Practical: 07

RENAL FUNCTION TESTS

Renal function test (RFT), also known as kidney function test is a group of tests
used to assess the functions of kidney. It is used screen for, detect, evaluate and
monitor acute and chronic kidney diseases. These are simple blood and urine tests
that are used identify kidneys problems. It includes:
• Blood urea nitrogen
• Serum creatinine
• Urine creatinine
• Serum Uric acid

Blood urea nitrogen:

• A blood urea nitrogen (BUN) test measures the amount of nitrogen in your
blood that comes from the waste product urea
• Urea is formed in the liver as an end product of protein metabolism and is
carried to the kidneys for excretion
• Nearly all kidney diseases cause inadequate excretion of urea, elevating BUN
levels in the blood.
• BUN-to-creatinine ratio can help your doctor check for problems, such as
dehydration, that may cause abnormal BUN and creatinine levels

Normal Value
BUN :
Adults :10-20 mg/dl
Children : 5-18 mg/dl
BUN :creatinine :
Adults: 6-25 mg/dl
Clinical Significance
High
• Kidney injury/disease
• Low blood flow to kidneys
due to dehydration or
heart failure
• High protein disease
• Addison disease
• Tissue damage
• Kidney disease
• Shock or severe
dehydration
• Bleeding in the digestive
tract or respiratory tract
Low
• Low in protein,
malnutrition
• Severe liver damage
• Low protein diet
• severe muscle injury
called rhabdomyolysis
• Pregnancy
• Cirrhosis
 • Syndrome of
inappropriate
antidiuretic hormone
secretion (SIADH)

Creatinine
• Creatinine is excreted exclusively by the kidneys, and its level in the blood is
proportional to the glomerular filtration rate
• The serum creatinine level provides a more sensitive test of kidney function than
BUN
• Because kidney impairment is almost the only cause of elevated creatinine.
• It can also be measured with a urine test

Clinical Significance
Normal Value High Low
Serum creatinine: • Acute kidney injury • Low muscle mass.
• Chronic kidney disease
Male: 0.5-1.4 mg/dl
• Kidney infections
Female: 0.5-1.2 mg/dl
• Obstructive uropathy
Children (up to 12 years
• Rhabdomylosis
of age): <0.7mg/dl
• Drugs : RAAS inhibitors,
antibiotics
Urine creatinine:
Males: 20-25 mg/kg/day
(roughly 1575 mg/day for
a 70-kg male)
Females: 15-20
mg/kg/day (roughly 1050
mg/day for a 60-kg
female)

Uric Acid
It determines how much uric acid is present in your blood. The test can help determine
how well your body produces and removes uric acid

Clinical Significance
Normal Value High Low
 Serum uric acid:
Male: 4.0-8.5 mg/dl
Female: 2.5-7.5 mg/dl
Urine uric acid:
250-750 mg/24 hour
• Kidney impairment such as • Fanconi syndrome
Acute kidney failure • Wilson’s disease
• urolithiasis
• Gout
• Metastasized cancers
• Multiple myeloma, Leukemia
• chemotherapy

Urinanalysis:

NORMAL
PARAMETER INTERPRETATION
RANGE
Pale-dark  Very dark yellow indicates dehydration
Color  Red traces in urine : hematuria
yellow

 Cloudy urine can be caused by pus (white blood

Clarity Clear cells), blood (red blood cells), sperm, bacteria,
yeast, crystals
 Very high specific gravity means very
concentrated urine, which may be caused by not
drinking enough fluid, loss of too much fluid
(excessive vomiting, sweating, or diarrhea), or
Specific gravity 1.005-1.030 substances (such as sugar or protein) in the
urine.
 Very low specific gravity means dilute urine,
which may be caused by drinking too much fluid,
severe kidney disease, or the use of diuretics.

 High pH can be caused by severe vomiting, a

kidney disease, some urinary tract infections,
and asthma.
pH 4.0-8.0  Low pH may be caused by severe lung disease
(emphysema), uncontrolled diabetes, aspirin
overdose, severe diarrhea, dehydration, drinking
too much alcohol etc.
 Protein in the urine may mean that kidney
damage, an infection, cancer, high blood
Protein None pressure, diabetes, systemic lupus
erythematosus (SLE), or glomerulonephritis is
present
Sugar 1–15  Uncontrolled diabetes
milligrams per  Brain injury
 deciliter  Pregnancy etc.
(mg/dL) in a
24-hour sample
 Uncontrolled diabetes
Ketones none  Atkins diet
 Alcoholism
 Starvation or eating disorders
 RBC -> kidney or bladder injury, kidney stones,
a urinary tract infection, glomerulonephritis, a
kidney or bladder tumor, lupus erythematosus
 Very few or  WBC -> urinary tract infection, bladder tumor,
no RBC, glomerulonephritis, lupus erythematosus, or
WBC or inflammation in the vagina or under the foreskin
casts of the penis.
Microscopic
 No bacteria,  Depending on the type, casts can mean
Examination
yeast cells, inflammation or damage to the tiny tubes in the
parasites kidneys, poor blood supply to the kidneys, metal
 Very few or poisoning (such as lead or mercury), heart
no crystals failure, or a bacterial infection
 Large crystals -> urolithiasis
 Bacteria -> urinary tract infection
 Yeast -> infection
800-2500 ml/24  Decreased urine output : Prostate disease,
Volume
hr Obstructive uropathy, Acute kindey injury, CKD