1. The right and left renal arteries are the pathways that allow blood to get to the kidneys.

These
arterioles split out into smaller branches inside of each kidney. The blood is under a tremendous
amount of pressure as it travels through the arterioles and into the globulus, which is a small
knot of blood arteries. These may be found in the nephrons of the kidney. When blood leaves
the glomerulus, it undergoes a decrease in pressure and then goes into the arterioles, which are
coiled around the nephrons. These, in turn, connect to a network of smaller veins throughout
the body. These veins eventually come together to create what is known as the renal vein. The
kidneys are responsible for the circulation of about one quarter of the total cardiac output (or
total blood flow). This amounts to little more than 1 liter of blood being pumped per minute.

2.

3. RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM
Regulating Blood Pressure: The Renin-Angiotensin-Aldosterone System

The renin-angiotensin-aldosterone system is a series of reactions designed to help regulate blood

pressure. When blood pressure falls (for systolic, to 100 mm Hg or lower), the kidneys release the
enzyme renin into the bloodstream. Renin splits angiotensinogen, a large protein that circulates in the
bloodstream, into pieces. One piece is angiotensin I. Angiotensin I, which is relatively inactive, is split
into pieces by angiotensin-converting enzyme (ACE). One piece is angiotensin II, a hormone, which is
very active. Angiotensin II causes the muscular walls of small arteries (arterioles) to constrict, increasing
blood pressure. Angiotensin II also triggers the release of the hormone aldosterone from the adrenal
glands and vasopressin (antidiuretic hormone) from the pituitary gland Aldosterone
and vasopressin cause the kidneys to retain sodium (salt). Aldosterone also causes the kidneys to
excrete potassium. The increased sodium causes water to be retained, thus increasing blood volume and
blood pressure.

4. WHAT ARE THE RENAL FUNCTION TESTS: DESCRIBE THE CLINCIAL SIGNIFICANCE OF EACH TESTS
 Creatinine: A serum creatinine blood test measures the amount of creatinine in your blood. If your
kidneys are not working like they should, your serum creatinine level goes up. Normal levels for you
will depend on your sex, age, and the amount of muscle mass your body has.

 CLINICAL SIGNIFICANCE: Serum creatinine is elevated when there is a significant reduction in

the glomerular filtration rate or when urine elimination is obstructed. About 50% of kidney
function must be lost before a rise in serum creatinine can be detected. Thus serum creatinine is
a late marker of acute kidney injury.

 BUN: Serum urea/BUN level increases in acute and chronic renal disease.
 This test measures the amount of urea nitrogen in your blood. Urea nitrogen is a waste product
your body makes from the breakdown of protein in the foods you eat. Healthy kidneys filter
urea nitrogen out of your blood and it leaves your body through your urine. This process helps
keep your BUN level within a normal range. A normal level of urea nitrogen will depend on your
age and other health conditions you may have, but usually ranges from 7 to 20. If your levels are
higher than normal, this may be a sign that your kidneys are not working as well as they should.
As kidney disease progresses, your BUN level goes up.
 If your BUN level reveals signs of kidney disease, your doctor will use your BUN test results,
along with other tests, to decide on a treatment plan that best fits your needs.

 eGFR equations are used to determine the presence of renal disease, stage of CKD, and to monitor
response to treatment.
 The GFR is a measure of how well your kidneys remove waste, toxins, and extra fluid from your
blood. Your serum creatinine level, age, and sex are used to calculate your GFR number. Like
other kidney tests, a normal GFR number for you will depend on your age and sex. If your GFR is
low, your kidneys are likely not working as they should. As kidney disease progresses, your GFR
goes down.