腎臟公式

1.
2. 溶液平衡：M1V1=M2V2
3. Calculation of Intracellular Volume：Intracellular volume = Total body water - Extracellular volume
4. Calculation of Interstitial Fluid Volume：Interstitial fluid volume = Extracellular fluid volume - Plasma
volume

5. Measurement of Blood Volume：

6. Calculation of Fluid Shifts and Osmolarities After Infusion of Hypertonic Saline Solution：
if 2 liters of a hypertonic 3.0 percent sodium chloride solution are infused into the extracellular fluid
compartment of a 70-kilogram patient whose initial plasma osmolarity is 280 mOsm/L, what would be
the intracellular and extracellular fluid volumes and osmolarities after osmotic equilibrium?
a. Calculate the initial conditions, including the volume, concentration, and total milliosmoles in
each compartment. Assuming that extracellular fluid volume is 20 percent of body weight and
intracellular fluid volume is 40 percent of body weight, the following volumes and concentrations
can be calculated.

b. we calculate the total milliosmoles added to the extracellular fluid in 2 liters of 3.0 percent sodium
chloride. A 3.0 percent solution means that there are 3.0 g/100 ml, or 30 grams of sodium chloride
per liter. Because the molecular weight of sodium chloride is about 58.5 g/mol, this means that
there is about 0.5128 mole of sodium chloride per liter of solution. For 2 liters of solution, this
 would be 1.0256 mole of sodium chloride. Because 1 mole of sodium chloride is equal to
approximately 2 osmoles (sodium chloride has two osmotically active particles per mole), the net
effect of adding 2 liters of this solution is to add 2051 milliosmoles of sodium chloride to the
extracellular fluid. In Step 2, we calculate the instantaneous effect of adding 2051 milliosmoles of
sodium chloride to the extracellular fluid along with 2 liters of volume. There would be no change
in the intracellular fluid concentration or volume, and there would be no osmotic equilibrium. In
the extracellular fluid, however, there would be an additional 2051 milliosmoles of total solute,
yielding a total of 5971 milliosmoles. Because the extracellular compartment now has 16 liters of
volume, the concentration can be calculated by dividing 5971 milliosmoles by 16 liters to yield a
concentration of about 373 mOsm/L. Thus, the following values would occur instantly after
adding the solution.

c. calculate the volumes and concentrations that would occur within a few minutes after osmotic
equilibrium develops. In this case, the concentrations in the intracellular and extracellular fluid
compartments would be equal and can be calculated by dividing the total milliosmoles in the body,
13,811, by the total volume, which is now 44 liters. This calculation yields a concentration of
313.9 mOsm/L. Therefore, all the body fluid compartments will have this same concentration after
osmotic equilibrium. Assuming that no solute or water has been lost from the body and that there
is no movement of sodium chloride into or out of the cells, we then calculate the volumes of the
intracellular and extracellular compartments. The intracellular fluid volume is calculated by
dividing the total milliosmoles in the intracellular fluid (7840) by the concentration (313.9
mOsm/L), to yield a volume of 24.98 liters. Extracellular fluid volume is calculated by dividing
the total milliosmoles in extracellular fluid (5971) by the concentration (313.9 mOsm/L), to yield a
volume of 19.02 liters. Again, these calculations are based on the assumption that the sodium
chloride added to the extracellular fluid remains there and does not move into the cells.

7. Capillary Filtration：
8. Urinary excretion rate = Filtration rate − Reabsorption rate + Secretion rate
9. = GFR/Renal plasma flow(RPF)
10. GFR = Kf ×Net filtration pressure ( ) {Kf = GFR/Net filtration pressure}
, 是 reflection coefficient，通常是 1(百分百回來)
GFR=K f [ ( P G−P B )−σ ( π G −π B ) ] σ
11. Renal blood flow =

12. Urinary excretion = Glomerular filtration − Tubular reabsorption + Tubular secretion

13. Filtration = Glomerular filtration rate × Plasma concentration
14. Reabsorption = Kf ×Net reabsorptive force
15. Clearance: cleared of the substance by the kidneys per unit of time → Cs ×Ps = Us × V. Cs is the
clearance rate of a substance s, Ps is the plasma concentration of the substance, Us is the urine
concentration of that substance, and V is the urine flow rate.
16. If a substance is freely filtered (filtered as freely as water) and is not reabsorbed or secreted by the renal
tubules, then the rate at which that substance is excreted in the urine (Us × V) is equal to the filtration

rate of the substance by the kidneys (GFR × Ps).

Cx>GFR→X was secreted

Cx<GFR→X was reabsorpted

17.
18. if a substance is completely cleared from the plasma, the clearance rate of that substance is equal to the

total RPF.

19. Assume that the plasma concentration of PAH is 0.01 mg/ml, urine concentration is 5.85 mg/ml, and
urine flow rate is 1 ml/min. PAH clearance can be calculated from the rate of urinary PAH excretion
(5.85 mg/ml × 1 ml/min) divided by the plasma PAH concentration (0.01 mg/ml). Thus, clearance of
PAH calculates to be 585 ml/min. If the extraction ratio for PAH is 90 percent, the actual RPF can be
calculated by dividing 585 ml/min by 0.9, yielding a value of 650 ml/min. Thus, total RPF can be

calculated as

The extraction ratio (EPAH) is calculated as the difference between the renal arterial PAH (PPAH)
and renal venous PAH (VPAH) concentrations, divided by the renal arterial PAH concentration:

One can calculate the total blood flow through the kidneys from the total RPF and hematocrit (the
percentage of red blood cells in the blood). If the hematocrit is 0.45 and the total RPF is 650 ml/min,
the total blood flow through both kidneys is 650/(1 – 0.45), or 1182 ml/min.
20. Renal blood flow(RBF)= PAH clearance
1−hematocrit
21. if the rate of excretion of the substance (Us × V) is less than the filtered load of the substance (GFR ×
Ps), then some of the substance must have been reabsorbed from the renal tubules. Conversely, if the
excretion rate of the substance is greater than its filtered load, then the rate at which it appears in the
urine represents the sum of the rate of glomerular filtration plus tubular secretion.
The following example demonstrates the calculation of tubular reabsorption. Assume the following
laboratory values for a patient were obtained:
Urine flow rate = 1 ml/min
Urine concentration of sodium (UNa) = 70 mEq/L = 70 μEq/ml
Plasma sodium concentration = 140 mEq/L = 140 μEq/ml
GFR (inulin clearance) = 100 ml/min
In this example, the filtered sodium load is GFR × PNa, or 100 ml/min × 140 μEq/ml = 14,000
μEq/min. Urinary sodium excretion (UNa × urine flow rate) is 70 μEq/min.
Therefore, tubular reabsorption of sodium is the difference between the filtered load and urinary
excretion, or 14,000 μEq/min − 70 μEq/min = 13,930 μEq/min.
Quantifying Renal Urine Concentration And Dilution: “Free Water” and Osmolar Clearances : The
total clearance of solutes from the blood can be expressed as the osmolar clearance (Cosm); this is the
volume of plasma cleared of solutes each minute, in the same way that clearance of a single substance is
calculated:

where Uosm is the urine osmolarity, V_ is the urine flow rate, and Posm is the plasma osmolarity.
Free-water clearance (CH2O) is calculated as the difference between water excretion (urine flow
rate) and osmolar clearance:

When free-water clearance is positive, excess water is being excreted by the kidneys; when free-water
clearance is negative, excess solutes are being removed from the blood by the kidneys and water is being
conserved.
For example, if plasma osmolarity is 300 mOsm/L, urine osmolarity is 600 mOsm/L, and urine flow
rate is 1 ml/min (0.001 L/min), the rate of osmolar excretion is 0.6 mOsm/min (600 mOsm/L × 0.001
L/min) and osmolar clearance is 0.6 mOsm/min divided by 300 mOsm/L, or 0.002 L/min (2.0 ml/min).
This means that 2 milliliters of plasma are being cleared of solute each minute.
Using the example discussed earlier, if urine flow rate is 1 ml/min and osmolar clearance is 2
ml/min, free-water clearance would be −1 ml/min. This means that instead of water being cleared from
the kidneys in excess of solutes, the kidneys are actually returning water to the systemic circulation, as
occurs during water deficits. Thus, whenever urine osmolarity is greater than plasma osmolarity, free-
water clearance is negative, indicating water conservation. When the kidneys are forming a dilute urine
(i.e., urine osmolarity is less than plasma osmolarity), free-water clearance will be a positive value,
denoting that water is being removed from the plasma by the kidneys in excess of solutes. Thus, water
free of solutes, called “free water,” is being lost from the body and the plasma is being concentrated
when free-water clearance is positive.
如果 Uosm = Posm，則尿液是等滲滲透壓的，沒有自由水的增加或減少。仍然有等於 QU 的水分
流失，但體液並未被濃縮或稀釋。如果 free-water clearance 為正，則表示 Uosm < Posm 且自由水正在
被排泄或清除。在這種情況下，尿液為低滲性物質(水>ion, Uosm < Posm)，並且通過除去水來濃縮
體液。如果自 free-water clearance 為負，則表示 Uosm >Posm 和尿是高滲性(水<ion, Uosm >Posm)：游離
水被保留在身體，而多餘的鹽分和其他滲透壓被排泄。
腎臟及其對抗利尿激素（ADH）的反應是維持正常血漿張力（滲透壓）所必需的主要保護
 機制。因此，確定 ADH 腎軸對血漿張力異常的反應是了解水體內平衡的重要步驟。free-water
clearance 的測定是衡量腎臟重吸收或排泄水的能力的最直接的臨床方法。它可以用作研究水代謝
的靈敏方法，用簡單的定量術語描述異常的水穩態。不含電解液的正淨水清除率表示排出過量的
游離水。不含電解質的淨水率為負值表示多餘的水分被重吸收。在高滲過程中升高的 ADH 濃度
可增強腎臟對游離水的重吸收。由於 ADH 分泌減少和腎功能正常，對低滲刺激會清除大量游離
水。在高滲條件下，正的自由水清除率> 0.4 L /天，或在低滲時負的自由水清除率確認 ADH-腎
軸反應異常
22.

23.
24. Fractional Excretion of Sodium (FENa), % = 100 × (SerumCr × UrineNa ) / (SerumNa × UrineCr) AKI
中拿來鑑別 Pre-renal 跟 intrinsic-renal 的重要指標