Analysis Of Urine and other Body Fluids

Week 2 / Strasinger’s Urinalysis and Body Fluids 6th Edition

RENAL FUNCTION NOTE

TOPIC OUTLINE
 Erythropoiesis – production of RBC
1 Urinary System  Erythropoietin - hormone produced primarily
2 Kidney’s Function by the kidneys, with small amounts made by the
3 Renal Anatomy & Physiology liver.
4 Renal Function Test

RENAL ANATOMY & PHYSIOLOGY

URINARY SYSTEM NEPHRON
KIDNEY where urine is formed by FILTRATION
of blood  The functional unit of the kidney
URETERS carry the urine to the bladder
BLADDER stores the urine produced  Approximately 1 to 1.5 million each kidney.
URETHRA delivers the urine for EXCRETION
PARTS OF NEPHRON

KIDNEY’S FUNCTION PARTS OF NEPHRON

1. Maintaining homeostasis: regulation of body 1. Glomerulus (Renal Corpuscle)- consists of a

fluids, acid–base balance, electrolyte balance
2. Excretion of waste products
3. Concerned with the maintenance of blood
pressure and erythropoiesis.
coil of approx. eight capillary lobes (capillary
tuft)
2. Bowman’s Capsule
3. Proximal Convoluted Tubule (PCT)
4. Loop of Henle (Descending/ Ascending)
5. Distal Convoluted Tubule (DCT)
6. Afferent arteriole – point of entry
(UNFILTERD BLOOD)
7. Efferent arteriole – point of exit (FILTERED
BLOOD)
8. Peritubular capillaries –surround the
proximal and distal convoluted tubules
9. Vasa recta – located adjacent to the
ascending and descending loop of Henle

1
  TOTAL RENAL PLASMA FLOW: 600 to
700 mL/min

GLOMERULAR FILTRATION

GLOMERULUS
 Consists of coil of approx. eight capillary
lobes referred to as capillary tuft.
 Served as a sieve or a filter of plasma
substances with molecular weight of
<70,000
 Located within the BOWMAN’S CAPSULE
2 TYPES OF NEPHRON (forms the beginning of the renal tubule)

1. Cortical Nephron
 Approximately 85% GLOMERULAR PRESSURE
 Responsible for removal of waste
products & reabsorption.  Presence of HYDROSTATIC PRESSURE (cause
by size of afferent and efferent arteriole)
2. Juxtamedullary Nephron (15%)
 Primary function is concentration of the  HYDROSTATIC PRESSURE are necessary to
urine overcome the opposition of pressure from
the fluid from the Bowman’s capsule and
RENAL FUNCTION the ONCOTIC PRESSURE of unfiltered
plasma protein
A. Renal Blood Flow
B. Glomerular Filtration RAAS (Renin-Angiotensin-Aldosterone System)
C. Tubular Reabsorption
D. Tubular Secretion  This system respond to changes in blood
pressure and plasma sodium content
RENAL BLOOD FLOW
 Monitored by JUXTAGLOMERULAR
 The kidneys receive a large blood flow APPARATUS
(25%)
 RENAL ARTERY supplies blood to the Mechanism:
kidney.
 Based on average body size of 1.73m:

 TOTAL RENAL BLOOD FLOW: approx.

1200 mL/min
 GLOMERULAR FILTRATION
FUNCTIONS OF ANGIOTENSIN II:
1. Vasodilation of afferent & vasoconstriction
of efferent arteriole.
2. Stimulate Sodium reabsorption in the
Proximal Convoluted Tubule (PCT).
3. Release of the hormone Aldosterone from
adrenal cortex.
4. Release of Antidiuretic hormone from
hypothalamus.
TUBULAR REABSORPTION
REABSORPTION MECHANISM
1. ACTIVE TRANSPORT
 Substance to be reabsorbed must combine
to a carrier protein contained in the
membranes of the renal tubular cells.
 Can be influenced by the concentration of
the substance being transported.
 Renal threshold- plasma concentration at
which active transport stops.
Ex. Renal threshold for glucose is 160 to 180
mg/dL
2. PASSIVE TRANSPORT
- movement of molecules across membrane as a
result of differences in their concentration or
electrical potential.
NOTE: Exceeding the renal threshold of
substances affects the Maximal reabsorptive
capacity of the tubules, leading to the
appearance of the substance in the urine.
NOTE: All parts of the tubules can reabsorb
water except your Ascending Loop of Henle
because it is impermeable to water.
TUBULAR CONCENTRATION
 Begins in the descending and ascending
Loop of Henle
COLLECTING DUCT CONCENTRATION
 Depends on the osmotic gradient in the
medulla and the hormone VASOPRESSIN
(ADH)
 Production of vasopressin is determined by
the state of body hydration
TUBULAR SECRETION
2 MAJOR FUNCTIONS:
1. Elimination of waste products not
filtered by the glomerulus
Ex. Urea & Medications
2. Regulation of Acid- Base Balance
(Secretion of Hydrogen Ions)
 As a result of its molecular size, hydrogen
ion are readily filtered and absorbed.
 Secretion of hydrogen ions by the renal
tubular cells into the filtrate prevents the
filtered bicarbonate from being excreted
 BICARBONATE ACTS AS BUFFER TO THE
BLOOD MAINTAINING NORMAL pH
3
 RENAL FUNCTION TESTS
GLOMERULAR FILTRATION RATE
CLEARANCE TEST
 Measure the filtering capacity of the
glomeruli.
 Measures the rate at which the kidneys are
able to remove (to clear) a filterable
substance from the blood.
 The substance analyzed must be one that is
neither reabsorbed nor secreted by the
tubules.
 Stability of substance in urine during 24-
hour urine collection
 Consistency of plasma level
 Substances availability to the body
 Availability of tests for analysis of the
substance
 Reported in mL/min
CREATININE CLEARANCE
 Most commonly used; screening
method of GFR waste product of
muscle metabolism
 Excellent measurement of renal
function – creatinine is freely filtered
by the glomerulus but not reabsorbed.
 A measure of the completeness of a 24
hour urine collection.
REFERENCE VALUES:
 85-125 mL/ min → Male
 75- 112 mL/ min → Female
CALCULATED GLOMERULAR FILTRATION
ESTIMATES
• COCKCROFT AND GAULT
CrCl = (140 – age) (weight in kilograms) 72 X
Serum creatinine in mg/dL
For female Patients: Results are multiplied by
0.85
NOTE:
• 140-AGE → Total population being tested
• 72 → Average serum creatinine of 140 tested
TUBULAR REABSORPTION TESTS
CONCENTRATION TEST
 Ability of the tubules to reabsorb the
essential salts and water that have been
non-selectively filtered by glomerulus.
 The specific gravity of urine before
entering the renal tubules is 1.010, the
specific gravity will vary when the urine
enters the renal tubules for the
reabsorption process.
SPECIFIC GRAVITY
1. FISHBERG TEST - Patients were deprived of
fluids for 24 hours prior to measuring
specific gravity.
2. MOSENTHAL TEST - Compare the volume
and specific gravity of urine of day and
night urine samples
 OSMOLALITY  Phenolsulfonaphthalein – not completely
removed as it passed through the kidney &
 Affected only by the number of particles unsatisfactory for assessing the RPF
present.
 NORMAL SERUM OSMOLALITY: 275 to 300
mOsm
Titratable Acidity and Urinary Ammonia
 NORMAL URINE OSMOLALITY: 50 to 1400
mOsm  H+ → Secretion
Substance of interest:
 NH3 (Ammonia) → Production & secretion
 Na
 Cl
 Titratable Acid (H+ )
Osmole
 H2PO4
 1 g molecular weight of a substance
divided by the number of particles into
 HN4
which it dissociates.
 Alkaline Tides (diurnal variation) → 2pm –
 Unit: milliosmole (mOsm)
8pm

 Lowest pH: Night

RENAL TUBULAR ACIDOSIS

 Inability to produce acid urine

 Metabolic acidosis
 Impaired tubular secretion

TUBULAR SECRETION & RENAL BLOOD FLOW TEST

 An exogenous, nontoxic, weak organic acid

that is secreted almost exclusively by the
proximal tubules.
 It is secreted completely during its first pass
through the kidneys hence provide not only
an excellent indicator of renal tubular
secretory function but also a means of
determining Renal Plasma Flow (RPF) and
Renal Blood Flow (RBF).

 REFERENCE METHOD for measurement of

RPF