シンポジウム S11

尿検査・腎機能検査の新しい流れ(1)

尿検査・腎機能検査を診療に活かすには

神　出　毅一郎*1　遠　藤　正　之*2　堺　　　秀　人*3
　　　　　　　　　　　　　　　　　　　　　　
Usefulness of Urine Analysis in Clinical Nephrology

Kiichiro JINDE*1, Masayuki ENDOH*2and Hideto SAKAI*3

In chronic glomerular nephritis(CGN), it is important to estimate the renal function and 24hr urinary protein excretion to estimate the effectiveness of the treatment. In this study, we evaluated the usefulness of a microscopic urine test in making pathological diagnosis. As a result, we found that IgA nephritis has a significantly higher urinary RBC count among the CGN group, and found focal glomerular sclerosis and membranoproliferatine GN patients have significantly higher urinary RBC count among nephrotic patients. Among patients who have moderate renal insufficiency, acute tubular necrosis and acute interstitial nephritis have higher levels in urinary RBC counting. In summary, we can estimate the pathology of renal diseases by microscopic urinary tests to a certain extent.
In western countries, physician have used the Cockcroft and Gault formula to estimate creatinine clearance, and they also have used urine protein-to-creatinine ratio to estimate 24hr urinary protein excretion. We evaluated these formulae with Japanese, and as a result, found lower estimation of creatinine clearance and urinary protein excretion, which may be due to lower their muscle mass. We need further evaluation to make suitable changes to these formulae for Japanese.
[Rinsho Byori 51 : 214〜218, 2003]

*1Division of Nephrology and Metabolism, Internal Medicine, Tokai Univ. School of Medicine. Isehara Kanagawa

【Key Words】urinary sediment(尿沈渣)，glomerulonephritis(糸球体腎炎)，nephritic syndrome(ネフローゼ症候群)，creatinine clearance(クレアチニンクリアランス)，urinary protein(尿蛋白)

*1〜3東海大学医学部腎内分泌代謝内科学(〒259-1193 伊勢原市下粕屋143)