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Urine ph


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The value of UrinePH

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Urine ph

  2. 2. URINE PH Mohamad reza tohidi pediatric nephrologist Kermanshah University of Medical Sciences
  3. 3. The kidneys and lungs normally work in concert to maintain acid-base equilibrium The lung excretes carbon dioxide the renal contribution is that of reclaiming and generating bicarbonate and secreting ammonium ions The proximal renal tubule is responsible for the bulk of the bicarbonate reabsorption/generation, and the distal tubule provides the remaining function. The tubular cells exchange hydrogen ions for sodium of the glomerular filtrate.
  4. 4. The metabolic activity of the body produces nonvolatile acids, principally sulfuric, phosphoric, and hydrochloric acids, but also small amounts of pyruvic, lactic, and citric acids and ketone bodies. These are excreted by the glomerulus as salts (sodium, potassium, calcium, and ammonium salts) and, together with ammonia produced by the renal tubules, can then go on to trap secreted hydrogen ions for elimination in the urine urine pH, a reflection of acid–base balance
  5. 5. Normal pH In healthy individuals, urine pH may vary from 4.5to 8. It varies with food intake (lower pH with high protein diet). Fasting produces low values, and the highest pH measurements are seen following meals. Measurement of urine pH and acidity must always be made on freshly voided specimens. Measured by pH meter with a glass electrode (more accurate) or reagent strips(is usually sufficient). measurement with a pH meter may be indicated in some clinical circumstances, such as the diagnosis and treatment of patients with disturbances of acid-base balance or monitoring urine alkalinization in patients receiving high-dose methotrexate therapy or undergoing treatment for nephrolithiasis Dipsticks can read pH 5–9.They are not accurate when pH <5.5 or >7.5.
  6. 6. urine pH, a reflection of acid–base balance • Early morning pH <5.5 is an indicator of good acidification • pH >7 may suggest defective acidification in absence of infection and prolonged storage. pH values are low where acidemia is present except for where this is secondary to renal tubular acidosis
  7. 7. Urinary pH is important in diagnosing : renal tubular acidosis and monitoring in the treatment or prevention of urinary stones Therapeutic urinary alkalinization may be indicated in cystine and urate stones poisonings (salicylates, methotrexate, and barbiturates) in rhabdomyolysis Alkaline urine in a patient with urinary tract infection suggests presence of a urea-splitting organism like Proteus
  8. 8. Acid Urine a diet high in meat protein and with some fruits such as cranberries SOME CONDITIONES WITH LOW PH URINE : Diabetic ketoacidosis(metabolic acidosis) large quantities of hydrogen ions are excreted, much as ammonium ion Sever Diarrhea Starvation metabolic syndrome During the mild respiratory acidosis of sleep, a more acid urine may be formed
  9. 9. In acid-base disturbances, the pH of the urine reflects attempts at compensation by the kidneys. Patients with metabolic or respiratory acidosis should produce acid urine with increased titratable acidity and ammonium ion concentration. Urinary pH generally reflects the serum pH, except in patients with renal tubular acidosis
  10. 10. an increased incidence of nephrolithiasis in low PH urine Therapeutic acidification of the urine by various pharmacologic agents, including ammonium chloride, methionine, and methenamine mandelate, is used in the treatment of some calculi. This would include phosphate and calcium carbonate stones, which tend to develop in alkaline urine. In potassium depletion, such as in hypokalemic alkalosis of prolonged vomiting, or with prolonged use of diuretics, paradoxical aciduria with slightly acid urine may occur in the presence of a metabolic alkalosis.
  11. 11. Alkaline Urine Alkaline urine may be induced by a diet high in certain fruits and vegetables, (especially citrus fruits ) The urine tends to become less acid following a meal (the so-called alkaline tide). And tends to become more acid during fasting .
  12. 12. In metabolic alkalosis: an alkaline urine with higher levels of urinary bicarbonate is produced, and ammonia production is decreased. In respiratory alkalosis: an alkaline urine is produced that is associated with increased excretion of bicarbonate.
  13. 13. Urine PH in RTA The inability to acidify urine to a pH of less than 5.5 despite an overnight fast and administration of an acid load is the hallmark of RTA. In type I (distal) RTA : the serum is acidic but the urine is alkaline, secondary to an inability to secrete protons into the urine and inability to form of ammonia and urine PH remain >5.5 despite sever acidosis . In Type II (proximal) RTA : is characterized by an inability to reabsorb bicarbonate(bicarbonate wasting occurs). This situation initially results in alkaline urine, but as the filtered load of bicarbonate decreases, the urine becomes more acidic and as distal acidification is intact urine PH may reduced to <5.5 .
  14. 14. Therapeutic alkalization of urine Determination of urinary pH is useful in the diagnosis and management of UTIs and calculi. Sodium bicarbonate, potassium citrate, and acetazolamide may be used to induce alkaline urine in the treatment of some calculi, particularly those composed of uric acid, cystine, or calcium oxalate. These agents may also be used in some urinary tract infections (the antibiotics neomycin, kanamycin, and streptomycin are more active in alkaline urine). and in the treatment of salicylate poisoning.
  15. 15. In children, urine pH are associated with certain causative uropathogens, and less acidic urine is particularly associated with P. mirabilis or P. aeruginosa infections. the urine pH is also a predisposing factor of UTI in children. Alkaline urine in a patient with a UTI suggests the presence of a urea-splitting organism, which may be associated with magnesium-ammonium phosphate crystals and can form staghorn calculi.
  16. 16. No conflict of interest