1. Dr. Salwa Al-ansari
Renal Diagnostic andRenal Diagnostic and
Laboratory TestsLaboratory Tests
ByBy
Dr Salwa Alansari; PhDDr Salwa Alansari; PhD
2. Dr. Salwa Al-ansari
IntroductionIntroduction
Kidneys and urinary tractKidneys and urinary tract
1- Control the quantity and quality of fluids1- Control the quantity and quality of fluids
within the bodywithin the body..
2- Produce hormones and vitamins2- Produce hormones and vitamins
Diseases and conditions affecting theDiseases and conditions affecting the
kidneykidney
1-Diseases that affect the blood vessels1-Diseases that affect the blood vessels
2-Disease and infection in other parts of the2-Disease and infection in other parts of the
bodybody
3. Dr. Salwa Al-ansari
3-kidney diseases:
• ObstructionObstruction
• InfectionInfection
• Glomerular diseasesGlomerular diseases
• Other factorsOther factors
Signs and symptomsSigns and symptoms
• Swelling or puffinessSwelling or puffiness
• Urine character or amountUrine character or amount
5. Dr. Salwa Al-ansari
Guidelines for proper testGuidelines for proper test
preparation and performancepreparation and performance
To ensure the use of correct diagnostic testsTo ensure the use of correct diagnostic tests
can confirm or eliminate the presence ofcan confirm or eliminate the presence of
disease and improve the cost efficiency ofdisease and improve the cost efficiency of
screening testsscreening tests.
1.Universal Precautions1.Universal Precautions
• All patients considered potentially infectious.All patients considered potentially infectious.
6. Dr. Salwa Al-ansari
• Use of protective barriersUse of protective barriers.
2-Proper sequencing and scheduling of2-Proper sequencing and scheduling of
the tests.the tests.
• Affect ability to perform tests in limited timeAffect ability to perform tests in limited time
period.period.
• Patient preparation before the test.Patient preparation before the test.
3-Patient Identification & Education3-Patient Identification & Education
• Safety Factor.Safety Factor.
• More cooperationMore cooperation
• Better test results.Better test results.
8. Dr. Salwa Al-ansari
6-Trasnsport and Processing of the6-Trasnsport and Processing of the
SampleSample..
• As soon as possibleAs soon as possible
7-SI Units7-SI Units
• Standardized International MeasuresStandardized International Measures.
8-Reporting Test Result8-Reporting Test Result
• Clear and easy to interpret.Clear and easy to interpret.
9. Dr. Salwa Al-ansari
Clinical Examination testsClinical Examination tests
• Assessment of cardiovascular and volumeAssessment of cardiovascular and volume
statusstatus
• Pulse rate and blood pressurePulse rate and blood pressure
• Abdominal examination:Abdominal examination:
e.g. Obstructione.g. Obstruction
Epigastric bruit:Epigastric bruit: renal vascular hypertensionrenal vascular hypertension
• Blood pressure recordingsBlood pressure recordings
10. Dr. Salwa Al-ansari
Clinical Laboratory TestsClinical Laboratory Tests
Urine-analysisUrine-analysis :DM, glomerulonephritis, chronic UTI.
• A paper or plastic dipstickA paper or plastic dipstick or Microchemistry system.or Microchemistry system.
• Macroscopic analysisMacroscopic analysis
Normal urine volume is 750 to 2000 mlNormal urine volume is 750 to 2000 ml//24hr24hr
Types:Types:
11stst
morning specimenmorning specimen
RandomRandom
Timed urine collectionTimed urine collection
Appearance ; Color ; Odor; pHAppearance ; Color ; Odor; pH
1-RBC1-RBC
2-WBC2-WBC
3-Nitrite3-Nitrite
16. Dr. Salwa Al-ansari
• PSA Density ( PSA /gland volume)PSA Density ( PSA /gland volume)
• PSA Velocity (PSA/time)PSA Velocity (PSA/time)
• %%fPSAfPSA
• < 25 high probability of ca.< 25 high probability of ca.
• > 25 low probability of ca.> 25 low probability of ca.
Immunology testsImmunology tests
• Lupus?Lupus?
• ComplementComplement
• ASOT; nuclear ABASOT; nuclear AB
Kidney stone analysisKidney stone analysis
17. Dr. Salwa Al-ansari
Urine Culture &SensitivityUrine Culture &Sensitivity
UTIUTI
ElectrophoresisElectrophoresis (urine)(urine)
Protein loosing nephropathiesProtein loosing nephropathies (N.S & Nephrosis)(N.S & Nephrosis)
Nephrotic syndromeNephrotic syndrome
↓↓↓↓AlbuminAlbumin
↑↑↑↑αα22 globulinglobulin
N or ↑N or ↑ ββ globulinglobulin
SelectiveSelective : lipoid nephrosis: lipoid nephrosis
Non-selectiveNon-selective : glomerulonephritis: glomerulonephritis
19. Dr. Salwa Al-ansari
Injury biomarkers:Injury biomarkers:
1-Glutathione S1-Glutathione S--
transferasestransferases ((GSTsGSTs))
• alpha GST in proximalalpha GST in proximal
tubule (graph 1)tubule (graph 1)
• Pi GST in the distalPi GST in the distal
(graph2).(graph2).
2-Collagen IV2-Collagen IV :
Glomerular basement
membrane (graph3)
3-b-trace protein (BTP)3-b-trace protein (BTP)
indicator of reduced GFRindicator of reduced GFR
21. Dr. Salwa Al-ansari
Proteomic approachProteomic approach
Mass spectrophotometerMass spectrophotometer
• Coupled to capillary electrophoresisCoupled to capillary electrophoresis
• 2-Dimensional electrophoresis2-Dimensional electrophoresis
• SELDI: surface enhanced laser desorption /ionizationSELDI: surface enhanced laser desorption /ionization
protein chip array time of flight mass spectrometryprotein chip array time of flight mass spectrometry
22. Dr. Salwa Al-ansari
Condition Tests Used in Diagnosis Tests Used to Follow
Chronic kidney
disease
(chronic
renal failure)
Blood urea, creatinine, estimated GFR, urinalysis Urea, creatinine, estimated
GFR, electrolytes,
calcium, phosphate,
alkaline
phosphatase, parathyroid
hormone, FBC
Urinary tract
infections
Urinalysis, urine culture Urinalysis, urine culture
Kidney stones Imaging (see below), urinalysis Urine sodium, calcium,
phosphate, citrate,
oxalate, uric acid
Nephrotic
syndrome
Urinalysis; serum albumin, total protein, cholesterol; urine
total protein; antinuclear antibody (ANA) test, hepatitis
B test, hepatitis C test; complement levels
Urine total protein, serum
cholesterol, urea,
creatinine, estimated
GFR
Nephritis Urinalysis, serum urea, creatinine, estimated GFR, serum
albumin, urine total protein, antinuclear antibody
(ANA) test, antistreptolysin O, antiglomerular basement
membrane antibody, antineutrophil cytoplasmic
antibodies
Urea, creatinine, estimated
GFR, urinalysis
Kidney disease
due to
diabetes or
high blood
pressure
Microalbumin Microalbumin,
urine total protein, urea,
creatinine, estimated
GFR
SummarySummary
31. Dr. Salwa Al-ansari
Renal structural scanRenal structural scan ((99m99m
Tc DTPA orTc DTPA or 99m99m
Tc DSMA)Tc DSMA)
IndicationIndication
1-Alteration in anatomic structure1-Alteration in anatomic structure ((tumor; cyst;tumor; cyst;
abscessabscess))
2-Congenital disorders2-Congenital disorders (hypoplasia; a plasia mal-(hypoplasia; a plasia mal-
position of kidney)position of kidney)
3-Transplant rejection3-Transplant rejection
32. Dr. Salwa Al-ansari
Renal function scanRenal function scan ((RenogramRenogram))
IndicationIndication
1-1- 99m99m
Tc DTPA: GFRTc DTPA: GFR
2-2- 99m99m
Tc DMSA: tubular cell excretionTc DMSA: tubular cell excretion
3- Iodohippurate Na3- Iodohippurate Na 131131
I or Iodohippurate NaI or Iodohippurate Na 133133
I: GFR &I: GFR &
tubular cell excretion.tubular cell excretion.
37. Dr. Salwa Al-ansari
3-Tests for genetic diseases associated with3-Tests for genetic diseases associated with
kidney dysfunction (renal transport)kidney dysfunction (renal transport)
e.g Fanconi’s syndrome; cysteinuriae.g Fanconi’s syndrome; cysteinuria
Amino acid quantitationsAmino acid quantitations
Urine ( random ; 24- hours); serum and
CSF
38. Dr. Salwa Al-ansari
MethodMethod
High-pressure liquid chromatography (HPLC)High-pressure liquid chromatography (HPLC)
separation with post-column Ninhydrin quantitationseparation with post-column Ninhydrin quantitation
39. Dr. Salwa Al-ansari
Sample Points
1. PER
2. TAU
3. PETN
4. THR
5. GLU
6. GLY
7. ALA
8. MET
9. CYST
10. ILE
11. LEU
12. TYR
13. PHE
14. BALA
15. BABA
16. TRP
17. EIN
18. NH3
19. ORN
20. LYS
21. 1 ME-HIS
22. HIS
23. 3 ME-HIS
24. ANS
25. CARN
26. ARG
2424--hours urine aminohours urine amino
acidsacids
40. Dr. Salwa Al-ansari
Research TestsResearch Tests
• Clinical trialsClinical trials
• Renal PapillaryRenal Papillary Antigens 1 andAntigens 1 and 22::collecting ducts ofcollecting ducts of
the rat kidney:the rat kidney: Renal Papillary NecrosisRenal Papillary Necrosis
• Ischaemia-Reperfusion Injury /kidneyIschaemia-Reperfusion Injury /kidney
transplant:transplant: GST & collagen IVGST & collagen IV
• VUR : DNA and immortalized lymphocytesVUR : DNA and immortalized lymphocytes
from sibling pairsfrom sibling pairs
• peritoneal dialysisperitoneal dialysis
41. Dr. Salwa Al-ansari
• transplant: long term outcometransplant: long term outcome
• fibronectin: scar proteinfibronectin: scar protein
• Studies aimed at DNA vaccinationStudies aimed at DNA vaccination
RCC associated peptides e.g. CA9 antigen derived peptides.RCC associated peptides e.g. CA9 antigen derived peptides.
Detected in peripheral mononuclear cells by INF-Detected in peripheral mononuclear cells by INF-γγ releaserelease
assay.assay.
• Podocytes associated proteins (graph)Podocytes associated proteins (graph)
Characterization of each proteins and mutations associatedCharacterization of each proteins and mutations associated
46. Dr. Salwa Al-ansari
• Lithium clearanceLithium clearance
1- Clearance Depend GFR1- Clearance Depend GFR
2- Hyponatraemia vs. litium2- Hyponatraemia vs. litium
• Urinary transthyretinUrinary transthyretin
Mutation in the gene gives transthyretin amyloidosisMutation in the gene gives transthyretin amyloidosis
47. Dr. Salwa Al-ansari
Research involving nuclear material andResearch involving nuclear material and
production of New tracer:production of New tracer:
• Technologies for real-time, in vivo imaging ofTechnologies for real-time, in vivo imaging of
gene expression in health and disease;gene expression in health and disease;
• Labeling of progenitor cells for non-invasivelyLabeling of progenitor cells for non-invasively
imaging and tracking their behavior and fate inimaging and tracking their behavior and fate in
vivo and their overall role in organ and tissuevivo and their overall role in organ and tissue
regeneration in disease states;regeneration in disease states;
48. Dr. Salwa Al-ansari
• In vivo targeting of mutated proteins critical toIn vivo targeting of mutated proteins critical to
carcinogenesis and tumor cell growth.carcinogenesis and tumor cell growth.
• Enabling in vivo imaging assay ofEnabling in vivo imaging assay of
neurotransmitter chemistry and brain functionneurotransmitter chemistry and brain function
49. Dr. Salwa Al-ansari
ReferencesReferences
1.1. Yagame, M. et al. (1997). Significance of urinary type IVYagame, M. et al. (1997). Significance of urinary type IV
collagen in patients with diabetic nephropathy using a highlycollagen in patients with diabetic nephropathy using a highly
sensitive one-step sandwich enzyme immunoassay. Journal ofsensitive one-step sandwich enzyme immunoassay. Journal of
Clinical and Laboratory Analysis 11. 110-116Clinical and Laboratory Analysis 11. 110-116
2.2. Okinogi et alOkinogi et al. (. (20012001).). Urinary Type IV Collagen ExcretionUrinary Type IV Collagen Excretion
Reflects Renal Morphological Alterations and Type IVReflects Renal Morphological Alterations and Type IV
expression in patients with type 2 Diabetesexpression in patients with type 2 Diabetes.. Clinical NephrologyClinical Nephrology
55, 357-36455, 357-364..
3.3. Maxwell P-R et al. (2004). Differentiation between renal injuryMaxwell P-R et al. (2004). Differentiation between renal injury
and compensatory responses by the use of specific biomarkers.and compensatory responses by the use of specific biomarkers.
Poster presented at the 43rd Annual meeting of the AmericanPoster presented at the 43rd Annual meeting of the American
Society of Toxicology, Baltimore March 21-25, 2004.Society of Toxicology, Baltimore March 21-25, 2004.
50. Dr. Salwa Al-ansari
4. Corrigal, A.V. et al. (1988). Glutathione S-transferaseCorrigal, A.V. et al. (1988). Glutathione S-transferase
distribution and concentration in human organs. Biochem.distribution and concentration in human organs. Biochem.
Int. 16: 443-448.Int. 16: 443-448.
5. Sundberg A.G.M. et al. (1994). Urinary pi class glutathione5. Sundberg A.G.M. et al. (1994). Urinary pi class glutathione
S-transferase as an indicator of tubular damage in the humanS-transferase as an indicator of tubular damage in the human
kidney. Nephron 67: 308-316.kidney. Nephron 67: 308-316.
6. Daeman, J.W. H.C. et al. (1997). Glutathione S-transferase6. Daeman, J.W. H.C. et al. (1997). Glutathione S-transferase
as predictor of functional outcome in transplantation ofas predictor of functional outcome in transplantation of
machine preserved non-heart-beating donor kidneys.machine preserved non-heart-beating donor kidneys.
Transplantation 63 (1):89-93.Transplantation 63 (1):89-93.
7. Falkenberg, F. et al. (1996). Papillary antigens as markers of7. Falkenberg, F. et al. (1996). Papillary antigens as markers of
papillary toxicity. I Identification and characterisation of ratpapillary toxicity. I Identification and characterisation of rat
papillary antigens with monoclonal antibodies. Arch.papillary antigens with monoclonal antibodies. Arch.
Toxicol. 71, 80-92Toxicol. 71, 80-92
51. Dr. Salwa Al-ansari
8. Bagley DH, Liu JB: Endoureteral sonography to define the
anatomy of the obstructed ureteropelvic junction. Urol Clin
North Am 1998 May; 25(2): 271-9.
10. Kathleen & Timothy Pagana. Mosby’s manual of diagnostic
and laboratory tests. 2nd
edition. 2002.
11. Daniel R, Anjali S, Tibor N, et al. Nature Clinical Practice
Nephrology (2007) 3, 287-293 .
12. www.wickpedia.com
