RENAL FUNCTION TEST

Introduction to RENAL FUNCTION TEST

FORMATION OF URINE

  • Nephron is the functional unit of kidney.
  • Strucure of nephron-bowman’s capsules,proximal convoluted tubule(PCT),loop of Henle , distal convoluted tubule, collecting tubule.
  • Process involves 2 steps-
  • a)Glomerular filtration
  • b)tubular reabsorption

RENAL THRESHOLD SUBSTANCES

  • Certain substances in blood whose excretion in urine is dependent on their concentration.Such substances are called renal threshold substances.
  • Defined as its concentration in blood beyond which it is excreted into urine.
  • Renal threshold for glucose-180mg/dl
  • For calcium-10mg/dl
  • For ketone bodies-3mg/dl
  • For bicarbonate-30mg/dl

TEST TO ASSESS RENAL FUNCTION

  • Glomerular function test
  • Tubular function test
  • Analysis of blood/serum
  • Urine examination

CLEARANCE MEASUREMENTS

  • The rate at which creatinine and urea are removed or cleared from the blood into the urine is termed clearance.
  • Defined as that volume of plasma from which a measured amount of substance can be completely eliminated into urine per unit of time expressed in millilitres per minute.

CREATININE

  • Ideal substance for  measurement of clearance.
  • Endogenous metabolic product synthesized at a constant rate for a given individual & cleared essentially only by glomerular filtration.
  • Levels are higher in males than females.
  • Analysis is simple & inexpensive using colorimetric assays. 

CREATININE CLEARANCE

  • Value is derived by mathematically relating the serum creatinine concentration to the urine creatinine concentration excreted during a period of time usually 24 hours.
  • Specimen collection include both a 24hr urine specimen & a serum creatinine value ,ideally collected at midpoint of 24hr urine collection.
  • Creatinine clearance is widely used to approximate GFR.
  • The total volume of urine is carefully measured & the creatinine clearance is calculated by the following formula-

         {(Ucr(mg/dl)*Vur(ml/24hr))/(Pcr(mg/dl)*1440min/24hr)}*1.73/A

  • Cr=creatinine clearance
  • Ucr=urine creatinine clearance
  • Vur=urine volume excreted in 24 hr
  • Pcr=serum creatinine concentration
  • 1.73/A=normalization factor for body surface area 
  • Reference range-
  • Males-97ml/min per 1.73m sq. to 137 ml/min per 1.73m sq.
  • Females-88ml/min per 1.73 m sq. to 128ml/min per 1.73 m sq.s

UREA CLEARANCE TEST

  • Urea clearance is not as sensitive as creatinine clearance because urea is partially reabsorbed by renal tubules.
  • Hence its clearance is less than GFR.
  • It is defined as volume of plasma that would be completely cleared of urea per minute.
  • DIAGNOSTIC IMPORTANCE

   Blood urea level is found to increase only when clearance falls below 50% normal. 

Inulin clearance

  • Inulin is homopolysaccharide made up of fructose.
  • Neither reabsorbed nor secreted by renal tubules.
  • Clearance is equal to GFR. 

Tubular functions

  • Urine concentration test
  • Dilution test
  • PSP excretion test
  • PAH(Para Amino Hippurate) clearance test
  • Acidification test

URINE CONCENTRATION TEST

  • This is a test to assess  the renal tubular function.
  • It involves the accurate measurement of specific gravity. 

Other blood tests

  • Serum calcium and phosphate estimation.
  • Serum uric acid.
  • Serum electrolytes.
  • Serum urea.

Routine urinalysis

  • Sugars
  • Proteins
  • Ketone bodies 
  • Bile salts
  • Blood pigment

Clinical Study

RENAL CALCULI

  • Solid masses made of crystals.
  • Originate in kidneys but can be found at any point in urinary tract.
  • TYPES-
    • 1.Calcium stones
    • 2.Uric acid
    • 3.Struvite
    • 4.Cystine

SIGN & SYMPTOMS

  • Cause severe pain
  • May not occur until stone begins to move down the ureters.
  • Severe pain is called renal colic.
  • Pain may be located on one side of back or abdomen.
  • Pain of renal colic comes &goes but is quite intense.
  • Blood in urine ,vomiting,nausea,chills,fever.

DIAGNOSIS

  • Requires complete health history assessment & a physical examination.
  • Blood test for calcium,phosphorous,uric acid& electrolytes.
  • Blood urea nitrogen(BUN) & creatinine to assess kidney functioning
  • Urinalysis
  • Examination of passed stones to determine types.

TREATMENT

  • Drinking 6-8 glasses of water a day increases urine flow.
  • Dehydrated patients or with severe nausea ,vomiting may need intravenous fluid.
  • Medication –narcotics ,antibiotics,allopurinol for uric acid stones, diuretics.

UREMIA

  • It is the illness accompanying kidney failure in particular the nitrogenous waste products associated with failure of this organ.
  • In kidney failure, urea & other waste products, which are normally excreted into the urine, are retained in the blood.

SIGN & SYMPTONS

  • Neural & muscular-
    • -fatigue, peripheral neuropathy
    • -seizures, anorexia, nausea, 
    • -weakness, cramps.
  • Endocrine & metabolic-
    • -amenorrhea , sexual dysfunction, reduced body temperature
    • -altered levels of amino acid 

CAUSES

Besides renal failure it can also increased by-

  • Increased production of urea in the liver due to-
    • -high protein diet
    • -increased protein breakdown
    • -gastrointestinal bleeding
  • b) decreased elimination of urea due to-
    • -decreased blood flow through kidney
    • -urinary outflow obstruction
  • c) dehydration
  • d) chronic infection of the kidney such as chronic pyelonephritis 

DIAGNOSIS

  • A detailed & accurate history & physical will help to determine if uremia is acute or chronic.
  • BLOOD TEST-
    • Basic metabolic panel,serum calcium & phospherous to evaluate GFR ,blood urea nitrogen & creatinine.
    • Serum pot.,phosphorous, calcium , & sodium levels.
  • URINE TEST-
    • A 24hr urine collection for determination of creatinine clearance may be done.
    • Urinalysis with microscopic examination for the presence of protein,casts,blood & pH.

GLOMERULONEPHRITIS

  • Glomerule are structures in kidneys made up of tiny blood vessels.
  • These help filter blood & remove excess blood.
  • Conditions that damage the glomeruli are referred to as glomerulonephritis.
  • Can be both acute and chronic glomerulonephritis.

SYMPTOMS 

  • SYMPTOMS OF ACUTE GN
    • -Puffiness in face (edema)
    • -urinating less often, blood in urine
    • -high blood pressure

DIAGNOSIS

  • Urinalysis test is done
  • Blood & protein in urine during urinalysis are imp. markers for the disease.
  • Creatinine clearance
  • Total protein in urine
  • Urine concentration
  • Urine specific gravity
  • Blood tests may show anemia, abnormal albumin levels, abnormal blood urea nitrogen, high creatinine levels
  • Biopsy of the kidneys to confirm diagnosis
  • CT scan ,kidney ultrasound chest x-ray

Blood tests

  • Serum urea 
  • Serum creatinine
  • Calcium and phosphorus estimation
  • Uric acid
  • Serum electrolytes

Other Biochemistry Notes

Biochemistry of Proteins

Carbohydrate Metabolism

VITAMIN PYRIDOXINE AND BIOTIN

Vitamin A

VITAMIN D

Pyrimidine metabolism

Purine Metabolism

Cardiac Biomarkers

. Blood Metabolism (Heme synthesis and breakdown)

Haemoglobinopathies

DNA Repair

Regulation of gene expression

DNA Replication

Transcription

Protein synthesis and genetic code

Detoxification (Xenobiotics)

Liver Function Test

Transamination Deamination & Urea Cycle

METABOLISM OF INDIVIDUAL AMINO ACIDS

Hydroxy amino acids

ACIDIC AMINO ACIDS (Aspartate and Glutamate)

Inborn Error Of Phenyl alanine, Tyrosine Metabolism

Electron Transport Chain & Biological Oxidation

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