Chronic metabolic acidosis may be caused by impaired urine acidification. Kim et al correlated impaired urine acidifcation with the urine anion and osmolal gaps. The authors are from Seoul University in South Korea.
Patient selection: chronic metabolic acidosis with kidney disease
Manifestations of impaired urine acidification - both of the following:
(1) increase in urine anion gap
(2) decrease in urine osmolal gap
Patients at risk include:
(1) distal renal tubular acidosis
(2) chronic kidney disease
The presence of an increased urine anion gap was associated with decreased urine ammonium (NH4).
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