総合診療27巻10号

2017年10月発行

I LOVE Urinalysis｜シンプルだけどディープな尿検査の世界・7

腎前性腎不全の判断にFENaは万能か？

著者： 上田剛士¹

所属機関： ¹洛和会ヘルスケアシステム洛和会丸太町病院救急・総合診療科

ページ範囲：P.1403 - P.1407

Case
患者：78歳、女性。
現病歴：3日前から39℃台の発熱と悪寒戦慄があったが、自宅で様子を見ていた。意識が悪いことに気づいた家人が救急車を要請した。
既往歴：慢性心房細動、心不全。
服薬歴：フロセミド、スピロノラクトン、ワルファリン、ACE阻害薬。
バイタルサイン：血圧92/56mmHg、心拍数108回/分。
　　　　　　　　検査値
比重　　　　　　1.012
血清Na　　　　　141mEq/L
血清Cr　　　　　2.6mg/dL
BUN　　　　　　 43mg/dL
尿Na　　　　　　52mEq/L
尿Cr　　　　　　48mg/dL
尿UN　　　　　　263mg/dL
FENa　　　　　　2.0%
FE-UN　　　　　 33.1%
尿細管上皮細胞　1〜5/HPF
顆粒円柱　　　　1〜5/LPF

参考文献

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