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Clinical significance

(a) Decrease of urinary chlorides:

1. Markedly decreased by excessive sweating by loss of chlorides in sweat.

2. During fasting, chloride excretion may fall to a trace, even though the concentration of blood chlorides is approximately normal. This shows the remarkable capacity of the kidneys to conserve electrolytes for the maintenance of the osmotic pressure of the body fluids.

3. Excretion of chlorides in urine is also decreased, when blood chlorides levels are lowered by loss through diarrohoea and excessive vomiting.

4. Oedema – patients with oedema from practically any cause (nephrotic syndrome, nephritis, malnutration, or cardiac decompensation) show decreased urine chlorides rather independent of blood chlorides concentration.

5. Diabetes insipidus – urine chlorides may be extremely low in cases of severe D.insipidus.

6. Infections – during pneumonia and other infectious diseases, hypochloraemia, results from the withdrawal of blood chlorides into exudates, and the excretion of chlorides in urine falls. Upon resolution of exudates, excretion of chlorides increases.

7. Urinary excretion of chlorides is decreased in Adrenocortical hyperfunction (Cushing’s syndrome).

(b) Increase of urinary chlorides

Excessive water drinking and the resulting diuresis cause increased chloride excretion.

2. Addison’s disease – Excessive amounts of sodium and chloride are excreted in the urine in cases of adrenal cortical insufficiency

3. Use of diuretics.

II. Phosphates

Phosphate ions rank next to Cl- - among the anions in urine.

Normal value: the amount varies widely depending on the diet. Usually it is 0.8 to 1.3g of P per day (average about 1.1g).

Most of the urinary PO4 is present as

(i) inorganic PO4

(ii) organic PO4 – only 1 to 4% of the total.

Source: Urinary PO4 arises largely from the breakdown of phospholipids, nucleoproteins, nucleotides and phosphoproteins of foods and tissues. Reaction of intestinal contents determine the quantity of PO4 absorbed into the blood and excreted in urine. An acid condition increases the intestinal absorption.

Clinical significance

(a) Increase:

Urinary phosphate excretion is increased in diseases of bones such as rickets, osteomalacia, and periostosis.

2. Parathyroid hyperfunction – In hyperparathyroidism increased amounts of phosphates are excreted.

3. Acidosis – In acidosis, PO4 excretion may rise (unless the kidney is incapable of secreting it, as may be in nephritis).

(b) Decrease: Low urinary PO4 is likely to be associated with:

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