ORGAN FUNCTION TEST

Dr. Rekha Choudhary

Assistant Professor
Department of
Biochemistry

NINTH EDITION
RENAL FUNCTION TEST
 RENAL FUNCTION TEST
Kidney performs following important
functions:

Urine formation
Electrolyte balance
Maintains pH
Vitamin D activation
Synthesis of Hormones

The functional unit in the kidney is the nephron.

STRUCTURE OF NPHRON
 RENAL FUNCTION TEST
1. Glomerular function tests

Clearance test

 Creatinine clearance test

 Urea clearance test
 Inulin clearance test.
 RENAL FUNCTION TEST

2. Tubular function tests

 Urine concentration test (fluid deprivation

test)
 Urine dilution test (excess fluid intake test)
 Acid load test (urine acidification test)
 Phenosulfonaphthalein (PSP) test.
 RENAL FUNCTION TEST

3. Serum and urine markers of renal

function

 Serum creatinine
 Serum urea
 Urine protein
 Urine RBC
 RENAL FUNCTION TEST

4. Urine analysis

 Physical examination
 Chemical examination
 Microscopic examination.
 GLOMERULAR FUNCTION TEST
1.Glomerular Function Tests
GFR is assessed through clearance test.
Renal clearance (C) is calculated by using
following formula.
C=UxV
P
where,
C: Renal clearance = GFR of a substance in ml/
minute
U: Concentration of substance in urine (mg/100 ml)
V: Volume of urine in ml excreted per minute
P: Concentration of substance in plasma (mg/100
 GLOMERULAR FUNCTION TEST
Creatinine clearance test
Creatinine clearance is defined as the volume of
plasma (in ml) that would be completely cleared off
creatinine per minute.

Creatinine clearance = GFR= U x V

P
where,
U is urinary creatinine (mg/dl)
P is plasma creatinine (mg/dl)
V is volume of urine excreted (ml/minute).
 GLOMERULAR FUNCTION TEST

• Normal range = 90 to 120 ml/minute.

• Decreased creatinine clearance may be due to

reduced blood flow to glomeruli or damage to the
glomerulus.

Decreased GFR:
- ARF & CRF
- Glomerulonephritis
- Nephrotic Syndrome
 GLOMERULAR FUNCTION TEST
Urea clearance test
Urea clearance is defined as the volume of plasma (in
ml) that would be completely cleared off urea per
minute.

Urea clearance = U x V
P
where,
U is urinary urea (mg/dl)
P is plasma urea (mg/dl)
V is volume of urine in ml excreted per minute
 GLOMERULAR FUNCTION TEST

Normal range = 75 ml/minute.

40-70 ml/min mild impairment
20-40 ml/min moderate impairment
< 20 ml/min severe impairment
 GLOMERULAR FUNCTION TEST

Inulin clearance test:

Inulin clearance is calculated by the following
formula:

Inulin clearance = U x V
P
U is urinary inulin (mg/dl)
P is plasma inulin (mg/dl)
V is volume of urine in ml excreted per minute.

Normal value = 120 ml/min.

 GLOMERULAR FUNCTION TEST

Cockcroft Gault Formula:

Estimated GFR (creatinine clearance) mL/min

= (140-age) x weight (kg) x 0.85

(female)
72x serum creatinine mg/dl)
 TUBULAR FUNCTION TEST
2. Tubular Function Tests

•Ability to concentrate or dilute urine depends

upon renal tubular reabsorption function and
presence of antidiuretic hormone (ADH).

• Urinary specific gravity and osmolality are

measured for the concentrating and diluting
ability of the tubules.
 TUBULAR FUNCTION TEST

Urine concentration test (fluid deprivation

test)

•Fluid intake is withheld for 15 hours.

• First urine sample of morning is collected and
osmolality or specific gravity is measured.

• Normally Osmolality = 850 mOsmol/kg

Specific gravity = 1.025

• ADH secretion is stimulated.

 TUBULAR FUNCTION TEST
Urine dilution test

After emptying of bladder, 1 to 1.2 L of

water is given to the patient. Urine specimens
are collected every hour for the next 4 hours.

 Urine specific gravity should fall to 1.005 or

less or an osmolality of less than 100 mOsm/
kg.
 TUBULAR FUNCTION TEST

Acid load test or ammonium chloride loading

test:

Ammonium chloride is administered orally in gelatin

capsule (100 mg/kg) to cause metabolic acidosis and
the capacity of kidneys is assessed for the production
of acidic urine.
Urine samples are collected hourly for the following
8 hours.
 TUBULAR FUNCTION TEST

In normal subjects, the urine pH falls below 5.5 in at

least one sample. Normal urine pH is 5.5 to 7.5.

In an individual with renal tubular acidosis this

decrease does not occur, which remains between 5.7
and 7.0.

Diagnosis of renal tubular acidosis in which

metabolic acidosis arises due to diminished tubular
secretion of H+ ions.

.
 TUBULAR FUNCTION TEST

Phenolsulfonphthalein(PSP) test or phenol red

test:

PSP dye is nontoxic and exclusively excreted by

kidney.

The test is conducted by measuring the rate of

excretion of the dye is after I/V administration.

 Intravenous injection of 6 mg of PSP in 1 ml of

saline, Urine specimen is collected at 15,30,60 and
120 minutes
 SERUM MARKERS FOR RFT

3. Blood Analysis

Normal Range
Blood urea = (20-40 mg/dl)
Creatinine = (0.5 to 1.5 mg/dl).

An increase of the end products urea

and creatinine in the blood is called
azotemia.
 URINE MARKERS FOR RFT
3. Test for proteins in urine
•In diseased conditions, plasma proteins
appears in urine and the condition is
proteinuria.
• Excretion of albumin more than 300 mg/day
is indicates significant damage to the
glomerular membrane.
• Excretion of albumin in the range 30-300 mg/
day is k/a microalbuminuria, which is the
earliest sign of renal damage due to diabetes
mellitus and hypertension.
 URINE ANALYSIS

4. Urine analysis
Physical Examination

Appearance
Volume
 Colour
Specific gravity
pH
Odor.
 URINE ANALYSIS

 Chemical examination

Glucose
 Protein
 Blood.
 URINE ANALYSIS
Microscopic examination
•Cells, e.g. RBC, WBC, pus cells

• Crystals, e.g. calcium phosphate, calcium

oxalate,
amorphous phosphates, etc.

• Casts, e.g. hyaline casts, granular casts, red

blood
casts, etc.
 CLINICAL CASES
CASE 1
A 23 year old male is coming with complain of high grade fever for past 10 days
which is associated with nausea and loss of appetite. He complains of yellow
dicolouration of eye and skin for past 1 week. On examination, he was found to be
icteric and liver was mildly enlarged.
Following are the results of various laboratory investigations: Blood biochemistry
Total bil – 5.2 mg/dl
Indirect bil.- 3.7 mg/dl
Direct bil – 1.5 mg/dl
SGOT – 1145 IU/L
SGPT – 692 IU/L
ALP – 220 U/L
Urine examination
Bile pigments - Positive
Urobilinogen – Positive
Bile Salts – Positive.
Diagnose the case.
 CLINICAL CASES
CASE 2

A 50 year old man, an industrialist by profession, had a routine check up. He was
found to have slightly enlarged liver. His laboratory findings are as:
Blood glucose fasting – 100 mg/dl
Blood urea – 30 mg/dl
Serum Bilirubin – 0.8 mg/dl
SGPT – 250 IU/L
SGOT – 550 IU/L
GGT – 700 U/L .
Diagnose the disease