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    Renal Function Tests

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    Abeer Ahmed
    The document discusses renal function tests and kidney function. It describes the functions of the kidney including regulatory, excretory, endocrinal and metabolic roles. It explains the structures of the nephron and describes glomerular filtration, tubular reabsorption and secretion. It lists indications for renal function tests and types of tests including urine analysis, clearance tests to measure glomerular filtration rate, and tests of tubular function. It also discusses acute renal failure, chronic kidney disease, stages of chronic renal failure, and compares features of acute versus chronic renal failure.

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    Renal Function Tests

    Uploaded by

    Abeer Ahmed
    238 views28 pages
    The document discusses renal function tests and kidney function. It describes the functions of the kidney including regulatory, excretory, endocrinal and metabolic roles. It explains the structures of the nephron and describes glomerular filtration, tubular reabsorption and secretion. It lists indications for renal function tests and types of tests including urine analysis, clearance tests to measure glomerular filtration rate, and tests of tubular function. It also discusses acute renal failure, chronic kidney disease, stages of chronic renal failure, and compares features of acute versus chronic renal failure.

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    The document discusses renal function tests and kidney function. It describes the functions of the kidney including regulatory, excretory, endocrinal and metabolic roles. It explains the structures of the nephron and describes glomerular filtration, tubular reabsorption and secretion. It lists indications for renal function tests and types of tests including urine analysis, clearance tests to measure glomerular filtration rate, and tests of tubular function. It also discusses acute renal failure, chronic kidney disease, stages of chronic renal failure, and compares features of acute versus chronic renal failure.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    238 views28 pages

    Renal Function Tests

    Uploaded by

    Abeer Ahmed
    The document discusses renal function tests and kidney function. It describes the functions of the kidney including regulatory, excretory, endocrinal and metabolic roles. It explains the structures of the nephron and describes glomerular filtration, tubular reabsorption and secretion. It lists indications for renal function tests and types of tests including urine analysis, clearance tests to measure glomerular filtration rate, and tests of tubular function. It also discusses acute renal failure, chronic kidney disease, stages of chronic renal failure, and compares features of acute versus chronic renal failure.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
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    At a glance
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    The key takeaways are the functions of the kidney include regulatory, excretory, endocrine and metabolic functions. The nephron is the functional unit of the kidney.

    The functional units of the kidney are nephrons. A nephron consists of blood vessels and urinary tubules including the proximal convoluted tubule, loop of Henle, distal convoluted tubule and collecting duct.

    The main functions of the nephron include glomerular filtration, tubular reabsorption and tubular secretion.

    Renal function tests

    Dr Abeer Ahmed

    Functions of the kidney


    Regulatory function Excretion of waste products: Endocrinal function Metabolic Function

    Nephron
    Functional unit of the kidney. Consists of:
    Blood vessels: Urinary tubules:
    PCT. LH. DCT. CD.

    NEPHRON FUNCTIONS

    GLOMERULAR FILTRATION: glucose, amino acids, creatinine, urea, phosphates, uric acid TUBULAR REABSORPTION: bicarbonate, phosphates, sulfates, 65% of Na and water, glucose, K, amino acids, H ions TUBULAR SECRETION: hydrogen and potassium, remove acids (hydrogen) to maintain appropriate acid base balance, potassium,

    Glomerular filtration
    Of one-fifth of the cardiac output flows through the two kidneys (i.e. a flow rate of 10001200 ml/min), the glomerulus filters 125130 ml/min (GFR) of an essentially protein-free, cell-free fluid, called glomerular filtrate. The rate of filtration across this membrane is governed by multiple factors including renal blood flow and the integrity of the glomerulus membrane. Glomerulus has multiple small pores through which chemicals are filtered from the blood but excluding any substance with a molecular radius more than 4 nm (e.g. cellular blood component). Moreover, substances that are neutral or have positive charge are more likely to pass through the pores of the glomerulus than substances that are negatively charged (e.g. albumin).

    Tubular reabsorption and secretion


    The filtrate flows through the renal tubules, where water and solutes may be reabsorbed, secreted, synthesized, or metabolized. Sodium is exchanged in the presence of the hormone aldosterone and water is exchanged in the presence of antidiuretic hormone (ADH). Exchange of solutes may occur as active transport, which occurs against the concentration gradient of the chemical and uses energy, or as passive transport, which occurs with the concentration gradient of the chemical.

    Indications for RFT


    To asses the functional capacity of kidney To identify early renal impairment in patients at risk, such as
    i. Diabetes mellitus ii. Hypertension iii. SLE iv. UTI v. UT obstruction vi. Older age

    To diagnose certain renal disorders To asses response to treatment in renal disorders To adjust dosage of chemotherapeutic drugs To plan renal replacement therapy in advanced renal diseases

    1. Urine analysis 2. Tests for assessment of glomerular Glomerular filtration Tests on glomerular permeability function 3. Tests to measure renal plasma flow 4. Tests for assessment of tubular function

    Physical examination

    Chemical examination

    Microscopic examination

    Renal clearance test

    Blood urea and serum creatinine

    RFT Proteinuria Haematuria

    Substances used for clearance test Endogenous creatinine and urea Exogenous inulin
    Renal clearance test used to assess the rate of glomerular filtration and renal blood flow

    Creatinine
    Creatinine (Mol. Wt. 113) is formed from breaking of 1-2% daily of muscle creatine (relative to muscle mass). Freely filtered by the glomeruli. Not reabsorbed. Conc inversely related to eGFR. Low serum and urine creatinnie is found in children, females, and elderly. Small changes in creatinine within and around the reference limits = large changes in GFR. Increased conc occurred very late ( after GFR decrease about 50% of its normal value). Normal values: (Female 0.6-1.1 mg/dl) (Male 0.9-1.3 mg/dl) BUN/Creatinine ratio 10:1

    BUN ( urea )
    BUN results from catabolism of amino acids. After filtration, about 50% is reabsorbed by the tubules. Blood level is related to: renal function, Protein intake, and liver function Urea production is increased by a high protein intake , GIT bleeding , Catabolic state and it is decreased in patients with a low protein intake or in patients with liver disease. Less useful than Creatinine better to be used with Cr Sensitive but non-specific test Reference Range of Serum or plasma BUN is: 820 mg/dL. Reference Range of Blood urea = ( BUN X 2.14 ) is: 1545 mg/dL.

    Determination of Clearance Rate


    Clearance = (U x V) / P
    U is the urinary concentration of creatinine (mg/dl) V is the 24-hours collected urine (L). P is the plasma concentration of creatinine (mg/dl)

    Units = volume/unit time (mL/min)


    Normal: Male: 97 to 137 ml/min. Female: 88 to 128 ml/min.

    (GFR) Glomerular Filtration Rate


    Estimation of GFR is the Best single measure of assessment of renal function since its value is proportional to the number of intact nephrons. The GFR is the volume of fluid filtered from the glomeruli into Bowman's space per unit time. eGFR is more accurate than serum creatinine alone. Serum creatinine is affected by muscle mass, and related factors of age, sex, and race. Many methods are used to estimate the eGFR.

    Estimated GFR ( eGFR)


    Cockcroft - Gault equation Ccr = (140 age in yrs) x wt(kg) (0.85 in females) x Pcr 72 MDRD ( modification of diet in renal disease) eGFR = 186 x {creatinine} - 1.154 ( age ) 0.203 x 0.742 88.4

    Urine concentration test Urine dilution test Specific proteinuria or Tubular proteinuria Glycosuria Amino aciduria

    Renal Function Tests:


    Serum BUN and creatinine ( convenient & insensitive ) Clearance rate (Creatinine ) eGFR Full urine examination Osmolarity measurement in plasma and urine Water depriviation test Acid load test Urine analysis:specific proteinuria, glycosuria,aminoaciduria

    RENAL FAILURE
    Results when the kidneys cannot remove the bodys metabolic wastes or perform their regulatory functions. The substances normally eliminated in the urine accumulate in the body fluids as a result of impaired renal excretion, leading to a disruption in endocrine and metabolic functions as well as fluid, electrolyte, and acid-base disturbances. It is a systemic disease and is a final common pathway of many different kidney and urinary tract diseases

    Types
    Acute

    Chronic

    Acute renal failure


    Sudden onset with oliguria/anuria
    Rapid rise in BUN and S Creatinine

    Definition of CKD
    Structural or functional abnormalities of the kidneys for >3 months, as manifested by
    Kidney damage, with or without decreased GFR, 2. GFR <60 ml/min/1.73 m2, with or without kidney damage

    The progressive, irreversible deterioration in renal function to maintain metabolic and fluid and electrolyte balance resulting in uremia and azotemia.

    Stages of CRF
    Stages of CRF: are based on the GFR. The normal GFR is 125cc/min/1.73m2 1. Stage 1 = GFR > 90 ml/min/1.73m2. Kidney damage with normal or increased GFR. 2. Stage 2 = GFR = 60-89 mL/min/1.73m2. Mild decrease in GFR. 3. Stage 3 = GFR = 30-59 mL/min/1.73m2. Moderate decrease in GFR. 4. Stage 4 = GFR = 15-29 mL/min/1.73m2. Severe decrease in GFR. 5. Stage 5 = GFR <15 mL/min/1.73 m2. Kidney failure

    Chronic Renal Failure

    Chronic Renal Failure


    Impaired homeostasis due to structural damage to kidney
    Metabolic acidosis Hypocalcemia Hyperphosphatemia Altered Vit D metabolism Toxemia

    Manifestations
    1. CV manifestations: a. HPN due to Na and H20 retention or from R-A-A activation, b. heart failure and edema - due to fluid overload c. pericarditis - due to irritation of pericardial lining by uremic toxins 2. Dermatologic manifestations a. severe pruritus is common b. uremic frost, the deposit of urea crystals on the skin. 3. GI manifestations: a. anorexia, nausea and vomiting, and hiccups b. The patients breath may have the odor of urine (uremic fetor); this may be associated with inadequate dialysis 4. Neurologic manifestations a. altered LOC, inability to concentrate, muscle twitching,

    Acute renal failure

    Chronic Renal failure polyuria, polydipsia

    History

    recent drug administration, toxin exposure,surgery/hypovolemia

    Urine output Kidney size Anemia Metabolic bone disease

    oliguria normal to large absent absent

    polyuria small present present

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