AUBF

Renal Function Tests • Disadvantages:

o Secreted by tubules
1. Glomerular Filtration Tests § Falsely elevated rates
• Determining the flow of fluids from circulation to renal o Chromogens in plasma react with chemical
tubule analysis
§ Counteracts falsely elevated rated
a. Clearance tests (tubular secretion)
• Test the filtrate capacity o Affected by medications
• Standard: filtering capacity § Gentamicin, cephalosporin, cimetidine
• Rate: to remove (clear) solute / filterable substances (Tagamet)
from blood § Inhibit secretion à ↑ serum levels
o Analyte: must neither be reabsorbed nor o Bacterial breakdown
secreted by the kidneys § Prolonged storage (RT)
• Volume of plasma (mL) completely cleared of a o Diet: meat
substance per limit of time (min) o Not reliable in: muscle wasting disease,
• Evaluates GFR heavy exercise, athletes
§ ↑ muscle mass à store more creatine
• Clinical significance: à ↑ serum creatinine
o Detection of early renal disease is difficult (slow o Accuracy dependent on collection (24-hr)
progression) that would translate to late o Correction (body surface area)
detection
§ Functional nephrons compensate non- • Procedure:
functional nephrons o Blood & urine
o Extent of nephron damage § 24-hour urine specimen
o Monitor effectiveness of treatment § Greatest source of error: improperly
o Feasibility of administering medication timed urine specimen
• Ex. half is non-functional
o No change in GFR (nephrons double their 𝑈𝑉
𝐶=
capacity) 𝑃

• C = creatine clearance (mL/min)

• Factors to consider in determining clearance
o Stability (24 hours) • U = urine creatinine (mg/dL)
o Consistency (plasma levels) • V = urine volume (mL/min)
o Availability (body) • P = plasma creatinine (mg/dL)
o Test availability
• Ex. Calculate the urine volume (V) for a 2-hour
1. Urea clearance specimen measuring 240 mL
• Analyte: urea (from proteins) o 2 𝑥 60 𝑚𝑖𝑛𝑠 = 120 𝑚𝑖𝑛𝑠
012 34
o 𝑉 = 502 367 = 2 𝑚𝐿/𝑚𝑖𝑛
• Earliest test for GFR
• 40% reabsorbed
• Affected by: • Ex. A male patient has a urine creatinine of 120
o Urine flow rate mg/dL, plasma creatinine of 1.0 mg/dL, and urine
§ < 2 mL/min = large amount reabsorbed volume of 1440 mL obtained from a 24-hour
§ > 2 mL/min = constant, minimal specimen. Calculate the GFR and interpret the
reabsorption result.
o Diet o Given:
§ U = 120 mg/dL
2. Inulin clearance § P = 1 mg/dL
• Inulin: polymer of fructose § V = 1440 mL / (24 x 60 mins) = 1
o MW: 5200 Da mL/min
:; 502 = 5
• Neither reabsorbed nor secreted o 𝐶 = < = 5 = 120 𝑚𝐿/𝑚𝑖𝑛
• Exogenous: introduced to the patient o Interpretation: GFR is normal
• No longer used in GFR testing
• NV (males): 107-139 mL/min
3. Creatinine clearance
• Creatine (proteins) à stored in skeletal muscle • Correction
à creatine phosphate à creatine o Body size (children)
:; 5.?@
phosphokinase à creatinine (storage form) § 𝐶= 𝑥
< A
2
• Produced at a steady rate § A = actual body size (m )
o Constant plasma concentration
o Constant urine excretion b. Estimated Glomerular Filtration Rate
• Routinely used for screening GFR 1. Cockcroft and Gault
512 – CDE (GH 67 ID)
• 𝐶=
?0 = KELM3 NLECH6767E 67 3D/O4

1
 AUBF

• Compute and interpret the estimated GFR using

Cockcroft and Gault’s formula
o Sample: 20-year old male
o Serum creatine = 15 mg/L = 1.5 mg/dL
o Weight = 110 lbs = 50 kg

(512P502)(Q2)
o 𝐶= = 55.56 𝑚𝐿/𝑚𝑖𝑛
?0 = 5.Q

o Interpretation: GFR is decreased

2. Modification of Diet in Renal Disease (MDRD)

System
• 𝐺𝐹𝑅 = 173 𝑥 𝑠𝑒𝑟𝑢𝑚 𝑐𝑟𝑒𝑎𝑡𝑖𝑛𝑖𝑛𝑒 5.5Q1
𝑥 𝑎𝑔𝑒 P2.02@ 𝑥 0.742 (𝑖𝑓 𝑝𝑎𝑡𝑖𝑒𝑛𝑡 𝑖𝑠 𝑓𝑒𝑚𝑎𝑙𝑒)
𝑥 1.212 (𝑖𝑓 𝑝𝑎𝑡𝑖𝑒𝑛𝑡 𝑖𝑠 𝑏𝑙𝑎𝑐𝑘)

c. Serum markers
1. Cystatin C
• MW: 13,358
• Present in plasma/serum at constant rate (all
nucleated cells)
• Readily filtered
• Completely reabsorbed
o Broken down by tubular cells
• Not secreted
• ↑ serum concentration = ↓ GFR
• In pediatric, diabetic, elderly, critically ill
• Advantage over creatinine: independent of
muscle mass

2. b2-microglobulin
• MW: 11,800
• In MHC class I
• Constant rate (dissociated from HLA)
• Rapidly filtered
• ↑ serum concentration = ↓ GFR
• Not reliable in:
o Immunologic disorders
o Malignancies

d. Radionucleotides
• Exogenous
125
o I iothalamate
• Plasma disappearance
• Visualization of filtration (kidneys)
• Viability of transplant