SlideShare a Scribd company logo
1 of 59
Dr. N. Sivaranjani ,MD
Asst Prof
RENAL
FUNCTION
TESTS
Formation of
urine as the waste
product
Excretion of NPN
substances
Metabolic –
Gluconeogenesis,
Urea cycle
Regulation of salt
& water balance
Regulation of
acid-base balance
Production of Hormones –
Renin , Calcitriol,
Erythropoietin.
Functions of KIDNEY
Early detection,
Assessment of the
extent of renal
damage
Measure the
progression of renal
damage
Monitoring and
adjusting the dose
of renal toxic drugs
Renal Function Tests –required for……
 Early detection of possible renal damage &
assessment of its severity
 Measure progression of the renal impairment
& efficacy of corrective therapy
 Predict when renal replacement therapy may
be necessary
 Monitor safe & effective use of drugs, which
are principally eliminated through urine.
OBJECTIVES OF RFT :
5
Nephron - the functional unit of kidney
Segment of nephron Reabsorption of Secretion of
Proximal convoluted
tubule (PCT)
Na+, Cl–, HCO3 (85%),
Glucose (100%),
Amino acids (100%),
Uric acid,
Water (obligatory).
H+,
acid and bases,
NH4
+ ,
Loop of Henle Na+, Cl–, Ca++, Mg++
Distal convoluted
tubule (DCT)
Na+, Cl–,
Water (facultative)
H+, K+, NH4
+, uric
acid
Glomerular function – filter the incoming blood – formation of
ultra filtrate of blood – cells , large proteins are retained,
metabolic waste products are filtered.
Tubular function – about 170 L ultra filtered is formed , only
1.5 L excreted as Urine.
Selective reabsorption and secretion of molecules.
Renal Threshold
is the plasma level above which the compound is
excreted in urine.
maximum reabsorptive capacity of the substances - Tubular
maximum or Tm.
Ex – Glucose - 180 mg/dl , Tm - 375 mg/min
Lactate - 60 mg/dl
Bicarbonate - 28 mEq/L
• Lowered renal threshold - at lower blood levels compounds
are excreted in urine .
Renal glycosuria , Renal tubular acidosis
I. To screen for kidney disease
• Complete urine analysis
• Plasma urea and creatinine
• Plasma electrolytes
II. To assess renal function
a. To assess glomerular function
• Glomerular filtration rate - Clearance tests
• Glomerular permeability - Proteinuria
b. To assess tubular function
• Specific gravity
• Reabsorption & Secretion tests
• Concentration and dilution tests
• Renal acidification
Physical
examination
Chemical
examination
Microscopic
examination
Urine Analysis
Extremely valuable
 most easily performed test
CLASSIFICATION OF RENAL FUNCTION TESTS
On the basis of functions
1.Test measuring GFR
2.Test measuring tubular
function
On the basis of clinical applications
1.Routine clinical tests
a. Complete urine analysis
b. Measurement of NPN in blood
c. Measurement of serum electrolytes
2. Markers of GFR - Clearance tests
3.Markers of glomerular permeability
- Proteinuria
4. Markers of tubular function
a. Urinary &plasma osmolality
b. Concentration & dilution test
c. Test to assess renal acidification
Tests for assessment of glomerular function
Renal clearance test -
Markers of GFR
Blood urea and serum
creatinine
Proteinuria- Marker of
glomerular
permeability
Hematuria
RFT
 It is the volume of fluid filtered from the glomerular
capillaries into the Bowman's capsule per unit time
 Normal – 120 to 125 ml/min/1.73 m2
 Affected by -
 Age, sex, BSA, protein intake and pregnancy.
 Loss of functional nephrons (>75%) - ↓ GFR
 General index to assess severity of renal damage.
GFR
• Measurement of the clearance is predominantly a
test of glomerular filtration rate (GFR).
• Renal plasma flow is 700ml/min and GFR is 125
ml/min –so only 1/5th of the plasma brought to
glomeruli becomes the glomerular filtrate -
FILTRATION FRACTION
 GFR decreases
• Age
• BP is below 80 mmHg
• Obstruction to the renal flow (calculi and enlarged
prostate)
Clearance tests -
 the volume of plasma, completely cleared of a
substance , per unit time ( ml /min) .
C = UV / P
mg of cr./100ml urine
Cr.Cl.= ------------------ X ml. of urine exr/ min
(ml/min) mg of cr. /100 ml plasma
The amount of substance excreted in urine is the result of–
• Glomerular Filtration
• Tubular Reabsorption / secretion.
Urinary excretion rate = Filtration rate - Reabsorption
rate + Secretion rate
Inulin -125GFR
Gl.-
PCT
L.H
DCT
Clearance 125
Urea-125
75
Diodrast,
PAH -125
700
INULIN ,
Creatinine
Urea
Electrolytes
A.A
Glucose
Organic Acids
Bases ,
K , H ions
GFR = clearance
C < GFR
C = 0
C > GFR
• Endogenous - Creatinine and Urea
• Exogenous - Inulin (gold standard)
,51Cr-labelled EDTA, 99Tec-labelled
EDTA - not used in clinical practice.
Substances used for clearance test
Renal clearance test used to assess the rate
of glomerular filtration and renal blood flow
GFR
INULIN ,CREATININE
125 ML/MINUTE
CLEARANCE
INULIN, CREATININE
125 ML/MINUTE
SUBSTANCE FILTERED
NEITHER REABSORBED
NOR SECRETED
GFR = CLEARANCE
GLOMERULI
PCT
LOOP OF HENLE
DCT
GFR
GLUCOSE
125 ML/MINUTE
CLEARANCE
GLUCOSE
0 ML/MINUTE
SUBSTANCE FILTERED
COMPLETELY REABSORBED
CLEARANCE=0
GFR
UREA
125 ML/MINUTE
CLEARANCE
UREA
75 ML/MINUTE
SUBSTANCE FILTERED
PARTIALLY REABSORBED
CLEARANCE<GFR
GFR
DIODRAST,PAH
125 ML/MINUTE
CLEARANCE
DIODRAST,PAH
700 ML/MINUTE
SUBSTANCE FILTERED
NOT REABSORBED
BUT SECRETED
CLEARANCE>GFR
Creatinine Clearance - ideal marker to measure
GFR
• Procedure - 500 ml of water
– After 30 min. – Discard that sample.
– After 60 min. – Collect the sample.
– Note the Volume of urine= V
– collect Blood Sample .
– Estimate Sr. , Urine Creatinine by Jaffe`s
method
– Early marker for Renal impairment rather
than Plasma Creatinine level.
• Males 85-125ml/min
• Females 80-115ml/min
When corrected for surface area, the cr cl value will
become comparable b/w males, females and children,
which is about 100 ml/min/1.73 sq meter.
Creatinine co-efficient
• Urinary creatinine expressed in mg /kg body wt
• Value raised in muscular dystrophy
Males 20-28mg/kg
Females 15-21mg /kg
Creatinine
Creati
nine
INTERPRETATION OF CREATININE CLEARANCE
• Dec. cr cl - very sensitive indicator of reduced GFR
• Because of the steady rate of creatinine excretion,
substances in the urine are conveniently measured "per
gram of creatinine".
• Urine creatinine is used to check whether the 24 hr
urine sample does actually contain total urine volume or
not.
• However still creatinine is generally considered a somewhat
more sensitive and specific test of renal function than BUN
Urea clearance
• Normal -75 ml/min
• It is not as sensitive as creatinine clearance –
• 40-60% of urea is reabsorbed by renal tubule
• Influenced by number of extra renal factors – dietary
proteins, fluid intake, Hemorrhage, infection etc.
Plasma cystatin C –
• Small MW protease inhibitor syn by nucleated cells
• Cleared by glomerulus
• Plasma conc is measure of GFR.
Plasma ß2-Microglobulin estimation
• Plasma concentration increases as the GFR declines
• Estimation involves expensive immunoassay- not
useful in clinical practice
GFR estimation- new endogenous markers
serum urea , creatinine – used as convenient but
insensitive measure of GFR.
• Serum creatinine concentration is an insensitive
index of renal function, as it may not appear to be
elevated until the GFR has fallen below 50% of
normal.
• So serum cr increases late in renal failure.
• eGFR is an improvement on serum creatinine to
estimate GFR and should be interpreted cautiously.
• Estimated GFR (eGFR)
• The relatively poor inverse correlation between
serum creatinine and GFR can be improved by
taking into account some of the confounding
variables, such as age, sex, ethnic origin and body
weight.
Blood urea nitrogen (BUN)
• Estimates the nitrogen content of urea.
• Urea – MW 60, of which 28 comes from the two nitrogen
atoms.
Urea = BUN x (60/28), Urea= BUN x 2.14.
• Normal BUN is 10-18 mg/dL.
• Increased BUN or urea - ‘Azotemia’.
• Azotemia- retention of nitrogenous waste products
excreted by the kidney. It is either due to increased
protein catabolism or impaired kidney function.
Normal urinary protein excretion - less than 150 mg/24 hours,
made up of mostly - albumin (5 mg/L), Tamm Horsfall
glycoprotein and alpha-1 microglobulin (5 mg/L)
• Albuminuria is always pathological
• Proteinuria in urine is an indicator of leaky glomeruli
Endothelial cell – impermeable to RBC
Glomerular BM – impermeable to Albumin
• The glomerulus act as a selective filter of the
blood passing through capillaries.
• Urea, glucose ,creatinine and electrolytes are
freely filtered
• Urinary concentration of proteins depend on the
permeability of glomerular membrane and the
reabsorptive capacity of PCT
• 99% of the filtered proteins are reabsorbed by
healthy kidney
 Proteinuria-
 First sign of Glomerular injury, before ↓ in GFR.
 ↑ Glomerular permeability - smaller molecules of albumin
pass through damaged glomeruli more readily than
the heavier globulins. NEPHROTIC SYNDROME
 ↓Tubular reabsorption - Retinol binding protein (RBP) and
alpha-1 microglobulin in urine increased.
 Overflow proteinuria - SMW proteins are increased in
blood, they overflow into urine.
 Bence-jones proteins – Multiple myeloma
Monoclonal light chains of Ig,
Urogenic protienuria - due to
inflammation of lower urinary tract,
when proteins are secreted into the
tract.
Nephron loss proteinuria -occurs when
functional Nephrons are reduced
GFR is decreased
Remaining Nephrons are over working
• Microalbuminuria / minimal albuminuria /
paucialbuminuria
– small quantity of Albumin is excreted 30-300mg/day
• Early indicator of nephropathy in HTN , D.M.
• is an indicator of future renal failure
• The test should be done at least once in an year.
• It is expressed as albumin-creatinine ratio;
• normal ratio Males < 23 mg/gm of creatinine
Females < 32 mg/gm of creatinine
Test to assess Tubular function
• SPECIFIC GRAVITY :
• simplest test
• index of concentrating ability of tubules
• 1/α volume
• Increase in sp.gravity - dehydration, DM.
• Decrease in sp.gravity - renal failure, DI, ATN &
excessive fluid intake.
• Fixed sp.gr – 1.010 – ISOSTHENURIA - CRF
39
Measurement of Osmolality
• depends on the number of osmotically active particles
• Urine samples vary widely from (60 milliosmol/ kg to
1200 milliosmol/kg).
• Plasma osmolality is 285-300 mosm/kg
• ratio of osmolality of urine/plasma - 3-4.5
• Osmolality is measured by osmometer and based on the
depression of freezing point
40
Urine Conc. Test / Fluid deprivation test
earliest manifestation of tubular damage may be difficulty in
concentrating the urine.
Early dinner  no food/fluid after 6 PMbladder emptied @
7AM  discarded specimens collected @ 8 AM &
9AMatleast one should have SG >1.022 or Osm >850
mOsm/kg
Dehydration – ADH – Reabsorption
If S.G < 1.022 – D.I ( ↓ADH ) - {ADH stimulation test}
measurement of the volume of urine excreted during the day
and the night is another simple index of tubular function
Night vol is ½ of day vol.
Nocturia – early indicator of tubular dysfunction.
Urine Dilution Test
more sensitive and less harmful than concentration test.
Pt. completely empties bladder (at 7 am) after overnight fast
drinks 1L /1.2L water hourly urine specimens collected
for next 4 hrs
A normal person will excrete almost all the water load within
4 hours and the specific gravity of at least one
sample should fall to 1.003 and osmolality to 50 mosmol/kg.
Urine Acidification test / NH4Cl Loading test –
To ∆ Hyperchloremic Met. Acidosis .
0.1 g/kg body wt. of enteric coated NH4Cl –
Collect urine sample every hr. , from 2 hrs – 8hrs.
Normally – pH of atleast 1 U. sample - <5.3.
NH4 excretion – 30 – 90 m.mole /hr.
CRF – pH -low , ↓NH4.
RTA – pH – not < 5.3.
Liver disease is a contraindication to perform this test
Dye Excretion Test or PSP Test Phenolsulphonphthalein(Phenol red)
 It is dye of choice for excretory function of kidney.
 PSP dye – non-toxic and 94% excreted by tubular secretion.
 i.v inj. -6mg of PSP in 1ml .of saline .
 Collect urine – 15, 30, 60, 120 min.
 Normal – 15 min sample - > 25 % of dye
 1st hr- 40 – 60 % dye
 Impaired excretion - < 23% dye in 15 min.
- 2hr. Can be Normal
Renal Imaging studies
 Plain radiograph of abdomen
 IVP / Intravenous pyelography
 USG, CT Scan, MRI Scan
 Renal biopsy
 Strictly speaking, these are not considered to be
RFTs, but very useful in present day clinical
practice for structural & functional assessment of
kidneys.
Forms of renal failure
Two forms: acute (acute kidney injury) and
chronic (chronic kidney disease)
Acute kidney injury (AKI)
• Previously called acute renal failure (ARF), is a
rapid loss of kidney function.
• The causes categorised into prerenal, renal, and
postrenal.
• Diagnosed on the basis of clinical history and
laboratory data.
• A diagnosis is made when there is rapid reduction
in kidney function, as measured by serum urea,
creatinine, or based on a rapid reduction in urine
output, termed oliguria.
Chronic kidney disease (CKD)
• Previously called chronic renal disease, is a progressive loss
of renal function over a period of months or years.
• Most common causes - diabetic nephropathy, hypertension,
and glomerulonephritis.
• ARF can be reversible but CKD is not.
End stage kidney disease
• A 17 yr old man was involved in a road traffic accident.
Both femur were fractured and his spleen was ruptured.
Two days after surgery and transfusion of 16 units of
blood, the following results were found:
Plasma
• Sodium - 136 mmol/L (135-145)
• Potassium - 6.1 mmol/L (3.5-5)
• Urea - 20.9 mmol/L (2.5-7)
• Creatinine - 190 μmol/L (70-110)
• Phosphate - 2.8 mmol/L (0.80-1.35)
• Bicarbonate - 17 mmol/L (24-32)
Pt was producing only 10 ml of urine /hr, spot urinary Na
8mmol/L.
• Oliguria
• Low urinary Na conc.
• Hyperkalemia
• Hyperphosphatemia
• Low HCO3 conc.
Diagnosis – Pre renal Acute kidney injury –
secondary to massive blood loss.
Metabolic acidosis
• A 56 yr old man attended the renal out pt clinic because of
polycystic kidney, which had been diagnosed 20 yr
previously. He was Hypertensive and following blood results
Plasma
• Sodium - 132 mmol/L (135-145)
• Potassium - 6.2 mmol/L (3.5-5)
• Urea - 23.7 mmol/L (2.5-7)
• Creatinine - 360 mol/L (70-110)
• eGFR - 14ml/min per 1.73 m2
• Phosphate - 2.6 mmol/L (0.80-1.35)
• Bicarbonate - 13 mmol/L (24-32)
• Chronic kidney disease
• Raised plasma urea , creatinine conc.
• Hyperkalemia
• Low HCO3 conc.
• Hyponatremia
• Hypocalcaemia
• Hyperphosphataemia
Metabolic acidosis
Renal funcion test

More Related Content

What's hot

What's hot (20)

RENAL FUNCTION TESTS
RENAL FUNCTION TESTSRENAL FUNCTION TESTS
RENAL FUNCTION TESTS
 
Renal function tests
Renal function testsRenal function tests
Renal function tests
 
RENAL FUNCTION TESTS (RFT)
RENAL FUNCTION TESTS (RFT)RENAL FUNCTION TESTS (RFT)
RENAL FUNCTION TESTS (RFT)
 
Evaluation of kidney function
Evaluation of kidney functionEvaluation of kidney function
Evaluation of kidney function
 
Estimation of serum albumin by Dr.Tehmas
Estimation of serum albumin by Dr.TehmasEstimation of serum albumin by Dr.Tehmas
Estimation of serum albumin by Dr.Tehmas
 
Renal-function-tests
 Renal-function-tests Renal-function-tests
Renal-function-tests
 
Estimation of uric acid
Estimation of uric acidEstimation of uric acid
Estimation of uric acid
 
Kidney function test
Kidney function testKidney function test
Kidney function test
 
Normal constituents of urine
Normal constituents of urineNormal constituents of urine
Normal constituents of urine
 
Estimation of Blood Urea Nitrogen by Dr. Tehmas
Estimation of Blood Urea Nitrogen by Dr. TehmasEstimation of Blood Urea Nitrogen by Dr. Tehmas
Estimation of Blood Urea Nitrogen by Dr. Tehmas
 
creatinine clearance test
creatinine clearance testcreatinine clearance test
creatinine clearance test
 
Kft
KftKft
Kft
 
Renal function test
Renal function test   Renal function test
Renal function test
 
KIDNEY FUNCTION TEST
KIDNEY FUNCTION TESTKIDNEY FUNCTION TEST
KIDNEY FUNCTION TEST
 
Renal Function Tests by Dr.Ankur Puri
Renal Function Tests by Dr.Ankur PuriRenal Function Tests by Dr.Ankur Puri
Renal Function Tests by Dr.Ankur Puri
 
Glucose estimation
Glucose estimationGlucose estimation
Glucose estimation
 
renal function tests by Dr siva kumar
renal function tests by Dr siva kumarrenal function tests by Dr siva kumar
renal function tests by Dr siva kumar
 
Renal function tests
Renal function testsRenal function tests
Renal function tests
 
renal Function Test
renal Function Testrenal Function Test
renal Function Test
 
Creatinine and Creatinine Clearance
Creatinine and Creatinine ClearanceCreatinine and Creatinine Clearance
Creatinine and Creatinine Clearance
 

Viewers also liked

Viewers also liked (20)

Enzyme inhibition
Enzyme inhibitionEnzyme inhibition
Enzyme inhibition
 
Renal Function Test
Renal Function TestRenal Function Test
Renal Function Test
 
Hb chemistry and disorders
Hb chemistry  and disorders Hb chemistry  and disorders
Hb chemistry and disorders
 
Enzyme inhibition ppt final
Enzyme inhibition ppt finalEnzyme inhibition ppt final
Enzyme inhibition ppt final
 
Heme synthesis & disorders
Heme synthesis & disordersHeme synthesis & disorders
Heme synthesis & disorders
 
Viral hepatitis
Viral hepatitisViral hepatitis
Viral hepatitis
 
Why Peace
Why PeaceWhy Peace
Why Peace
 
Presentation
PresentationPresentation
Presentation
 
Renalfailure 090305183548-phpapp01
Renalfailure 090305183548-phpapp01Renalfailure 090305183548-phpapp01
Renalfailure 090305183548-phpapp01
 
Human kidney,structure and functions of kidney
Human kidney,structure and functions of kidneyHuman kidney,structure and functions of kidney
Human kidney,structure and functions of kidney
 
Renal func &amp; dysfunc may 2016
Renal func &amp; dysfunc may 2016Renal func &amp; dysfunc may 2016
Renal func &amp; dysfunc may 2016
 
Renal function tests
Renal function testsRenal function tests
Renal function tests
 
oct/nov 2007 biology paper 3
oct/nov 2007 biology paper 3oct/nov 2007 biology paper 3
oct/nov 2007 biology paper 3
 
Excretory kidney
Excretory kidneyExcretory kidney
Excretory kidney
 
Renal function tests
Renal function testsRenal function tests
Renal function tests
 
Rft
RftRft
Rft
 
Transcription
Transcription Transcription
Transcription
 
Kidney & Urinary System
Kidney & Urinary SystemKidney & Urinary System
Kidney & Urinary System
 
Irreversible enzyme inhibitores
Irreversible enzyme inhibitoresIrreversible enzyme inhibitores
Irreversible enzyme inhibitores
 
Kidneys
KidneysKidneys
Kidneys
 

Similar to Renal funcion test

Lab diagnosis in renal diseases
Lab diagnosis in renal diseasesLab diagnosis in renal diseases
Lab diagnosis in renal diseasesMeghana P
 
RENAL FUNCTION TESTS FOR PARAMEDICAL AND MEDICAL STUDENTS
RENAL FUNCTION TESTS FOR PARAMEDICAL AND MEDICAL STUDENTSRENAL FUNCTION TESTS FOR PARAMEDICAL AND MEDICAL STUDENTS
RENAL FUNCTION TESTS FOR PARAMEDICAL AND MEDICAL STUDENTSRAJNKIT
 
KIDNEY FUNCTION TEST STM.pptx by Dr Thakur
KIDNEY FUNCTION TEST STM.pptx by Dr  ThakurKIDNEY FUNCTION TEST STM.pptx by Dr  Thakur
KIDNEY FUNCTION TEST STM.pptx by Dr Thakurprajwalthakur110
 
Renal physiology and its anesthetic implications
Renal physiology and its anesthetic implicationsRenal physiology and its anesthetic implications
Renal physiology and its anesthetic implicationsSathya Prabu
 
Renal function test
Renal function testRenal function test
Renal function testKhadga Raj
 
Renal clearance test
Renal clearance testRenal clearance test
Renal clearance testANUSWARUM
 
function.pptx
function.pptxfunction.pptx
function.pptxNabdNabd
 
function.pptx
function.pptxfunction.pptx
function.pptxNabdNabd
 
Renal anatomy and physiology in relation.pptx
Renal anatomy and physiology in relation.pptxRenal anatomy and physiology in relation.pptx
Renal anatomy and physiology in relation.pptxibrahimelkathiri1
 
A detailed explanation of kidney function tests.ppt
A detailed explanation of kidney function tests.pptA detailed explanation of kidney function tests.ppt
A detailed explanation of kidney function tests.pptuzmabatool38
 
Biochemical kidney function tests with their clinical applications
Biochemical kidney function tests with their clinical applicationsBiochemical kidney function tests with their clinical applications
Biochemical kidney function tests with their clinical applicationsrohini sane
 
renal function test by Asma ppt
renal function test by Asma pptrenal function test by Asma ppt
renal function test by Asma pptPARUL UNIVERSITY
 
Renal function tests
Renal function testsRenal function tests
Renal function testsAbhra Ghosh
 
Kidney function tests used in clinical pathology.ppt
Kidney function tests used in clinical pathology.pptKidney function tests used in clinical pathology.ppt
Kidney function tests used in clinical pathology.pptuzmabatool38
 

Similar to Renal funcion test (20)

RFT.pptx
RFT.pptxRFT.pptx
RFT.pptx
 
Lab diagnosis in renal diseases
Lab diagnosis in renal diseasesLab diagnosis in renal diseases
Lab diagnosis in renal diseases
 
RENAL FUNCTION TESTS FOR PARAMEDICAL AND MEDICAL STUDENTS
RENAL FUNCTION TESTS FOR PARAMEDICAL AND MEDICAL STUDENTSRENAL FUNCTION TESTS FOR PARAMEDICAL AND MEDICAL STUDENTS
RENAL FUNCTION TESTS FOR PARAMEDICAL AND MEDICAL STUDENTS
 
KIDNEY FUNCTION TEST STM.pptx by Dr Thakur
KIDNEY FUNCTION TEST STM.pptx by Dr  ThakurKIDNEY FUNCTION TEST STM.pptx by Dr  Thakur
KIDNEY FUNCTION TEST STM.pptx by Dr Thakur
 
Renal Function Tests (RFT)
Renal Function Tests (RFT)Renal Function Tests (RFT)
Renal Function Tests (RFT)
 
Renal physiology and its anesthetic implications
Renal physiology and its anesthetic implicationsRenal physiology and its anesthetic implications
Renal physiology and its anesthetic implications
 
Renal function test
Renal function testRenal function test
Renal function test
 
Renal clearance test
Renal clearance testRenal clearance test
Renal clearance test
 
limitation and scope.pptx
limitation and scope.pptxlimitation and scope.pptx
limitation and scope.pptx
 
0FT 02. RFT.pptx
0FT 02. RFT.pptx0FT 02. RFT.pptx
0FT 02. RFT.pptx
 
Renal function test
Renal function testRenal function test
Renal function test
 
function.pptx
function.pptxfunction.pptx
function.pptx
 
function.pptx
function.pptxfunction.pptx
function.pptx
 
Renal anatomy and physiology in relation.pptx
Renal anatomy and physiology in relation.pptxRenal anatomy and physiology in relation.pptx
Renal anatomy and physiology in relation.pptx
 
A detailed explanation of kidney function tests.ppt
A detailed explanation of kidney function tests.pptA detailed explanation of kidney function tests.ppt
A detailed explanation of kidney function tests.ppt
 
Renal function test
Renal function testRenal function test
Renal function test
 
Biochemical kidney function tests with their clinical applications
Biochemical kidney function tests with their clinical applicationsBiochemical kidney function tests with their clinical applications
Biochemical kidney function tests with their clinical applications
 
renal function test by Asma ppt
renal function test by Asma pptrenal function test by Asma ppt
renal function test by Asma ppt
 
Renal function tests
Renal function testsRenal function tests
Renal function tests
 
Kidney function tests used in clinical pathology.ppt
Kidney function tests used in clinical pathology.pptKidney function tests used in clinical pathology.ppt
Kidney function tests used in clinical pathology.ppt
 

More from ranjani n

Heteropolysaccharides
Heteropolysaccharides Heteropolysaccharides
Heteropolysaccharides ranjani n
 
Disorders of electrolyte balance
Disorders of electrolyte balanceDisorders of electrolyte balance
Disorders of electrolyte balanceranjani n
 
Water and electrolyte
Water and electrolyte Water and electrolyte
Water and electrolyte ranjani n
 
Nucleic acid structure
Nucleic acid structure Nucleic acid structure
Nucleic acid structure ranjani n
 
Urea cycle and its disorders
Urea cycle and its disordersUrea cycle and its disorders
Urea cycle and its disordersranjani n
 
Purine catabolism
Purine catabolism Purine catabolism
Purine catabolism ranjani n
 
Heme catabolism and jaundice
Heme catabolism and jaundiceHeme catabolism and jaundice
Heme catabolism and jaundiceranjani n
 
Met of glycine
Met of glycineMet of glycine
Met of glycineranjani n
 
Tag metabolism
Tag metabolismTag metabolism
Tag metabolismranjani n
 
Dig and abs of lipids
Dig and abs of lipids Dig and abs of lipids
Dig and abs of lipids ranjani n
 
De Novo synthesis of fatty acids
De Novo synthesis of fatty acidsDe Novo synthesis of fatty acids
De Novo synthesis of fatty acidsranjani n
 
Immunoglobulins
ImmunoglobulinsImmunoglobulins
Immunoglobulinsranjani n
 
Cell membrane
Cell membraneCell membrane
Cell membraneranjani n
 
Protein structure
Protein structureProtein structure
Protein structureranjani n
 

More from ranjani n (14)

Heteropolysaccharides
Heteropolysaccharides Heteropolysaccharides
Heteropolysaccharides
 
Disorders of electrolyte balance
Disorders of electrolyte balanceDisorders of electrolyte balance
Disorders of electrolyte balance
 
Water and electrolyte
Water and electrolyte Water and electrolyte
Water and electrolyte
 
Nucleic acid structure
Nucleic acid structure Nucleic acid structure
Nucleic acid structure
 
Urea cycle and its disorders
Urea cycle and its disordersUrea cycle and its disorders
Urea cycle and its disorders
 
Purine catabolism
Purine catabolism Purine catabolism
Purine catabolism
 
Heme catabolism and jaundice
Heme catabolism and jaundiceHeme catabolism and jaundice
Heme catabolism and jaundice
 
Met of glycine
Met of glycineMet of glycine
Met of glycine
 
Tag metabolism
Tag metabolismTag metabolism
Tag metabolism
 
Dig and abs of lipids
Dig and abs of lipids Dig and abs of lipids
Dig and abs of lipids
 
De Novo synthesis of fatty acids
De Novo synthesis of fatty acidsDe Novo synthesis of fatty acids
De Novo synthesis of fatty acids
 
Immunoglobulins
ImmunoglobulinsImmunoglobulins
Immunoglobulins
 
Cell membrane
Cell membraneCell membrane
Cell membrane
 
Protein structure
Protein structureProtein structure
Protein structure
 

Recently uploaded

Q-Factor General Quiz-7th April 2024, Quiz Club NITW
Q-Factor General Quiz-7th April 2024, Quiz Club NITWQ-Factor General Quiz-7th April 2024, Quiz Club NITW
Q-Factor General Quiz-7th April 2024, Quiz Club NITWQuiz Club NITW
 
DIFFERENT BASKETRY IN THE PHILIPPINES PPT.pptx
DIFFERENT BASKETRY IN THE PHILIPPINES PPT.pptxDIFFERENT BASKETRY IN THE PHILIPPINES PPT.pptx
DIFFERENT BASKETRY IN THE PHILIPPINES PPT.pptxMichelleTuguinay1
 
How to Manage Engineering to Order in Odoo 17
How to Manage Engineering to Order in Odoo 17How to Manage Engineering to Order in Odoo 17
How to Manage Engineering to Order in Odoo 17Celine George
 
MULTIDISCIPLINRY NATURE OF THE ENVIRONMENTAL STUDIES.pptx
MULTIDISCIPLINRY NATURE OF THE ENVIRONMENTAL STUDIES.pptxMULTIDISCIPLINRY NATURE OF THE ENVIRONMENTAL STUDIES.pptx
MULTIDISCIPLINRY NATURE OF THE ENVIRONMENTAL STUDIES.pptxAnupkumar Sharma
 
Using Grammatical Signals Suitable to Patterns of Idea Development
Using Grammatical Signals Suitable to Patterns of Idea DevelopmentUsing Grammatical Signals Suitable to Patterns of Idea Development
Using Grammatical Signals Suitable to Patterns of Idea Developmentchesterberbo7
 
4.16.24 21st Century Movements for Black Lives.pptx
4.16.24 21st Century Movements for Black Lives.pptx4.16.24 21st Century Movements for Black Lives.pptx
4.16.24 21st Century Movements for Black Lives.pptxmary850239
 
Inclusivity Essentials_ Creating Accessible Websites for Nonprofits .pdf
Inclusivity Essentials_ Creating Accessible Websites for Nonprofits .pdfInclusivity Essentials_ Creating Accessible Websites for Nonprofits .pdf
Inclusivity Essentials_ Creating Accessible Websites for Nonprofits .pdfTechSoup
 
Transaction Management in Database Management System
Transaction Management in Database Management SystemTransaction Management in Database Management System
Transaction Management in Database Management SystemChristalin Nelson
 
ROLES IN A STAGE PRODUCTION in arts.pptx
ROLES IN A STAGE PRODUCTION in arts.pptxROLES IN A STAGE PRODUCTION in arts.pptx
ROLES IN A STAGE PRODUCTION in arts.pptxVanesaIglesias10
 
MS4 level being good citizen -imperative- (1) (1).pdf
MS4 level   being good citizen -imperative- (1) (1).pdfMS4 level   being good citizen -imperative- (1) (1).pdf
MS4 level being good citizen -imperative- (1) (1).pdfMr Bounab Samir
 
How to Make a Duplicate of Your Odoo 17 Database
How to Make a Duplicate of Your Odoo 17 DatabaseHow to Make a Duplicate of Your Odoo 17 Database
How to Make a Duplicate of Your Odoo 17 DatabaseCeline George
 
Influencing policy (training slides from Fast Track Impact)
Influencing policy (training slides from Fast Track Impact)Influencing policy (training slides from Fast Track Impact)
Influencing policy (training slides from Fast Track Impact)Mark Reed
 
Grade Three -ELLNA-REVIEWER-ENGLISH.pptx
Grade Three -ELLNA-REVIEWER-ENGLISH.pptxGrade Three -ELLNA-REVIEWER-ENGLISH.pptx
Grade Three -ELLNA-REVIEWER-ENGLISH.pptxkarenfajardo43
 
Visit to a blind student's school🧑‍🦯🧑‍🦯(community medicine)
Visit to a blind student's school🧑‍🦯🧑‍🦯(community medicine)Visit to a blind student's school🧑‍🦯🧑‍🦯(community medicine)
Visit to a blind student's school🧑‍🦯🧑‍🦯(community medicine)lakshayb543
 
ANG SEKTOR NG agrikultura.pptx QUARTER 4
ANG SEKTOR NG agrikultura.pptx QUARTER 4ANG SEKTOR NG agrikultura.pptx QUARTER 4
ANG SEKTOR NG agrikultura.pptx QUARTER 4MiaBumagat1
 
IPCRF/RPMS 2024 Classroom Observation tool is your access to the new performa...
IPCRF/RPMS 2024 Classroom Observation tool is your access to the new performa...IPCRF/RPMS 2024 Classroom Observation tool is your access to the new performa...
IPCRF/RPMS 2024 Classroom Observation tool is your access to the new performa...MerlizValdezGeronimo
 
BIOCHEMISTRY-CARBOHYDRATE METABOLISM CHAPTER 2.pptx
BIOCHEMISTRY-CARBOHYDRATE METABOLISM CHAPTER 2.pptxBIOCHEMISTRY-CARBOHYDRATE METABOLISM CHAPTER 2.pptx
BIOCHEMISTRY-CARBOHYDRATE METABOLISM CHAPTER 2.pptxSayali Powar
 
ESP 4-EDITED.pdfmmcncncncmcmmnmnmncnmncmnnjvnnv
ESP 4-EDITED.pdfmmcncncncmcmmnmnmncnmncmnnjvnnvESP 4-EDITED.pdfmmcncncncmcmmnmnmncnmncmnnjvnnv
ESP 4-EDITED.pdfmmcncncncmcmmnmnmncnmncmnnjvnnvRicaMaeCastro1
 
THEORIES OF ORGANIZATION-PUBLIC ADMINISTRATION
THEORIES OF ORGANIZATION-PUBLIC ADMINISTRATIONTHEORIES OF ORGANIZATION-PUBLIC ADMINISTRATION
THEORIES OF ORGANIZATION-PUBLIC ADMINISTRATIONHumphrey A Beña
 

Recently uploaded (20)

Q-Factor General Quiz-7th April 2024, Quiz Club NITW
Q-Factor General Quiz-7th April 2024, Quiz Club NITWQ-Factor General Quiz-7th April 2024, Quiz Club NITW
Q-Factor General Quiz-7th April 2024, Quiz Club NITW
 
DIFFERENT BASKETRY IN THE PHILIPPINES PPT.pptx
DIFFERENT BASKETRY IN THE PHILIPPINES PPT.pptxDIFFERENT BASKETRY IN THE PHILIPPINES PPT.pptx
DIFFERENT BASKETRY IN THE PHILIPPINES PPT.pptx
 
How to Manage Engineering to Order in Odoo 17
How to Manage Engineering to Order in Odoo 17How to Manage Engineering to Order in Odoo 17
How to Manage Engineering to Order in Odoo 17
 
MULTIDISCIPLINRY NATURE OF THE ENVIRONMENTAL STUDIES.pptx
MULTIDISCIPLINRY NATURE OF THE ENVIRONMENTAL STUDIES.pptxMULTIDISCIPLINRY NATURE OF THE ENVIRONMENTAL STUDIES.pptx
MULTIDISCIPLINRY NATURE OF THE ENVIRONMENTAL STUDIES.pptx
 
Using Grammatical Signals Suitable to Patterns of Idea Development
Using Grammatical Signals Suitable to Patterns of Idea DevelopmentUsing Grammatical Signals Suitable to Patterns of Idea Development
Using Grammatical Signals Suitable to Patterns of Idea Development
 
4.16.24 21st Century Movements for Black Lives.pptx
4.16.24 21st Century Movements for Black Lives.pptx4.16.24 21st Century Movements for Black Lives.pptx
4.16.24 21st Century Movements for Black Lives.pptx
 
Inclusivity Essentials_ Creating Accessible Websites for Nonprofits .pdf
Inclusivity Essentials_ Creating Accessible Websites for Nonprofits .pdfInclusivity Essentials_ Creating Accessible Websites for Nonprofits .pdf
Inclusivity Essentials_ Creating Accessible Websites for Nonprofits .pdf
 
Transaction Management in Database Management System
Transaction Management in Database Management SystemTransaction Management in Database Management System
Transaction Management in Database Management System
 
ROLES IN A STAGE PRODUCTION in arts.pptx
ROLES IN A STAGE PRODUCTION in arts.pptxROLES IN A STAGE PRODUCTION in arts.pptx
ROLES IN A STAGE PRODUCTION in arts.pptx
 
MS4 level being good citizen -imperative- (1) (1).pdf
MS4 level   being good citizen -imperative- (1) (1).pdfMS4 level   being good citizen -imperative- (1) (1).pdf
MS4 level being good citizen -imperative- (1) (1).pdf
 
How to Make a Duplicate of Your Odoo 17 Database
How to Make a Duplicate of Your Odoo 17 DatabaseHow to Make a Duplicate of Your Odoo 17 Database
How to Make a Duplicate of Your Odoo 17 Database
 
Influencing policy (training slides from Fast Track Impact)
Influencing policy (training slides from Fast Track Impact)Influencing policy (training slides from Fast Track Impact)
Influencing policy (training slides from Fast Track Impact)
 
Grade Three -ELLNA-REVIEWER-ENGLISH.pptx
Grade Three -ELLNA-REVIEWER-ENGLISH.pptxGrade Three -ELLNA-REVIEWER-ENGLISH.pptx
Grade Three -ELLNA-REVIEWER-ENGLISH.pptx
 
Visit to a blind student's school🧑‍🦯🧑‍🦯(community medicine)
Visit to a blind student's school🧑‍🦯🧑‍🦯(community medicine)Visit to a blind student's school🧑‍🦯🧑‍🦯(community medicine)
Visit to a blind student's school🧑‍🦯🧑‍🦯(community medicine)
 
ANG SEKTOR NG agrikultura.pptx QUARTER 4
ANG SEKTOR NG agrikultura.pptx QUARTER 4ANG SEKTOR NG agrikultura.pptx QUARTER 4
ANG SEKTOR NG agrikultura.pptx QUARTER 4
 
IPCRF/RPMS 2024 Classroom Observation tool is your access to the new performa...
IPCRF/RPMS 2024 Classroom Observation tool is your access to the new performa...IPCRF/RPMS 2024 Classroom Observation tool is your access to the new performa...
IPCRF/RPMS 2024 Classroom Observation tool is your access to the new performa...
 
BIOCHEMISTRY-CARBOHYDRATE METABOLISM CHAPTER 2.pptx
BIOCHEMISTRY-CARBOHYDRATE METABOLISM CHAPTER 2.pptxBIOCHEMISTRY-CARBOHYDRATE METABOLISM CHAPTER 2.pptx
BIOCHEMISTRY-CARBOHYDRATE METABOLISM CHAPTER 2.pptx
 
ESP 4-EDITED.pdfmmcncncncmcmmnmnmncnmncmnnjvnnv
ESP 4-EDITED.pdfmmcncncncmcmmnmnmncnmncmnnjvnnvESP 4-EDITED.pdfmmcncncncmcmmnmnmncnmncmnnjvnnv
ESP 4-EDITED.pdfmmcncncncmcmmnmnmncnmncmnnjvnnv
 
THEORIES OF ORGANIZATION-PUBLIC ADMINISTRATION
THEORIES OF ORGANIZATION-PUBLIC ADMINISTRATIONTHEORIES OF ORGANIZATION-PUBLIC ADMINISTRATION
THEORIES OF ORGANIZATION-PUBLIC ADMINISTRATION
 
prashanth updated resume 2024 for Teaching Profession
prashanth updated resume 2024 for Teaching Professionprashanth updated resume 2024 for Teaching Profession
prashanth updated resume 2024 for Teaching Profession
 

Renal funcion test

  • 1. Dr. N. Sivaranjani ,MD Asst Prof RENAL FUNCTION TESTS
  • 2. Formation of urine as the waste product Excretion of NPN substances Metabolic – Gluconeogenesis, Urea cycle Regulation of salt & water balance Regulation of acid-base balance Production of Hormones – Renin , Calcitriol, Erythropoietin. Functions of KIDNEY
  • 3. Early detection, Assessment of the extent of renal damage Measure the progression of renal damage Monitoring and adjusting the dose of renal toxic drugs Renal Function Tests –required for……
  • 4.  Early detection of possible renal damage & assessment of its severity  Measure progression of the renal impairment & efficacy of corrective therapy  Predict when renal replacement therapy may be necessary  Monitor safe & effective use of drugs, which are principally eliminated through urine. OBJECTIVES OF RFT :
  • 5. 5 Nephron - the functional unit of kidney
  • 6. Segment of nephron Reabsorption of Secretion of Proximal convoluted tubule (PCT) Na+, Cl–, HCO3 (85%), Glucose (100%), Amino acids (100%), Uric acid, Water (obligatory). H+, acid and bases, NH4 + , Loop of Henle Na+, Cl–, Ca++, Mg++ Distal convoluted tubule (DCT) Na+, Cl–, Water (facultative) H+, K+, NH4 +, uric acid Glomerular function – filter the incoming blood – formation of ultra filtrate of blood – cells , large proteins are retained, metabolic waste products are filtered. Tubular function – about 170 L ultra filtered is formed , only 1.5 L excreted as Urine. Selective reabsorption and secretion of molecules.
  • 7. Renal Threshold is the plasma level above which the compound is excreted in urine. maximum reabsorptive capacity of the substances - Tubular maximum or Tm. Ex – Glucose - 180 mg/dl , Tm - 375 mg/min Lactate - 60 mg/dl Bicarbonate - 28 mEq/L • Lowered renal threshold - at lower blood levels compounds are excreted in urine . Renal glycosuria , Renal tubular acidosis
  • 8. I. To screen for kidney disease • Complete urine analysis • Plasma urea and creatinine • Plasma electrolytes II. To assess renal function a. To assess glomerular function • Glomerular filtration rate - Clearance tests • Glomerular permeability - Proteinuria b. To assess tubular function • Specific gravity • Reabsorption & Secretion tests • Concentration and dilution tests • Renal acidification
  • 10. Urine Analysis Extremely valuable  most easily performed test
  • 11. CLASSIFICATION OF RENAL FUNCTION TESTS On the basis of functions 1.Test measuring GFR 2.Test measuring tubular function On the basis of clinical applications 1.Routine clinical tests a. Complete urine analysis b. Measurement of NPN in blood c. Measurement of serum electrolytes 2. Markers of GFR - Clearance tests 3.Markers of glomerular permeability - Proteinuria 4. Markers of tubular function a. Urinary &plasma osmolality b. Concentration & dilution test c. Test to assess renal acidification
  • 12. Tests for assessment of glomerular function Renal clearance test - Markers of GFR Blood urea and serum creatinine Proteinuria- Marker of glomerular permeability Hematuria RFT
  • 13.  It is the volume of fluid filtered from the glomerular capillaries into the Bowman's capsule per unit time  Normal – 120 to 125 ml/min/1.73 m2  Affected by -  Age, sex, BSA, protein intake and pregnancy.  Loss of functional nephrons (>75%) - ↓ GFR  General index to assess severity of renal damage. GFR
  • 14. • Measurement of the clearance is predominantly a test of glomerular filtration rate (GFR). • Renal plasma flow is 700ml/min and GFR is 125 ml/min –so only 1/5th of the plasma brought to glomeruli becomes the glomerular filtrate - FILTRATION FRACTION  GFR decreases • Age • BP is below 80 mmHg • Obstruction to the renal flow (calculi and enlarged prostate)
  • 15. Clearance tests -  the volume of plasma, completely cleared of a substance , per unit time ( ml /min) . C = UV / P mg of cr./100ml urine Cr.Cl.= ------------------ X ml. of urine exr/ min (ml/min) mg of cr. /100 ml plasma
  • 16. The amount of substance excreted in urine is the result of– • Glomerular Filtration • Tubular Reabsorption / secretion. Urinary excretion rate = Filtration rate - Reabsorption rate + Secretion rate
  • 18. INULIN , Creatinine Urea Electrolytes A.A Glucose Organic Acids Bases , K , H ions GFR = clearance C < GFR C = 0 C > GFR
  • 19. • Endogenous - Creatinine and Urea • Exogenous - Inulin (gold standard) ,51Cr-labelled EDTA, 99Tec-labelled EDTA - not used in clinical practice. Substances used for clearance test Renal clearance test used to assess the rate of glomerular filtration and renal blood flow
  • 20. GFR INULIN ,CREATININE 125 ML/MINUTE CLEARANCE INULIN, CREATININE 125 ML/MINUTE SUBSTANCE FILTERED NEITHER REABSORBED NOR SECRETED GFR = CLEARANCE GLOMERULI PCT LOOP OF HENLE DCT
  • 21. GFR GLUCOSE 125 ML/MINUTE CLEARANCE GLUCOSE 0 ML/MINUTE SUBSTANCE FILTERED COMPLETELY REABSORBED CLEARANCE=0
  • 22. GFR UREA 125 ML/MINUTE CLEARANCE UREA 75 ML/MINUTE SUBSTANCE FILTERED PARTIALLY REABSORBED CLEARANCE<GFR
  • 23. GFR DIODRAST,PAH 125 ML/MINUTE CLEARANCE DIODRAST,PAH 700 ML/MINUTE SUBSTANCE FILTERED NOT REABSORBED BUT SECRETED CLEARANCE>GFR
  • 24. Creatinine Clearance - ideal marker to measure GFR • Procedure - 500 ml of water – After 30 min. – Discard that sample. – After 60 min. – Collect the sample. – Note the Volume of urine= V – collect Blood Sample . – Estimate Sr. , Urine Creatinine by Jaffe`s method – Early marker for Renal impairment rather than Plasma Creatinine level.
  • 25. • Males 85-125ml/min • Females 80-115ml/min When corrected for surface area, the cr cl value will become comparable b/w males, females and children, which is about 100 ml/min/1.73 sq meter. Creatinine co-efficient • Urinary creatinine expressed in mg /kg body wt • Value raised in muscular dystrophy Males 20-28mg/kg Females 15-21mg /kg Creatinine Creati nine
  • 26. INTERPRETATION OF CREATININE CLEARANCE • Dec. cr cl - very sensitive indicator of reduced GFR • Because of the steady rate of creatinine excretion, substances in the urine are conveniently measured "per gram of creatinine". • Urine creatinine is used to check whether the 24 hr urine sample does actually contain total urine volume or not. • However still creatinine is generally considered a somewhat more sensitive and specific test of renal function than BUN
  • 27. Urea clearance • Normal -75 ml/min • It is not as sensitive as creatinine clearance – • 40-60% of urea is reabsorbed by renal tubule • Influenced by number of extra renal factors – dietary proteins, fluid intake, Hemorrhage, infection etc.
  • 28. Plasma cystatin C – • Small MW protease inhibitor syn by nucleated cells • Cleared by glomerulus • Plasma conc is measure of GFR. Plasma ß2-Microglobulin estimation • Plasma concentration increases as the GFR declines • Estimation involves expensive immunoassay- not useful in clinical practice GFR estimation- new endogenous markers
  • 29. serum urea , creatinine – used as convenient but insensitive measure of GFR. • Serum creatinine concentration is an insensitive index of renal function, as it may not appear to be elevated until the GFR has fallen below 50% of normal. • So serum cr increases late in renal failure. • eGFR is an improvement on serum creatinine to estimate GFR and should be interpreted cautiously.
  • 30. • Estimated GFR (eGFR) • The relatively poor inverse correlation between serum creatinine and GFR can be improved by taking into account some of the confounding variables, such as age, sex, ethnic origin and body weight.
  • 31. Blood urea nitrogen (BUN) • Estimates the nitrogen content of urea. • Urea – MW 60, of which 28 comes from the two nitrogen atoms. Urea = BUN x (60/28), Urea= BUN x 2.14. • Normal BUN is 10-18 mg/dL. • Increased BUN or urea - ‘Azotemia’. • Azotemia- retention of nitrogenous waste products excreted by the kidney. It is either due to increased protein catabolism or impaired kidney function.
  • 32. Normal urinary protein excretion - less than 150 mg/24 hours, made up of mostly - albumin (5 mg/L), Tamm Horsfall glycoprotein and alpha-1 microglobulin (5 mg/L) • Albuminuria is always pathological • Proteinuria in urine is an indicator of leaky glomeruli Endothelial cell – impermeable to RBC Glomerular BM – impermeable to Albumin
  • 33. • The glomerulus act as a selective filter of the blood passing through capillaries. • Urea, glucose ,creatinine and electrolytes are freely filtered • Urinary concentration of proteins depend on the permeability of glomerular membrane and the reabsorptive capacity of PCT • 99% of the filtered proteins are reabsorbed by healthy kidney
  • 34.  Proteinuria-  First sign of Glomerular injury, before ↓ in GFR.  ↑ Glomerular permeability - smaller molecules of albumin pass through damaged glomeruli more readily than the heavier globulins. NEPHROTIC SYNDROME  ↓Tubular reabsorption - Retinol binding protein (RBP) and alpha-1 microglobulin in urine increased.  Overflow proteinuria - SMW proteins are increased in blood, they overflow into urine.  Bence-jones proteins – Multiple myeloma Monoclonal light chains of Ig,
  • 35.
  • 36.
  • 37. Urogenic protienuria - due to inflammation of lower urinary tract, when proteins are secreted into the tract. Nephron loss proteinuria -occurs when functional Nephrons are reduced GFR is decreased Remaining Nephrons are over working
  • 38. • Microalbuminuria / minimal albuminuria / paucialbuminuria – small quantity of Albumin is excreted 30-300mg/day • Early indicator of nephropathy in HTN , D.M. • is an indicator of future renal failure • The test should be done at least once in an year. • It is expressed as albumin-creatinine ratio; • normal ratio Males < 23 mg/gm of creatinine Females < 32 mg/gm of creatinine
  • 39. Test to assess Tubular function • SPECIFIC GRAVITY : • simplest test • index of concentrating ability of tubules • 1/α volume • Increase in sp.gravity - dehydration, DM. • Decrease in sp.gravity - renal failure, DI, ATN & excessive fluid intake. • Fixed sp.gr – 1.010 – ISOSTHENURIA - CRF 39
  • 40. Measurement of Osmolality • depends on the number of osmotically active particles • Urine samples vary widely from (60 milliosmol/ kg to 1200 milliosmol/kg). • Plasma osmolality is 285-300 mosm/kg • ratio of osmolality of urine/plasma - 3-4.5 • Osmolality is measured by osmometer and based on the depression of freezing point 40
  • 41. Urine Conc. Test / Fluid deprivation test earliest manifestation of tubular damage may be difficulty in concentrating the urine. Early dinner  no food/fluid after 6 PMbladder emptied @ 7AM  discarded specimens collected @ 8 AM & 9AMatleast one should have SG >1.022 or Osm >850 mOsm/kg Dehydration – ADH – Reabsorption If S.G < 1.022 – D.I ( ↓ADH ) - {ADH stimulation test} measurement of the volume of urine excreted during the day and the night is another simple index of tubular function Night vol is ½ of day vol. Nocturia – early indicator of tubular dysfunction.
  • 42. Urine Dilution Test more sensitive and less harmful than concentration test. Pt. completely empties bladder (at 7 am) after overnight fast drinks 1L /1.2L water hourly urine specimens collected for next 4 hrs A normal person will excrete almost all the water load within 4 hours and the specific gravity of at least one sample should fall to 1.003 and osmolality to 50 mosmol/kg.
  • 43. Urine Acidification test / NH4Cl Loading test – To ∆ Hyperchloremic Met. Acidosis . 0.1 g/kg body wt. of enteric coated NH4Cl – Collect urine sample every hr. , from 2 hrs – 8hrs. Normally – pH of atleast 1 U. sample - <5.3. NH4 excretion – 30 – 90 m.mole /hr. CRF – pH -low , ↓NH4. RTA – pH – not < 5.3. Liver disease is a contraindication to perform this test
  • 44. Dye Excretion Test or PSP Test Phenolsulphonphthalein(Phenol red)  It is dye of choice for excretory function of kidney.  PSP dye – non-toxic and 94% excreted by tubular secretion.  i.v inj. -6mg of PSP in 1ml .of saline .  Collect urine – 15, 30, 60, 120 min.  Normal – 15 min sample - > 25 % of dye  1st hr- 40 – 60 % dye  Impaired excretion - < 23% dye in 15 min. - 2hr. Can be Normal
  • 45. Renal Imaging studies  Plain radiograph of abdomen  IVP / Intravenous pyelography  USG, CT Scan, MRI Scan  Renal biopsy  Strictly speaking, these are not considered to be RFTs, but very useful in present day clinical practice for structural & functional assessment of kidneys.
  • 46. Forms of renal failure Two forms: acute (acute kidney injury) and chronic (chronic kidney disease) Acute kidney injury (AKI) • Previously called acute renal failure (ARF), is a rapid loss of kidney function. • The causes categorised into prerenal, renal, and postrenal. • Diagnosed on the basis of clinical history and laboratory data. • A diagnosis is made when there is rapid reduction in kidney function, as measured by serum urea, creatinine, or based on a rapid reduction in urine output, termed oliguria.
  • 47.
  • 48.
  • 49.
  • 50. Chronic kidney disease (CKD) • Previously called chronic renal disease, is a progressive loss of renal function over a period of months or years. • Most common causes - diabetic nephropathy, hypertension, and glomerulonephritis. • ARF can be reversible but CKD is not. End stage kidney disease
  • 51.
  • 52.
  • 53.
  • 54.
  • 55. • A 17 yr old man was involved in a road traffic accident. Both femur were fractured and his spleen was ruptured. Two days after surgery and transfusion of 16 units of blood, the following results were found: Plasma • Sodium - 136 mmol/L (135-145) • Potassium - 6.1 mmol/L (3.5-5) • Urea - 20.9 mmol/L (2.5-7) • Creatinine - 190 μmol/L (70-110) • Phosphate - 2.8 mmol/L (0.80-1.35) • Bicarbonate - 17 mmol/L (24-32) Pt was producing only 10 ml of urine /hr, spot urinary Na 8mmol/L.
  • 56. • Oliguria • Low urinary Na conc. • Hyperkalemia • Hyperphosphatemia • Low HCO3 conc. Diagnosis – Pre renal Acute kidney injury – secondary to massive blood loss. Metabolic acidosis
  • 57. • A 56 yr old man attended the renal out pt clinic because of polycystic kidney, which had been diagnosed 20 yr previously. He was Hypertensive and following blood results Plasma • Sodium - 132 mmol/L (135-145) • Potassium - 6.2 mmol/L (3.5-5) • Urea - 23.7 mmol/L (2.5-7) • Creatinine - 360 mol/L (70-110) • eGFR - 14ml/min per 1.73 m2 • Phosphate - 2.6 mmol/L (0.80-1.35) • Bicarbonate - 13 mmol/L (24-32)
  • 58. • Chronic kidney disease • Raised plasma urea , creatinine conc. • Hyperkalemia • Low HCO3 conc. • Hyponatremia • Hypocalcaemia • Hyperphosphataemia Metabolic acidosis

Editor's Notes

  1. Radiopaque iodine, Para-aminohippurate
  2. indication of osmolality, It depends on concentration of solutes
  3. Water deprivation test to detect nephrogenic DI
  4. liver NH₄⁺ is converted to urea immediately,Cl⁻ counter balanced by H⁺ to form HCl excreted in urine-to produce acidification