AUBF

Tubular Reabsorption Tests 1. Freezing point osmometers

• Supercool sample below freezing point (–7°C)
• Tubular reabsorptive function • Stir à crystallize à heat of fusion à ↑ temp
• Renal concentrating ability (FP)
• 1st function affected • Thermistor: thermal resistor
o Change in resistance in conjunction with the
1. Conventional methods change in temperature of the solution
a. Concentration tests • Freezing point depression is correlated with
• Determines the ability of tubules to reabsorb osmolality
essential salts and water that have been filtered by o 1 mol (1000 mOsm) of a non-ionizing
the glomerulus substance dissolved in 1 kg of water lowers
freezing point by 1.86°C
b. Fishberg concentration test
• Patient deprived of fluids for 24 hours 2. Vapor pressure osmometers
• Measure specific gravity (SG) • Sample à filter paper à chamber à evaporate
• Normal: SG ≥ 1.025 à vapor à condense à heat of condensation
à ↑ temp (DP)
c. Mosenthal concentration test • Thermocouple
• Normal diet and fluid intake o Voltage form @ the junction of dissimilar
• Two separate 12-hour urine specimens methods
o Day • Dew point
o Night o Temperature at which water vapor
• Measure volume and specific gravity condense to a liquid
• Normal: o Depression of dew point parallels decrease
o Volume: day > night (500 mL) in vapor pressure
o SG:
§ Night: ≥ 1.018 • Technical factors
§ Day: variable (depends on state of 1. Lipemic serum
hydration) • Volume displacement (additional spaces
occupied by lipids in serum)
2. Modern methods 2. Lactic acid
a. Osmolality • False increase if not separated or
• Number of dissolved particles (Na, Cl, glucose, urea) refrigerated within 20 mins
• SG: # and size or particles 3. Volatile substances (i.e. ethanol)
• Water restriction • Not detected by VP osmometers
• Urine concentration (at timed intervals) • Elevated (FP osmometers)

• Typical protocol • Normal values

o 6 pm to 8 am: no fluid intake o Serum osmolality: 275-300 mOsm
o 8 am o Urine osmolality: 50-1400 mOsm
§ Urine specimen collected o Urine:serum
§ Osmolality determined § Normal conditions: 1:1
§ If > 800 mOsm/kg à normal (test is ended) § Controlled fluid intake: 3:1
§ If < 800 mOsm/kg à fluid deprivation
continues b. Free water clearance
o 10 am • Determines the ability of the kidney to respond to the
§ Urine & serum collected state of body hydration
§ Osmolality determined • Volume of blood plasma cleared of solute-free water
§ If urine osmolality > 800mOsm/kg or per unit time
urine:serum osmolality > 3.0 à normal (test
is ended) 𝐶"# $ = 𝑉 − 𝐶)*+
§ If neither condition is met à ADH
administered intravenously • Osmolar clearance
o 2 pm & 6 pm o Volume of water required to eliminate solutes
§ Urine & serum collected from the plasma
§ Osmolality determined o Theoretical volume of plasma per unit time that
§ If urine osmolality > 800mOsm/kg or the kidney has filtered in order to extract all
urine:serum osmolality > 3.0 solutes out the plasma
• Neurogenic diabetes insipidus
§ If neither condition is met 𝑈)*+ 𝑥 𝑉
𝐶)*+ =
• Nephrogenic diabetes insipidus 𝑃)*+

o Ex. Using a urine osmolality of 600 mOsm (U), a

urine volume of 2 mL/min (V), a plasma

1
 AUBF

osmolality of 300 mOsm (P). Calculate the free Assessment of Secretory Function for Acid Removal
water clearance.
§ 𝐶)*+ = /00 1#
200
1. Tubular secretions of acids
§ 𝐶"# $ = 2 − 4 = −2 • Acid base balance
• Ammonium salts – (NH4)2SO4
o Interpretations: • Titratable salts – NaH2PO4
–3
o Limited by PO4
Positive Excess H2O excreted (ex. excess fluid intake) • Secretory function NV: 50-100 mmol/day
Zero No renal concentration or dilution
Negative Less than necessary amount excreted (ex. 2. Oral ammonium chloride test
dehydration) • Ammonium chloride (oral) à urea + HCl in urine
• ↑ acid in the blood:
o Kidney:
Tubular Secretion and Renal Blood Flow Test § ↑ titratable acids = ↑ ammonium salts
§ Urine becomes more acidic
+
• Determination of renal plasma flow (RPF) & renal blood flow • Induce state of acidosis to correlate H secretion in form of
(RBF) NH4 salts and titratable acids
o Normal renal function: dependent of RBF
§ Filtration • Before the test
§ Reabsorption –
o Plasma HCO3
§ Secretion § < 2 mmol/L
§ Urine pH (morning, 2-hr) = < 5.3
• Renal blood flow vs renal plasma flow • Don’t perform test

𝑅𝑃𝐹 • During the test

𝑅𝐵𝐹 =
1 𝐻𝑐𝑡 o Urine collection every 2 hours for 8-10 hours
o Determine:
• Ideal substance § pH
o Exclusively in the plasma § Titratable acids
o Removed by secretion § Ammonium salts
o Removed in first pass
3. Titratable acidity and urinary ammonia
1. Phenolsulfonophthalein • Normal values
• Secreted o pH: < 5.3
• Not completely removed from first pass +
o Total H excretion
§ Titratable acid + ammonium salts
2. P-amino hippuric acid § > 60 mmol/min
• Most commonly used
• Reference method 4. Renal tubular acidosis
• Secreted by the renal tubules • Inability to produce an acid urine (metabolic acidosis)
• Exogenous, non-toxic, weak organic acid • Possible defects
• Completely removed upon 1st pass +
o H secretion
o NH3 production
𝑈<=" 𝑥 𝑉 –
o HCO3 reabsorption
𝐶<=" =
𝑃<="

• C = clearance
• U = urine
• P = plasma

• Normal values:
o RPF: 600-700 mL/min
o RBF: 1000-1200 mL/min

3. Radioactive hippurate
• Plasma disappearance
• Visualization of blood flow in kidneys
o Colored kidneys: normal blood flow