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Renal Function Tests 1 PDF
Renal Function Tests 1 PDF
J. Okoboi
Department of Biochemistry, SUN
By the end of the lecture you should be able to:
• List the functions of the glomerulus
• Explain tubular function
• Discuss the normal and abnormal constituents of urine
• Explain the biochemical basis of clearance test of renal function
• Describe kidney function tests that measure tubular functioning
Functions of the kidney
• Excretion of metabolic waste products
• Maintenance of body water, pH and electrolyte balance
• Production of calcitriol and erythropoietin
• Decrease in kidney function is usually due to reduction in the
performance of nephrons
• The nephron is the functional unit; it consists of Bowman’s capsule,
PCT, Loop of Henle, DCT, collecting ducts
Renal function tests
1. Tests to screen for kidney disease
• Complete urinalysis
• Plasma urea and creatinine
• Plasma electrolytes
2. Tests to assess renal function
a) To assess glomerular function
• Glomerular filtration rate
• Clearance tests
• Glomerular permeability
• Proteinuria
Renal function tests
B) Tests to assess tubular function
• Reabsorption studies
• Secretion tests
• Concentration and dilution tests
• Renal acidification
Glomerular function
• Ultrafiltration of blood occurs in the Bowman's capsule,
retains cells and proteins in blood
• Hb (Mol wt-64.6kD) is passed through while albumin (69kD)
is retained
• Appearance of albumin in urine is the earliest manifestation
of abnormal glomerular function
Glomerular filtration rate
• GFR is 120-125mL per liter per minute in a 70Kg man
• Daily, glomerular filtrate volume is 170-180L, of which only 1.7L are
excreted in urine
• GFR is decreased when BP is below 80mmHg
• Reduced GFR is observed in obstruction to renal flow (calculi,
enlarged prostate, age)
Functions of tubules
• Urobilinogen
• Urobilinogen is oxidized to urobilin causing the deepening colour of urine on
standing
• In hepatocellular jaundice, there is no urobilinogen in urine
• Appearance of urobilinogen in urine is an earliest sign of recovery
• In normal urine, there is traces of undetectable urobilinogen
• Identified by Ehrlich test or Schesinger’s test
• It is increased in hemolytic jaundice, testing positive
1. Markers of glomerular filtration rate
• GFR-the volume of blood filtered by the glomerulus in a unit time
• Clearance tests are used to estimate GFR
• A decrease in renal function is due to loss of functional nephrons, not an
individual nephron
• Usually kidney damage occurs before GFR is decreased.
• Clearance is defined as the amount of blood completely cleared of a substance
per unit time
• Unit-mL of plasma min-1
• It is the amount plasma that must have passed through the glomeruli in
1 min with complete removal of the substance
𝑼𝒙𝑽
• 𝑼𝒓𝒆𝒂 𝒄𝒍𝒆𝒂𝒓𝒂𝒏𝒄𝒆 = ,
𝑷
• U=mg of urea per ml of urine
• P=mg of urea per ml of plasma
• V=ml of urine excreted per minute
• This is called maximum urea clearance
• Normal-75ml/min
Standard urea clearance
• The clearance value is decreased when v is less than 2ml/min.
• Standard urea clearance is then used,
𝑼𝒙√𝑽
• 𝑺𝒄𝒍𝒆𝒂𝒓𝒆𝒏𝒄𝒆 = ’
𝑷
• Normal value- 54ml/min
• Interpretations
• A value below 75% of the normal is abnormal
• Clearance value may be abnormal even when plasma urea levels are within range
• Plasma urea levels start to rise when the value falls below 50% of the normal
Standard urea clearance …