MLT BIOCHEMISTRY

LABORATORY TESTS FOR DETECTION OF KIDNEY FUNCTION

Kidney function tests (KFTs)

The kidneys perform a wide range of functions therefore information regarding the
entire range of renal functions cannot be obtained from a single test. A
combination of tests is required to assess the different renal functions. Temporary
renal impairment can occasionally lead to abnormal results. Hence the test needs
be performed repeatedly and interpreted on the basis of a series of results.
Moreover, extra-renal factors may influence the results of renal function tests.
Therefore, the results must always be interpreted in conjunction with the clinical
picture.
A number of tests were introduced to assess the renal functions. The more
important and commonly employed tests will be discussed.

Estimation of Blood Urea Nitrogen (BUN)

Aim: To estimate blood urea
Introduction: Blood Urea Nitrogen is a common blood test used to assess kidney
function by measuring the amount of nitrogen in the blood that comes from urea, a
waste product produced by the liver during the breakdown of proteins. Urea
represents about 45-50% of the non-protein nitrogen in blood and 80–90% of the
total urinary nitrogen excretion. The glomerular filtrate and plasma have the same
concentration of urea. Since tubular reabsorption of urea fluctuates inversely with
the rate of urine flow, it is not a reliable indicator of GFR. Blood urea nitrogen has
direct correlation with protein intake and an inverse correlation with urea excretion
rate.
Patient Preparation:
 No special preparation is usually needed. However, your doctor might
advise you to fast for a few hours before the test.
 Avoid certain medications that could affect the results. Medications, such as
antibiotics and diuretics, can affect BUN levels.
  Hydration Status: Both dehydration and overhydration can influence BUN
measurements.
Sample Collection:
Blood sample is taken via venipuncture and the serum separated.
Normal Range:
The typical range for BUN is about 6 - 23mg/dL in adults. It is somewhat higher in
men than women and there is gradual rise with age. The urea concentration varies
with the amount of protein in the diet.
Interpretation of Results:
Elevated Levels
 Renal Disease (acute or chronic): Acute glomerulonephritis, Malignant
hypertension, Chronic pyelonephritis, Congenital cystic kidneys, Renal
failure.
 Acute intestinal obstruction: Severe Diarrhoea, Ulcerative colitis, Diabetic
Ketoacidosis.
 High Protein Diet: Excessive protein intake can lead to increased urea
production, elevating the BUN.
 Heart Failure: Reduced blood flow to the kidneys due to heart failure can
cause elevated BUN.
 Gastrointestinal Bleeding: Increased protein breakdown from bleeding in
the digestive tract can raise BUN.
 Shock, Severe Burns and haemorrhage: Conditions that affect blood flow
and kidney function can elevate BUN.
 Obstruction to flow of urine: Enlarged Prostate, stones in the urinary tract,
urethral strictures.
Low Levels:
Liver Disease: The liver produces urea, so liver dysfunction can reduce BUN
levels.
Malnutrition: Insufficient protein
Overhydration: Excess fluid intake or intravenous fluids can dilute blood urea
nitrogen levels.
Pregnancy: Increased plasma volume can dilute BUN levels.

BUN to Creatinine Ratio:

The BUN-to-creatinine ratio is a useful tool for differentiating the causes of kidney
dysfunction.
Formula:
BUN-to-Creatinine Ratio
= BUN (mg/dL)/Creatinine (mg/dL)
E.g.
BUN = 30mg/dL
Creatinine = 1.4mg/dL
BUN-to-Creatinine Ratio – 30/1.2 = 25

Normal Range: ~10:1 to 20:1.

Elevated BUN-to-Creatinine Ratio (>20:1): Same as for elevated BUN
Low BUN-to-Creatinine Ratio (<10:1):
Suggests intrinsic kidney damage, such as:
- Acute tubular necrosis
- Glomerulonephritis
- Chronic kidney disease
Liver disease - Decreased urea synthesis due to Liver dysfunction

Conclusion:
BUN is a valuable for assessing kidney function and general metabolic health. It
can be used in conjunction with other tests to identify and treat renal disorders and
other related conditions. Regular monitoring leads to early detection.