RENAL FUNCTION

TESTS

Dr. ANUPAM BISWAS

12/02/2019
 Salient features of a marker substance

1. Freely filtered
2. Should not bound to plasma proteins
3. Should not reabsorbed or secreted
4. Should not metabolized
5. Should not be stored
6. Non toxic and biologically inert
7. Has no effect on filtration rate
8. Easy to measure
9. Completely excreted from the body
Some examples of such substances
1. Inulin
2. Creatinine
3. Mannitol
4. Sucrose
5. Radio active Cobalt 69
6. Cr51- labelled with EDTA
7. Radio active Iodine
 Measurement of Glomerular Filtration Rate

• Inulin clearance
• A known amount of inulin is injected into the body. After
sometime, the concentration of inulin in plasma and urine and
the volume of urine excreted are estimated.
• Creatinine clearance is also used to measure GFR. It is easier
than inulin clearance, because, creatinine is already present in
body fluids and its plasma concentration is steady throughout
the day.
• It is completely filtered and being a metabolite it is neither
reabsorbed nor secreted.
• The normal value of GFR by this method is approximately the
same as determined by inulin clearance.
 Measurement of Renal Plasma Flow

• To measure renal plasma flow, a substance such

as paraaminohippuric acid (PAH) is used.
• PAH clearance indicates the amount of plasma
passed through kidneys.
• A known amount of PAH is injected into the body.
• After sometime, the concentration of PAH in
plasma and urine and the volume of urine
excreted are estimated.
• Diodrast clearance also can be used to measure
this.
 Measurement of Renal Blood Flow

• Values of factors necessary to determine renal blood flow

are:
i. Renal plasma flow
ii. Percentage of plasma volume in blood.
i. Renal plasma flow
• Renal plasma flow is measured by using PAH clearance.
ii. Percentage of plasma volume in blood
• Percentage of plasma volume is indirectly determined by
using packed cell volume (PCV).
Renal plasma flow
Renal blood flow =
% of plasma in blood
• Renal blood flow = RPF X 1
1- Haematocrit value
 Urea Clearance Test

• Urea clearance test is a clinical test to assess renal

function by using clearance of urea from plasma by
kidney every minute.
• This test requires a blood sample to determine urea level
in blood and two urine sample collected at 1 hour
interval to determine the urea cleared by kidneys into
urine.
• Normal value of urea clearance is 70 ml/min.
• Urea is a waste product formed during protein
metabolism and excreted in urine.
• So, determination of urea clearance forms a specific test
to assess renal function.
 Blood Urea Nitrogen (BUN) Test

• The determination of serum blood urea nitrogen

currently is the most widely used screening test
for the evaluation of kidney function.
• The test is frequently requested along with the
serum creatinine test since simultaneous
determination of these 2 compounds appears to
aid in the differential diagnosis of prerenal, renal
and postrenal hyperuremia.
 Calculations:-
• 1. Calculate GFR, if concentration of inulin in urine
= 125 mg/dl and concentration of inulin in plasma
= 1 mg/dl. Volume of urine output = 1 ml/min.
• Ans:
U V 125 × 1
• Glomerular filtration rate = =
P 1
= 125 ml/min
• 2. If the urine concentration of sucrose is
0.25mg/ml, the urine flow rate is 25ml/min and
the plasma concentration of sucrose is 0.12
mg/ml, what is the renal clearance?

• Ans:-
U = 0.25 mg/ml
V = 25 ml/min
P = 0.12 mg/ml, So Renal Clearance (C)=
0.25x25
0.12
= 52 ml/min
• 3. Calculate renal plasma flow of a 35 years old mans, his
concentration of PAH in urine = 66 mg/dl, concentration of PAH
in plasma = 0.1 mg/dl and volume of urine output = 2 ml/min.
• Ans:
UxV
• Renal plasma flow =
P
66 × 2
=
0.1
= 1320 ml/min
• 4. Calculate renal blood flow of a person who’s
urine PAH concentration in urine = 66 mg/dl,
concentration of PAH in plasma = 0.1 mg/dl and
volume of urine output = 1 ml/min and PCV is 45%.
• Ans:-
• i. Renal plasma flow- earlier done
• ii. Percentage of plasma volume in blood.
• Percentage of plasma volume is indirectly
determined by using packed cell volume (PCV).
• For example, If PCV = 45%, then-
• Plasma volume in the blood = 100 – 45 = 55%
• That is 55 ml of plasma is present in every 100 ml of
blood.
 Renal plasma flow
• Renal blood flow =
% of plasma in blood
• For example,
Renal plasma flow = 660 ml/min
Amount of plasma in blood = 55%
So, 660
Renal blood flow =
55/100
= 1,200 ml/min
5. Calculate renal blood flow of a 60 years old
lady, who’s renal plasma flow was 720
ml/min and hematocrit value was 45%.
Ans:- renal plasma flow
Renal blood flow =
1 - hematocrit
= 720
1- 45%
= 720 = 1309.09 ml/min
55/100