29. ● SIADH, ⃝ SD患者
• SD群では大体
UNa<30mEq/L,
FENa<0.5%だが,
• SIADH群でも
U/PCre >140で
尿中Na濃度,
FENaも低下する.
Fig. 1. Relationships between UNa and U/P creat (upper panel) and between FENa and the U/P creat (lower pane
42 SIADH patients (P) and in 21 salt-depleted patients ([). Nephron Physiol 2004;96:11-18
31. Table 1. Comparison of biochemical volume-related parameters in salt-depleted patients (SD), SIADH patients and
normonatremic contols (CO) with different diuresis, indirectly evaluated by the urinary to plasma creatinine ratio
• U/P Cre <140, >140別の各パラメータ
(data expressed as mean + SD)
U/P creat ! 140 U/P creat 1 140
CO SD SIADH CO SD SIADH
(n = 38) (n = 15) (n = 20) (n = 28) (n = 6) (n = 22)
Sodium, mEq/l 140B2 124B4* 127B4* 139B2 128B3* 126B4*
Urea, mg/dl 34B6 49B25* 22B9* 32B9 37B7 22B9*
Creatinine, mg/dl 0.9B0.2 0.9B0.3 0.7B0.1 0.8B0.2 1B0.2 0.8B0.2
Uric acid, mg/dl 5.6B1.4 5.4B2.3 2.5B0.6* 5.7B1.4 4.8B1.3 3.8B1.6*
UNa, mEq/l 98B36 22B19* 96B46** 112B48 21B16* 71B43**
UK, mEq/l 34B17 42B19 37B12 62B33 82B28 60B29
UNa+UK/PNa 0.9B0.4 0.4B0.3* 1B0.4** 1.2B0.4 0.6B0.3* 0.8B0.3*
Ucreat, mg/dl 74B29 84B35 62B15 163B50 214B88 153B40
FENa, % 0.9B0.3 0.2B0.2* 0.9B0.4** 0.4B0.2 0.1B0.04* 0.3B0.2**
FEurea, % 38B10 36B12 58B17* 35B10 31B10 46B17*, **
FEUA, % 8B3 9B5 18B7* 7B3 10B4 12B7*
U/P creat 85B28 92B30 89B21 194B48 218B46 191B40
* p ! 0.02 compared to controls; ** p ! 0.05 compared to salt-depleted patients.
UNa + UK/PNaはelectrolyte free water clearanceを示唆.
<1でClearance亢進, >1で低下を示唆する. SIADHでは>1となるが,
patient showed a clearly higher FENa value between 0.3 and 0.5% can be seen in SD patients with
his corresponding FECl value (0.18%). This normal or low U/P creat values, but for U/P creat values
上記からはあまり宛に成らないことが分かる.
red from bullous epidermolysis. Vomiting above 125, the highest corresponding FENa value was
ioned in his history. only 0.11%. Despite a certain degree of ‘overlapping’
nship between UNa and U/P creat in the 42 between the 2 groups, figure 1 (lower panel) shows that
Nephron Physiol 2004;96:11-18
32. Nephron Physiol 2004;96:11-18
• FENa, FEureaによるSIADH, SDの鑑別
U/PCre <140では,
Fig. 3. Relationships between FENa and FEurea in 20 SIADH patients (P) and 15 salt-depleted patients ([) with
SD(低張性脱水)群はFENa<0.5% 且つ FEurea<55%を満たす.
U/P creat below 140 (left panel) and in 22 SIADH patients (closed circles) and 6 salt-depleted patients ([) with U/P
creat above 140 (right panel).
それ以外ならば殆どがSIADHと言える.
U/PCre >140では,(尿量低下時)では,
panel). When U/P creat is below 140, SD patients are all several biochemical parameters, due to different body
but one, localized in the area described by FENa !0.5% compositions. Plasma sodium was monitored every 12 h,
SD群はFENa<0.15% 且つ FEurea<45%を満たす.
and FEurea !55%. SIADH patients differ from them by to avoid too excessive increase or decrease of plasma sodi-
either a FENa 10.5%, or a FEurea 155%. When U/P um. In our experience, mean plasma sodium after 2 liters
それ以外ならば殆どがSIADHと言える.
creat is higher than 140, SD patients cluster still together, isotonic saline in SIADH, slightly increases [4, 5]. About
but the recognition area is now restricted to perhaps a low- 25% of our SIADH patients show a slight decrease of plas-
