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Urine NH 4 + is difficult to measure directly, but its excretion is usually accompanied by the anion chloride. A negative urine anion gap can be used as evidence of increased NH 4 + excretion. In a metabolic acidosis without a serum anion gap: A positive urine anion gap suggests a low urinary NH 4 + (e.g. renal tubular acidosis).
The anion gap is the quantity difference between cations (positively charged ions) and anions (negatively charged ions) in serum, plasma, or urine. The magnitude of this difference (i.e., "gap") in the serum is calculated to identify metabolic acidosis .
Reference ranges for urine tests are described below: Measurement Lower limit Upper limit Unit Urinary specific gravity: 1.003 [1] [2] 1.030 [1] [2] g/mL Urobilinogen:
Urine osmolality — measure of the solute concentration of urine [16] Urine specific gravity ― another measure of urine concentration [16] Urine electrolyte levels — measurement of electrolytes such as sodium and potassium in urine [17] Urine anion gap — used to distinguish between some causes of metabolic acidosis [18]
Hyperchloremic acidosis is a form of metabolic acidosis associated with a normal anion gap, a decrease in plasma bicarbonate concentration, and an increase in plasma chloride concentration [1] (see anion gap for a fuller explanation).
Renal tubular acidosis (RTA) is a medical condition that involves an accumulation of acid in the body due to a failure of the kidneys to appropriately acidify the urine. [1] In renal physiology, when blood is filtered by the kidney, the filtrate passes through the tubules of the nephron, allowing for exchange of salts, acid equivalents, and other solutes before it drains into the bladder as urine.
Urine electrolyte levels can be measured in a medical laboratory for diagnostic purposes. The urine concentrations of sodium , chlorine and potassium may be used to investigate conditions such as abnormal blood electrolyte levels, acute kidney injury , metabolic alkalosis and hypovolemia .
Hyperparathyroidism – can cause hyperchloremia and increase renal bicarbonate loss, which may result in a normal anion gap metabolic acidosis. Patients with hyperparathyroidism may have a lower than normal pH, slightly decreased PaCO2 due to respiratory compensation, a decreased bicarbonate level, and a normal anion gap. [3]