good for 20 to 40 years old. It is the most common clinical type in RTA.

(2) proximal renal tubular acidosis (PRTA): due to proximal renal tubular reabsorption of HCO-3 disorders.

(3) Mixed renal tubular acidosis: It is a mixed type of the above two, which combines the first two clinical manifestations and treatments.

(4) Distal renal tubular acidosis with hyperkalemia: due to the lack of aldosterone or renal tubules, the aldosterone response is weakened, the distal nephron Na+ transport disorder or cl-reabsorption increases, thereby inhibiting the secretion of H+, leading to urine Acidification barrier. This type is mostly caused by chronic kidney disease and adrenal cortical disease, and clinically, hyperkalemia is the main manifestation.

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