Renal function tests can help screen and monitor patients for kidney disease. The creatinine and BUN can be elevated by factors other than kidney disease, such as increased protein intake or muscle breakdown. To determine if acute renal failure is prerenal or renal (ATN), fractional excretion of sodium and urea are used, with prerenal azotemia having FENa <1% and FEUrea <35%. Estimating glomerular filtration rate (GFR) stages chronic kidney disease.
This document discusses renal function tests and their clinical implications. It begins by outlining the general anatomy and functions of the kidney. It then classifies renal function tests into urine analysis, blood tests, and tests of glomerular and tubular function. Specific tests are described, including creatinine clearance for glomerular function and urine concentration tests for tubular function. The document discusses how renal function tests can help in assessing and monitoring kidney damage and adjusting drug dosages. Clinical conditions that can be indicated by renal function tests include diabetic nephropathy, acute kidney injury, glomerular diseases, and chronic kidney disease.
rft is described in detail . function of kidney, objectives of doing the test. the various test available for assessing the renal function with clinical interpretation is available.
This document provides an overview of renal function tests. It discusses the anatomy and physiology of the kidney and nephron. It describes various tests used to evaluate glomerular filtration rate (GFR) including creatinine clearance, urea clearance, insulin clearance, and inulin clearance tests. It also covers tests of tubular function like dilution and acidification tests. Normal ranges for urine and blood parameters are provided.
This document discusses renal function tests (RFTs). It begins by describing the functions of the kidney including formation of urine, excretion of waste products, and regulation of water, electrolytes and acid-base balance.
It then explains that RFTs are used to assess renal damage, monitor progression of renal disease, and adjust dosing of nephrotoxic drugs. RFTs provide information on renal blood flow, glomerular filtration rate, tubular function, and urine output. Tests include urine analysis, measurements of glomerular function like creatinine clearance, and tests of tubular function like concentration and dilution tests. The document describes several RFTs in detail.
This document discusses renal function tests and their use in assessing kidney function. It covers tests that measure glomerular filtration rate like creatinine clearance and urea clearance. Creatinine clearance is considered the best measure of glomerular filtration as creatinine is filtered at the glomerulus and neither reabsorbed nor secreted. Stages of kidney disease are defined based on glomerular filtration rate. Tubular function tests like urine concentration are also discussed. Biochemical changes in blood that occur with impaired kidney function are outlined.
This document discusses renal function tests and their importance in assessing kidney function and detecting impairment. It describes various tests including urine analysis, blood tests of creatinine and urea, and glomerular function tests. Common indications for evaluating renal function are listed, such as older age, diabetes, and hypertension. The document also outlines approaches to interpreting test results and diagnosing different kidney conditions like acute injury, nephritic syndrome, and nephrotic syndrome.
The document provides information on kidney function tests and renal assessment. It discusses the anatomy and function of the kidneys and urinary system. Various tests for evaluating glomerular filtration rate (GFR) and renal tubular function are described, including creatinine clearance, urea, uric acid, and beta-2 microglobulin. Urinalysis tests like specific gravity, pH, protein, glucose, and sediment examination are also covered. The document emphasizes the importance of renal function testing in conditions like diabetes, hypertension, and kidney disease.
The document provides information on renal function tests. It discusses the anatomy and functions of the kidneys. There are several reasons to test renal function, including to assess functional capacity, detect impairment, monitor treatment response, and ensure safe drug use. Tests can evaluate glomerular function, renal plasma flow, and tubular function. Common tests include urine analysis, creatinine clearance, urea clearance, inulin clearance, para-amino hippurate clearance, and tests of urine concentration, acidification, and dilution abilities.
This document discusses renal function tests and their clinical implications. It begins by outlining the general anatomy and functions of the kidney. It then classifies renal function tests into urine analysis, blood tests, and tests of glomerular and tubular function. Specific tests are described, including creatinine clearance for glomerular function and urine concentration tests for tubular function. The document discusses how renal function tests can help in assessing and monitoring kidney damage and adjusting drug dosages. Clinical conditions that can be indicated by renal function tests include diabetic nephropathy, acute kidney injury, glomerular diseases, and chronic kidney disease.
rft is described in detail . function of kidney, objectives of doing the test. the various test available for assessing the renal function with clinical interpretation is available.
This document provides an overview of renal function tests. It discusses the anatomy and physiology of the kidney and nephron. It describes various tests used to evaluate glomerular filtration rate (GFR) including creatinine clearance, urea clearance, insulin clearance, and inulin clearance tests. It also covers tests of tubular function like dilution and acidification tests. Normal ranges for urine and blood parameters are provided.
This document discusses renal function tests (RFTs). It begins by describing the functions of the kidney including formation of urine, excretion of waste products, and regulation of water, electrolytes and acid-base balance.
It then explains that RFTs are used to assess renal damage, monitor progression of renal disease, and adjust dosing of nephrotoxic drugs. RFTs provide information on renal blood flow, glomerular filtration rate, tubular function, and urine output. Tests include urine analysis, measurements of glomerular function like creatinine clearance, and tests of tubular function like concentration and dilution tests. The document describes several RFTs in detail.
This document discusses renal function tests and their use in assessing kidney function. It covers tests that measure glomerular filtration rate like creatinine clearance and urea clearance. Creatinine clearance is considered the best measure of glomerular filtration as creatinine is filtered at the glomerulus and neither reabsorbed nor secreted. Stages of kidney disease are defined based on glomerular filtration rate. Tubular function tests like urine concentration are also discussed. Biochemical changes in blood that occur with impaired kidney function are outlined.
This document discusses renal function tests and their importance in assessing kidney function and detecting impairment. It describes various tests including urine analysis, blood tests of creatinine and urea, and glomerular function tests. Common indications for evaluating renal function are listed, such as older age, diabetes, and hypertension. The document also outlines approaches to interpreting test results and diagnosing different kidney conditions like acute injury, nephritic syndrome, and nephrotic syndrome.
The document provides information on kidney function tests and renal assessment. It discusses the anatomy and function of the kidneys and urinary system. Various tests for evaluating glomerular filtration rate (GFR) and renal tubular function are described, including creatinine clearance, urea, uric acid, and beta-2 microglobulin. Urinalysis tests like specific gravity, pH, protein, glucose, and sediment examination are also covered. The document emphasizes the importance of renal function testing in conditions like diabetes, hypertension, and kidney disease.
The document provides information on renal function tests. It discusses the anatomy and functions of the kidneys. There are several reasons to test renal function, including to assess functional capacity, detect impairment, monitor treatment response, and ensure safe drug use. Tests can evaluate glomerular function, renal plasma flow, and tubular function. Common tests include urine analysis, creatinine clearance, urea clearance, inulin clearance, para-amino hippurate clearance, and tests of urine concentration, acidification, and dilution abilities.
Kidney function tests are used to identify impaired renal function, diagnose renal disease, monitor the course of renal disease and treatment response, and plan dialysis or transplantation. Tests of glomerular function include clearance tests measuring glomerular filtration rate (GFR) using creatinine, urea, inulin or radiolabeled substances. GFR declines with age. Tests of tubular function assess the proximal and distal tubules. The glomerular filtration rate (GFR) is the best measure of kidney excretory function and can be estimated using prediction equations or directly measured using clearance tests. Urine analysis provides additional information on renal function by examining the urine's physical, chemical, and microscopic properties.
Renal function tests assess kidney function and detect impairment. They include tests of glomerular filtration rate (GFR) using creatinine, urea and inulin clearance. GFR is calculated using creatinine levels and equations factoring age, weight and sex. Other tests evaluate tubular function through urine concentration, osmolality, and checking for proteins, glucose and amino acids in urine. Together these tests provide valuable information about both glomerular and tubular integrity and kidney health.
This document discusses renal function tests and their use in evaluating kidney function. It describes the key functions of the kidney including fluid balance, waste excretion, blood pressure regulation, vitamin D and erythropoietin production. Tests are classified as evaluating glomerular function like glomerular filtration rate (GFR) tests or tubular function. GFR is best measured by creatinine clearance or equations using creatinine, age, and other factors. Urine and blood tests can indicate glomerular or tubular dysfunction. Clearance tests measure the removal of substances from blood by the kidneys. Renal biopsy may be used to diagnose kidney disease when function tests are unclear.
The kidneys filter blood and produce urine to remove waste and regulate fluid balance. Renal function tests assess kidney health and include urine analysis and tests of glomerular filtration rate (GFR), renal plasma flow, and tubular function. GFR is measured using creatinine clearance, which involves collecting urine for 24 hours and testing creatinine levels in blood and urine. Lower GFR indicates worsening kidney function. Tubular function tests examine the kidneys' ability to concentrate and dilute urine and regulate acid-base balance. Together these tests provide information on both glomerular and tubular performance.
This document discusses renal function tests which are divided into three groups: glomerular function tests, tubular function tests, and urine analysis.
Glomerular function tests include clearance tests such as creatinine clearance test which measures glomerular filtration rate (GFR). Tubular function tests assess kidney's concentrating and diluting abilities through urine concentration and dilution tests. Urine analysis examines physical properties, chemical components, and microscopic contents of urine to detect abnormalities.
This document discusses various renal function tests used to evaluate different aspects of kidney function. It describes tests of glomerular filtration rate (GFR) including clearance tests using substances like creatinine, inulin, and radioactive tracers. It also discusses tubular function tests like urine concentration tests, osmolarity measurements, and tests of the kidney's response to vasopressin. Formulas for calculating clearance, osmolarity, and free water clearance are provided. The significance of GFR measurements and estimated GFR formulas like Cockcroft-Gault and MDRD are summarized.
This document discusses renal function tests (RFTs) which are used to assess kidney function. It outlines the key functions of the kidney including excretion of waste, regulation of acid-base balance and electrolyte levels. RFTs evaluate parameters like glomerular filtration rate, renal blood flow, and tubular function. There are four main types of RFTs: urine analysis, concentration/dilution tests, blood chemistry tests, and renal clearance tests. Blood chemistry tests measure waste products like creatinine and urea to indicate kidney excretion ability, while urine tests examine physical/chemical properties and sediment to identify abnormalities. RFTs are used to diagnose and monitor kidney disease as well as drug toxicity.
This document discusses various kidney function tests, including their purpose, methodology, and normal ranges. It describes tests of glomerular function like serum urea, serum creatinine, urea clearance, and creatinine clearance. It also covers tests of tubular function such as phenolsulphonephthalein excretion, concentration test, and dilution test. Less common tests like serum cystatin C and inulin clearance are also summarized. The document emphasizes interpreting results in light of clinical findings and notes factors that can influence certain test outcomes.
The liver has several important functions including metabolism, synthesis, and storage. Liver dysfunction can be caused by hepatocellular diseases, cholestatic diseases, cirrhosis, cancer, or genetic disorders. Diagnosis involves patient history, exams, labs, imaging, and biopsy. Liver function tests evaluate metabolism, damage to hepatocytes, cholestasis, and synthetic function. Elevations in certain enzymes and proteins provide clues to the type and severity of liver disease.
The document discusses kidney function testing and the urinary system. It provides information on various tests used to evaluate kidney function, including clearance tests to measure glomerular filtration rate (GFR) using creatinine, urea, and uric acid. Clearance tests determine the rate at which the kidneys filter these waste products from the blood into urine. The document also discusses factors that affect interpretation of test results and when assessment of renal function is recommended.
This document discusses various biochemical and radiological tests used to evaluate renal function and diagnose renal disease. It describes tests that measure glomerular filtration rate (GFR) like creatinine clearance, urea clearance, and inulin clearance. It also discusses tubular function tests like urine analysis, concentration tests, and acid load tests. Biomarkers of renal injury like kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and interleukin-18 are also summarized. Radiological investigations like ultrasound, CT, MRI, renal scans, biopsy and cystoscopy are also mentioned.
The document discusses renal function tests and kidney function. It covers:
1. The kidney's main functions including waste removal, electrolyte balance, and vitamin D activation.
2. Glomerular filtration rate (GFR) is measured using clearance tests for urea, creatinine, inulin, and other substances. Creatinine clearance is commonly used to estimate GFR and diagnose chronic kidney disease.
3. Tubular function is assessed using concentration, dilution and excretion tests to identify impaired reabsorption or secretion.
GFR and tubular function tests provide information on filtration and reabsorption rates to evaluate kidney health and diagnose disease.
The document summarizes renal function tests. It discusses how the kidneys maintain homeostasis by regulating water, electrolyte, and acid-base balance. They also excrete metabolic waste and retain vital substances. The kidneys have hormonal functions, producing erythropoietin, calcitriol, renin, angiotensin II, and aldosterone. Renal function tests assess glomerular and tubular function by measuring clearance, electrolyte excretion, and analyzing blood and urine. Abnormal results can indicate renal or other diseases. Tests of renal function are important for managing kidney disease and drug dosing.
This document provides an overview of applied renal physiology and renal function tests by Dr. Nilesh Kate. It discusses the pathophysiology of common renal disorders like renal failure and nephrotic syndrome. It also describes various renal function tests including analysis of urine and blood, clearance tests to measure GFR and RPF, and radiological tests. Diagnostic techniques like renal biopsy are also mentioned. The document concludes with an overview of dialysis methods like hemodialysis and peritoneal dialysis as well as renal transplantation.
This document summarizes the clinical pharmacology of oral anticoagulants including warfarin, dabigatran, rivaroxaban, apixaban, and edoxaban in patients with kidney disease. It finds that while these drugs require dosage adjustment for patients with reduced kidney function, warfarin remains the most widely used option due to lack of comparative data for the newer anticoagulants in patients with severe kidney disease. The pharmacokinetics and pharmacodynamics of each drug are reviewed in detail, along with considerations for reversal agents and monitoring in patients with kidney impairment. The conclusion recommends that apixaban may be an alternative to warfarin if time in the therapeutic INR range is low
The document discusses renal function tests and evaluation of kidney function. It describes the key functions of the kidneys which include regulation of fluid balance, electrolytes, acid-base balance, and excretion of waste. It outlines tests to evaluate glomerular filtration rate (GFR) including creatinine clearance, inulin clearance, and prediction equations. Elevated creatinine and BUN are indicators of reduced GFR but have limitations. Urine analysis and clearance of exogenous filtration markers provide detailed information on kidney function and disease staging.
The kidneys contain approximately 1 million nephrons each. Nephrons are the functional units of the kidney and consist of glomeruli and tubules. Nephron formation is complete by birth but maturation continues into childhood. A decreased number of nephrons can lead to renal disease later in life. Evaluation of renal function includes urine analysis, measurement of glomerular filtration rate (GFR) using creatinine clearance or formulas, and tests of urinary concentration and acidification abilities.
Kidney function test physical macroscopic and microscopic testsSELINA SRAVANTHI
The document discusses kidney function tests and urine analysis. It describes the key roles of the kidney in maintaining fluid, electrolyte, and acid-base balance and producing hormones. Each kidney contains over a million nephrons, the functional units, which are composed of a glomerulus and renal tubules. Urine is formed through glomerular filtration, tubular reabsorption and secretion. Urine analysis includes physical, microscopic and biochemical examinations to assess renal function, detect diseases, and monitor treatment. Macroscopic urine tests examine volume, color, odor, pH and specific gravity. Microscopic analysis identifies cells, crystals, casts and microorganisms. Biochemical tests detect proteins, sugars, ketone bodies and other substances.
Kidney function test npn constituents clearance tests_kidney stone_concentra...SELINA SRAVANTHI
The document discusses various kidney function tests and non-protein nitrogenous constituents in urine. It covers tests for urea, creatinine, and uric acid levels which can indicate kidney function and disease. Elevated or decreased levels of these compounds in blood and urine provide information about prerenal, renal, and postrenal conditions. Clearance tests using creatinine are also described as a way to estimate glomerular filtration rate and assess kidney function.
Acute renal failure (ARF) is defined as a rapid decline in kidney function over hours or days. It can be caused by decreased blood flow to the kidneys, damage or toxicity to the kidney cells. Symptoms include decreased urine output, fatigue, nausea and fluid retention. Treatment involves treating the underlying cause, fluid management, and potentially dialysis. Chronic renal failure (CRF) is the gradual, permanent loss of kidney function over months or years due to conditions like diabetes or hypertension. It leads to a buildup of waste products and imbalances in electrolytes. Management includes dietary modifications, medication, and long-term dialysis or transplant.
Sharir Kriya Instuments By Prof.Dr.R.R.Deshpande –
Sharir Kriya ( Ayurvedic Physiology) is Basic subject of First BAMS ( Ayurvedic Graduation).This PPT is very useful as a Teaching Aid for Ayurvedic Teachers & useful Assets for Learning to Ayurveda students.PPT covers all Important Instruments like Microscopes, Stethascope ,BP Apparatus,Haemocytometer,Neubaur’s chamber,Tunning fork,Clinical Hammer,Urinometer,Hepende’s caliper to measure skin fold thickness,ECG Machine,Thermometer,Nasal Speculum,ESR Tubes & Stands,Ryle’s tube,Autoscope,Vaginal Speculum,Proctoscope,Tonometer etc.Another interesting part is you will get Introduction to useful Books & web site Links of Prof.Dr.R.R.Deshpande .Visit – www.ayurvedicfriend.com
Kidney function tests are used to identify impaired renal function, diagnose renal disease, monitor the course of renal disease and treatment response, and plan dialysis or transplantation. Tests of glomerular function include clearance tests measuring glomerular filtration rate (GFR) using creatinine, urea, inulin or radiolabeled substances. GFR declines with age. Tests of tubular function assess the proximal and distal tubules. The glomerular filtration rate (GFR) is the best measure of kidney excretory function and can be estimated using prediction equations or directly measured using clearance tests. Urine analysis provides additional information on renal function by examining the urine's physical, chemical, and microscopic properties.
Renal function tests assess kidney function and detect impairment. They include tests of glomerular filtration rate (GFR) using creatinine, urea and inulin clearance. GFR is calculated using creatinine levels and equations factoring age, weight and sex. Other tests evaluate tubular function through urine concentration, osmolality, and checking for proteins, glucose and amino acids in urine. Together these tests provide valuable information about both glomerular and tubular integrity and kidney health.
This document discusses renal function tests and their use in evaluating kidney function. It describes the key functions of the kidney including fluid balance, waste excretion, blood pressure regulation, vitamin D and erythropoietin production. Tests are classified as evaluating glomerular function like glomerular filtration rate (GFR) tests or tubular function. GFR is best measured by creatinine clearance or equations using creatinine, age, and other factors. Urine and blood tests can indicate glomerular or tubular dysfunction. Clearance tests measure the removal of substances from blood by the kidneys. Renal biopsy may be used to diagnose kidney disease when function tests are unclear.
The kidneys filter blood and produce urine to remove waste and regulate fluid balance. Renal function tests assess kidney health and include urine analysis and tests of glomerular filtration rate (GFR), renal plasma flow, and tubular function. GFR is measured using creatinine clearance, which involves collecting urine for 24 hours and testing creatinine levels in blood and urine. Lower GFR indicates worsening kidney function. Tubular function tests examine the kidneys' ability to concentrate and dilute urine and regulate acid-base balance. Together these tests provide information on both glomerular and tubular performance.
This document discusses renal function tests which are divided into three groups: glomerular function tests, tubular function tests, and urine analysis.
Glomerular function tests include clearance tests such as creatinine clearance test which measures glomerular filtration rate (GFR). Tubular function tests assess kidney's concentrating and diluting abilities through urine concentration and dilution tests. Urine analysis examines physical properties, chemical components, and microscopic contents of urine to detect abnormalities.
This document discusses various renal function tests used to evaluate different aspects of kidney function. It describes tests of glomerular filtration rate (GFR) including clearance tests using substances like creatinine, inulin, and radioactive tracers. It also discusses tubular function tests like urine concentration tests, osmolarity measurements, and tests of the kidney's response to vasopressin. Formulas for calculating clearance, osmolarity, and free water clearance are provided. The significance of GFR measurements and estimated GFR formulas like Cockcroft-Gault and MDRD are summarized.
This document discusses renal function tests (RFTs) which are used to assess kidney function. It outlines the key functions of the kidney including excretion of waste, regulation of acid-base balance and electrolyte levels. RFTs evaluate parameters like glomerular filtration rate, renal blood flow, and tubular function. There are four main types of RFTs: urine analysis, concentration/dilution tests, blood chemistry tests, and renal clearance tests. Blood chemistry tests measure waste products like creatinine and urea to indicate kidney excretion ability, while urine tests examine physical/chemical properties and sediment to identify abnormalities. RFTs are used to diagnose and monitor kidney disease as well as drug toxicity.
This document discusses various kidney function tests, including their purpose, methodology, and normal ranges. It describes tests of glomerular function like serum urea, serum creatinine, urea clearance, and creatinine clearance. It also covers tests of tubular function such as phenolsulphonephthalein excretion, concentration test, and dilution test. Less common tests like serum cystatin C and inulin clearance are also summarized. The document emphasizes interpreting results in light of clinical findings and notes factors that can influence certain test outcomes.
The liver has several important functions including metabolism, synthesis, and storage. Liver dysfunction can be caused by hepatocellular diseases, cholestatic diseases, cirrhosis, cancer, or genetic disorders. Diagnosis involves patient history, exams, labs, imaging, and biopsy. Liver function tests evaluate metabolism, damage to hepatocytes, cholestasis, and synthetic function. Elevations in certain enzymes and proteins provide clues to the type and severity of liver disease.
The document discusses kidney function testing and the urinary system. It provides information on various tests used to evaluate kidney function, including clearance tests to measure glomerular filtration rate (GFR) using creatinine, urea, and uric acid. Clearance tests determine the rate at which the kidneys filter these waste products from the blood into urine. The document also discusses factors that affect interpretation of test results and when assessment of renal function is recommended.
This document discusses various biochemical and radiological tests used to evaluate renal function and diagnose renal disease. It describes tests that measure glomerular filtration rate (GFR) like creatinine clearance, urea clearance, and inulin clearance. It also discusses tubular function tests like urine analysis, concentration tests, and acid load tests. Biomarkers of renal injury like kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and interleukin-18 are also summarized. Radiological investigations like ultrasound, CT, MRI, renal scans, biopsy and cystoscopy are also mentioned.
The document discusses renal function tests and kidney function. It covers:
1. The kidney's main functions including waste removal, electrolyte balance, and vitamin D activation.
2. Glomerular filtration rate (GFR) is measured using clearance tests for urea, creatinine, inulin, and other substances. Creatinine clearance is commonly used to estimate GFR and diagnose chronic kidney disease.
3. Tubular function is assessed using concentration, dilution and excretion tests to identify impaired reabsorption or secretion.
GFR and tubular function tests provide information on filtration and reabsorption rates to evaluate kidney health and diagnose disease.
The document summarizes renal function tests. It discusses how the kidneys maintain homeostasis by regulating water, electrolyte, and acid-base balance. They also excrete metabolic waste and retain vital substances. The kidneys have hormonal functions, producing erythropoietin, calcitriol, renin, angiotensin II, and aldosterone. Renal function tests assess glomerular and tubular function by measuring clearance, electrolyte excretion, and analyzing blood and urine. Abnormal results can indicate renal or other diseases. Tests of renal function are important for managing kidney disease and drug dosing.
This document provides an overview of applied renal physiology and renal function tests by Dr. Nilesh Kate. It discusses the pathophysiology of common renal disorders like renal failure and nephrotic syndrome. It also describes various renal function tests including analysis of urine and blood, clearance tests to measure GFR and RPF, and radiological tests. Diagnostic techniques like renal biopsy are also mentioned. The document concludes with an overview of dialysis methods like hemodialysis and peritoneal dialysis as well as renal transplantation.
This document summarizes the clinical pharmacology of oral anticoagulants including warfarin, dabigatran, rivaroxaban, apixaban, and edoxaban in patients with kidney disease. It finds that while these drugs require dosage adjustment for patients with reduced kidney function, warfarin remains the most widely used option due to lack of comparative data for the newer anticoagulants in patients with severe kidney disease. The pharmacokinetics and pharmacodynamics of each drug are reviewed in detail, along with considerations for reversal agents and monitoring in patients with kidney impairment. The conclusion recommends that apixaban may be an alternative to warfarin if time in the therapeutic INR range is low
The document discusses renal function tests and evaluation of kidney function. It describes the key functions of the kidneys which include regulation of fluid balance, electrolytes, acid-base balance, and excretion of waste. It outlines tests to evaluate glomerular filtration rate (GFR) including creatinine clearance, inulin clearance, and prediction equations. Elevated creatinine and BUN are indicators of reduced GFR but have limitations. Urine analysis and clearance of exogenous filtration markers provide detailed information on kidney function and disease staging.
The kidneys contain approximately 1 million nephrons each. Nephrons are the functional units of the kidney and consist of glomeruli and tubules. Nephron formation is complete by birth but maturation continues into childhood. A decreased number of nephrons can lead to renal disease later in life. Evaluation of renal function includes urine analysis, measurement of glomerular filtration rate (GFR) using creatinine clearance or formulas, and tests of urinary concentration and acidification abilities.
Kidney function test physical macroscopic and microscopic testsSELINA SRAVANTHI
The document discusses kidney function tests and urine analysis. It describes the key roles of the kidney in maintaining fluid, electrolyte, and acid-base balance and producing hormones. Each kidney contains over a million nephrons, the functional units, which are composed of a glomerulus and renal tubules. Urine is formed through glomerular filtration, tubular reabsorption and secretion. Urine analysis includes physical, microscopic and biochemical examinations to assess renal function, detect diseases, and monitor treatment. Macroscopic urine tests examine volume, color, odor, pH and specific gravity. Microscopic analysis identifies cells, crystals, casts and microorganisms. Biochemical tests detect proteins, sugars, ketone bodies and other substances.
Kidney function test npn constituents clearance tests_kidney stone_concentra...SELINA SRAVANTHI
The document discusses various kidney function tests and non-protein nitrogenous constituents in urine. It covers tests for urea, creatinine, and uric acid levels which can indicate kidney function and disease. Elevated or decreased levels of these compounds in blood and urine provide information about prerenal, renal, and postrenal conditions. Clearance tests using creatinine are also described as a way to estimate glomerular filtration rate and assess kidney function.
Acute renal failure (ARF) is defined as a rapid decline in kidney function over hours or days. It can be caused by decreased blood flow to the kidneys, damage or toxicity to the kidney cells. Symptoms include decreased urine output, fatigue, nausea and fluid retention. Treatment involves treating the underlying cause, fluid management, and potentially dialysis. Chronic renal failure (CRF) is the gradual, permanent loss of kidney function over months or years due to conditions like diabetes or hypertension. It leads to a buildup of waste products and imbalances in electrolytes. Management includes dietary modifications, medication, and long-term dialysis or transplant.
Sharir Kriya Instuments By Prof.Dr.R.R.Deshpande –
Sharir Kriya ( Ayurvedic Physiology) is Basic subject of First BAMS ( Ayurvedic Graduation).This PPT is very useful as a Teaching Aid for Ayurvedic Teachers & useful Assets for Learning to Ayurveda students.PPT covers all Important Instruments like Microscopes, Stethascope ,BP Apparatus,Haemocytometer,Neubaur’s chamber,Tunning fork,Clinical Hammer,Urinometer,Hepende’s caliper to measure skin fold thickness,ECG Machine,Thermometer,Nasal Speculum,ESR Tubes & Stands,Ryle’s tube,Autoscope,Vaginal Speculum,Proctoscope,Tonometer etc.Another interesting part is you will get Introduction to useful Books & web site Links of Prof.Dr.R.R.Deshpande .Visit – www.ayurvedicfriend.com
This document summarizes renal function tests and urine analysis. It describes the anatomy and function of the nephron, steps in urine formation, and normal ranges for physical and chemical urine tests including volume, color, odor, specific gravity, pH, creatinine, BUN, electrolytes, glucose, protein, and ketones. It discusses clinical implications of abnormal test values and interfering factors. Macroscopic urine examination for casts and cells is also covered, in addition to exogenous markers of glomerular filtration rate like inulin and iothalamate clearance tests.
This document provides an overview of the normal histology of the kidney. It describes the anatomy and histological features of the major structures of the kidney, including the cortex, medulla, renal corpuscle, nephron (glomerulus, proximal and distal tubules, loop of Henle), collecting duct system, and juxtaglomerular apparatus. Key cellular components such as podocytes, mesangial cells, and intercalated cells are also discussed. The functions of the kidney in regulating fluid and electrolyte balance and producing hormones are briefly introduced.
The kidneys are located behind the peritoneum in the posterior abdomen, one on each side of the spine. The kidneys filter blood, remove waste through urine production, secrete hormones, and regulate fluid and electrolyte balance. Each kidney has an anterior and posterior surface, an upper and lower extremity, and a medial and lateral border. The kidneys receive their blood supply from the renal arteries, which branch into smaller arteries within the kidneys.
This document discusses the key functions and mechanisms of the kidneys. The kidneys are responsible for regulating water, electrolyte and acid-base balance, and excreting metabolic waste products like urea and creatinine. They also retain substances vital to the body like glucose and amino acids. The kidneys function as endocrine organs by producing hormones like erythropoietin and calcitriol. The nephron is the functional unit of the kidney, and glomerular filtration and tubular reabsorption are the key processes in urine formation. Various tests are used to assess kidney function, including clearance tests using creatinine and urea, as well as examining the blood, urine and using thresholds.
The kidney has four main functions:
1. Excretory - forms and excretes urine through glomerular filtration, reabsorption, and secretion
2. Homeostatic - regulates blood volume, pressure, pH and electrolyte concentrations
3. Endocrine - produces hormones like erythropoietin, renin, and prostaglandins
4. Metabolic - performs gluconeogenesis during starvation and metabolizes hormones
The document discusses renal function tests which evaluate how well the kidneys are functioning. There are three main groups of renal function tests: urine and blood analysis, assessment of renal clearance, and additional specialized tests. Renal function tests are useful for early detection of kidney damage, monitoring disease progression and treatment effectiveness, and predicting when renal replacement therapy may be needed. Common tests include analysis of urine volume, appearance, constituents, and sediment as well as blood tests of urea and creatinine levels. Clearance tests measure the glomerular filtration rate using markers like inulin, creatinine, or iohexol.
This document discusses acute and chronic renal failure. It defines renal failure and describes how acute failure has a sudden onset and may be reversible, while chronic failure progresses slowly over months and can lead to permanent damage. Causes of acute failure include reduced blood flow or obstruction, while chronic failure may result from conditions like diabetes, hypertension, or glomerulonephritis. Symptoms depend on the type and stage of renal failure. Treatment involves managing fluid, electrolytes, diet, and potentially dialysis or transplantation.
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ICU presentation - Hannah Bond and Kim TreierKimberly Treier
This document provides an overview of drugs affecting the kidney including their mechanisms and common examples. It discusses kidney anatomy and outlines common drugs that can cause vasoconstriction or vasodilation in the afferent or efferent arterioles. Examples of drugs that can cause tubular epithelial cell damage through acute tubular necrosis are also provided, such as aminoglycoside antibiotics and radiographic contrast media. The document also briefly discusses chronic kidney disease, acute kidney injury, and drug-induced nephrotoxicity.
best Ckd presentation1 by Dr. sachin kr ranaSachin Rana
Chronic Kidney Disease is defined as a slow loss of renal function over time leading to decreased ability to remove waste from the body. It affects about 26 million people in the US and is increasing due to diabetes and hypertension. Pathophysiology involves a decrease in nephrons leading to adaptive changes that eventually cause glomerular sclerosis and further kidney function decline. Stages are based on Glomerular Filtration Rate from normal to end stage renal disease requiring dialysis. Treatment focuses on controlling hypertension, acidosis, electrolyte abnormalities, secondary effects like anemia and bone disease through diet, medication and potentially dialysis. Dialysis options include peritoneal dialysis with advantages of immediate initiation but risks of peritonitis
This document provides information on chronic kidney disease (CKD), including its definition, causes, stages, clinical assessment, complications, treatment, and management of associated conditions like hypertension and dyslipidemia. CKD is defined as kidney damage or decreased kidney function lasting 3 months or more. The three most common causes are diabetes, hypertension, and glomerular disease. CKD progresses through five stages depending on kidney damage severity and function level. Treatment focuses on slowing disease progression, managing complications, and reducing cardiovascular risk through blood pressure control, cholesterol lowering, and other measures.
The document provides an overview of renal function tests, including their indications, procedures, and clinical significance. It discusses various markers used to assess glomerular filtration rate (GFR) like creatinine, cystatin C, and blood urea nitrogen. It also covers urine analysis to detect proteinuria, albuminuria, and tubular disorders. Normal GFR is 90-120 ml/min while a level below 15 ml/min indicates kidney failure. Acute kidney injury is defined as a rapid decline in renal function over hours to days, while chronic kidney disease occurs over months to years.
Pitfalls in estimating renal failure in the elderly by eGFRRanjit Singh
The document discusses methods of estimating glomerular filtration rate (GFR) including direct and indirect assessments. Direct assessments involve clearance tests using exogenous or endogenous substances like inulin, iohexol, creatinine, and cystatin C. Indirect assessments utilize estimating equations like Cockcroft-Gault, MDRD, and CKD-EPI which take factors like age, sex, and creatinine levels into account. The CKD-EPI equation is currently recommended for GFR estimation in adults. Age-related declines in GFR are also discussed.
A 30-year old female patient was admitted with symptoms of shortness of breath, pedal edema, facial puffiness, and periorbital swelling. She has a history of acute kidney infection. Laboratory tests revealed decreased calcium and albumin levels, increased phosphorus, and a glomerular filtration rate of 18 ml/min, consistent with chronic kidney disease. Her treatment plan includes medications to reduce swelling, acidosis, and blood pressure, as well as mineral and vitamin supplements. She was counseled on lifestyle changes like a salt-restricted diet and exercise to help manage her condition.
This document provides an overview of chronic kidney disease (CKD). It defines CKD as a progressive loss of kidney function over time, usually defined as a glomerular filtration rate (GFR) below 60 mL/min/1.73m2 for 3 months or more. The leading causes of CKD are diabetes and hypertension. The stages of CKD are defined based on GFR levels. Symptoms arise as GFR declines and waste builds up. Management involves controlling risk factors, treating complications, nutritional therapy, and possibly dialysis or transplantation.
Accuracy of Laboratory Parameters in Management of CKD.Ravi Kumudesh
This document discusses laboratory parameters for managing chronic kidney disease (CKD). It covers direct and indirect methods of nutritional assessment, modifiable and non-modifiable risk factors for CKD, types of assays including static and functional, targets for assay accuracy and precision, categories and specific tests of renal function including glomerular filtration rate (GFR) tests. It addresses factors that can interfere with creatinine levels, patient preparation, reference ranges, and interpretation of creatinine concentrations. Stages of CKD and roles in patient safety are outlined. Alternative ways to identify early CKD and approaches for the future are proposed.
This document provides information on managing renal failure in primary care. It presents a case study of a 46-year-old woman with chronic kidney disease due to uncontrolled diabetes and hypertension. Key steps in management include controlling blood pressure and diabetes, addressing complications like anemia and bone disease, and referring to nephrology if glomerular filtration rate drops below 30 or complications require treatment. The take-home message is that lifestyle modification, monitoring for complications, and early nephrology referral can help slow chronic kidney disease progression.
Dosage regimen in renal failure ( Neha Mayekar).pptxSaishDalvi
This document discusses dosage adjustment in patients with renal failure. It notes that renal failure can impact drug absorption, distribution, metabolism and excretion. Two main methods are described for adjusting dosages - based on drug clearance or based on changes in elimination rate constant. The goal is to maintain therapeutic drug concentrations while accounting for changes like prolonged half-life. Formulas for estimating creatinine clearance, which indicates renal function, are also provided to help determine appropriate dosage adjustments for patients with impaired kidney function.
Dosage adjustment in Hepatic Failure.pdfsamthamby79
This document discusses dosage adjustment considerations in patients with hepatic impairment. It covers hepatic drug clearance and how it is affected by factors like hepatic blood flow and extraction ratio. Drugs are classified as having high, intermediate, or low extraction ratios. The Child-Pugh score and MELD classification scheme are presented as tools to assess liver disease severity and determine appropriate dosage adjustments. Recommendations are provided for various drug types based on their extraction ratios and protein binding properties.
1) The document discusses the approach to chronic kidney disease (CKD). It defines CKD and outlines its stages based on glomerular filtration rate and albuminuria levels.
2) Risk factors for CKD mentioned include diabetes, hypertension, family history of kidney disease, use of certain medications, and prior acute kidney injury. The pathogenesis of CKD involves initial injury followed by adaptive hyperfiltration and long-term damage to remaining nephrons.
3) Evaluation of patients with suspected CKD involves obtaining a history, physical exam, lab tests including serum creatinine and urine analysis, and imaging like renal ultrasound. A kidney biopsy may be done if disease-specific therapy is still possible.
1) Diabetic nephropathy is characterized by persistent albuminuria, declining GFR, and presence of retinopathy. It involves thickening of basement membranes and expansion of the mesangial matrix.
2) It progresses through five stages from hyperfiltration to end-stage renal disease. Glycemic control, blood pressure management, and ACE inhibitors or ARBs can slow its progression.
3) Treatment involves tight glycemic and blood pressure control, lipid lowering, dietary protein restriction, anemia management, and renal replacement therapy through hemodialysis, peritoneal dialysis, or transplantation if end-stage is reached.
1) Diabetic nephropathy is characterized by persistent albuminuria, declining GFR, and presence of retinopathy. It involves thickening of basement membranes and expansion of the mesangial matrix.
2) It progresses through five stages from hyperfiltration to end-stage renal disease. Glycemic control, blood pressure management, and ACE inhibitors or ARBs can slow progression.
3) For patients reaching end-stage renal disease, treatment options include hemodialysis, peritoneal dialysis, and kidney transplantation. Kidney transplantation has the best outcomes, but survival is still worse for diabetics than non-diabetics.
Cystatin-C is a protein produced by all nucleated cells and filtered out of the bloodstream by healthy kidneys. It is a more sensitive marker of kidney function than creatinine, as its levels rise earlier when glomerular filtration rate decreases. Measurement of cystatin-C can help detect chronic kidney disease at an earlier stage than creatinine. The document discusses the history, molecular biology, structure, role in medicine, prevalence, and stages of chronic kidney disease, highlighting how cystatin-C can be a useful marker for detecting and monitoring kidney function and disease.
1. Chronic kidney disease (CKD) affects 1 in 10 people in the UK and is often unrecognized as it commonly occurs alongside other conditions like cardiovascular disease or diabetes.
2. CKD is defined as abnormalities of the kidneys persisting for over 3 months, determined by markers of kidney damage or a glomerular filtration rate (GFR) of under 60 ml/min/1.73m^2.
3. People with CKD should be monitored for progression and referred to a nephrologist if their GFR declines rapidly or they have advanced CKD with a GFR under 30 ml/min/1.73m^2.
Over 40% of new end-stage renal disease cases are caused by diabetes. Diabetic nephropathy progresses through 5 stages as kidney function declines and protein passes into the urine. The average time to progress from stage 1 to kidney failure is 23 years. Treatment focuses on blood pressure and glucose control using ACE inhibitors, diet modification, and dialysis or transplant for kidney failure.
The summary of the document is:
1. The Renin-Angiotensin-Aldosterone System (RAAS) is activated in response to hypotension, decreased sodium concentration, and decreased blood volume to increase blood pressure through vasoconstriction and sodium retention.
2. Nephrotic syndrome requires proteinuria over 3g per day, hypobulinemia, and edema. The most common causes are membranous glomerulonephritis, minimal-change GN, and focal segmental glomerulosclerosis.
3. Nephritic syndrome presents with hematuria, proteinuria, hypertension, edema, and oliguria. It is often seen in IgA nep
Uremia refers to the pathological manifestations that result from severe azotemia or high levels of urea in the blood due to kidney failure. The onset of uremia symptoms can vary depending on how quickly kidney function is lost. Both uremia and the uremic syndrome describe a very high plasma urea concentration caused by renal failure. As kidney function declines in chronic kidney disease, patients may experience fluid and electrolyte abnormalities, endocrine and metabolic issues, neurological problems, cardiovascular and pulmonary issues, dermatological changes, gastrointestinal disturbances, and hematological and immunological abnormalities. Many of these complications improve with dialysis treatment, while some persist even with optimal therapy.
2. Goals and objectives
• At the end of this discussion you will be
able to state:
• What test you should use to screen a
patient for renal disease
• What can raise the BUN and Creatinine
other than kidney disease
• How to determine prerenal azotemia
from acute tubular necrosis (ATN).
3.
4. When should you assess renal
function?
• Risk factors for kidney disease:
– Older age
– Family history of Chronic Kidney disease (CKD)
– Decreased renal mass
– Low birth weight
– US racial or ethic minority
– Low income
– Lower education level
– Diabetes Mellitus (DM)
– Hypertension (HTN)
– Autoimmune disease
– Systemic infections
– Urinary tract infections (UTI)
– Nephrolithiasis
– Obstruction to the lower urinary tract
– Drug toxicity
6. BUN
• Urea is a relatively nontoxic substance
made by the liver to dispose of ammonia
resulting from protein metabolism.
• The real urea concentration is BUN x 2.14
• Normal BUN range is 8-25 mg/dL
• BUN is a sensitive indicator of renal disease
7. BUN
• Increased BUN = Azotemia
– Causes: increased protein catabolism
or impaired kidney function
– Increased protein catabolism:
• Increased dietary protein
• Severe tress: MI, fever, etc
• Rhabdomyolysis
• Upper GI bleeding
– Impaired renal function
• Pre renal azotemia: renal hypoperfusion
• Renal azotemia: acute tubular necrosis
• Post renal azotemia: obstruction of
urinary flow
8. Creatinine
• The breakdown product of
creatine phosphate released
from skeletal muscle at a
steady rate.
• It is filtered by the
glomerulus.
• It is generally a more
sensitive and specific test for
renal function than the BUN.
• Normal range is 0.6-1.3 mg/dL
– *non pregnant state
9. Creatinine
• Increased serum creatinine:
– Impaired renal function
– Very high protein diet
– Anabolic steroid users
– Vary large muscle mass: body
builders, giants, acromegaly patients
– Rhabdomyolysis/crush injury
– Athletes taking oral creatine
– Drugs:
• Probenecid
• Cimetidine
• Triamterene
• Trimethoprim
• Amiloride
10.
11. Creatinine clearance
• A timed urine sample and serum
sample used to approximate the
glomerular filtration rate.
• It is not an exact measure of the
GFR because some is not filtered
and some is secreted into the
proximal tubule.
– In health these cancel each other out.
– When the GFR drops below 30mL/min
the tubular secretion exceeds the
amount filtered and can give a false
elevation.
12. Glomerular filtration rate: GFR
• GFR: sum of the filtration rates in all of the
functioning nephrons
GFR = [UCr x V]/PCr
**Timed collection over 24 hours
CCr = [UCr md/dL x V L/day]/ PCr mg/dL =
liter/day
*This value can be multiplied by 1000 to
convert to mL and divided by 1400 (the
number of minutes in a day) to convert into
units of mL/min
13. GFR
• Erroneous values:
• Increasing creatinine secretion
– As the GFR falls, the rise in the
PCr is partially ameliorated by
increased creatinine secretion.
14. GFR
• Erroneous values in GFR:
– Incomplete urine collection
• Assess adequacy of collection from steady
state creatinine:
– Adult < 50 years of age (lean body weight)
» Male 20-35 mgs/kg daily creatinine
excretion
» Females 15-20 mgs/kg daily creatinine
excretion
– Adult ages 50-90 (lean body weight)
» There is a progressive 50% decline in
creatinine excretion
15. Estimation formulas
• May be less accurate in certain populations:
– Normal or near normal renal function
– Children
– >70 years of age
– Ethnic groups
– Pregnant women
– Unusual muscle mass
– Morbid obesity
• It is recommended to obtain a creatinine
clearance in stable renal function and prior
to dosing toxic drugs that are renally
excreted.
17. MDRD Equation
GFR (ml/min/1.73m2) =
186 x (Pcr)1.154 x Age0.203 x (0.742 if female) x (1.210 if African American)
MDRD = Modification of Diet in Renal Disease Study
Levey et al. Ann Int Med 139:137-147, 2003
Download GFR calculator at www.nkdep.nih.gov
The equation requires 4 variables:
• Serum creatinine
• Age
• Sex
• African American or not
18. Staging of chronic kidney disease
CKD
Renal
replacement
therapy if uremic
<15 or
dialysis
Kidney
failure
5
Preparation for
renal
replacement
therapy
15-29Severe ↓GFR
4
Evaluating and
treating
complications
30-59Moderate
↓GFR3
Estimate
progression60-89Kidney
damage with
mild ↓GFR
2
Diagnosis and
treatment;
treat comorbid
conditions Slow
progression of cvd
>90Kidney damage
with normal or
↑GFR
1
RecommendationGFR
mL/min/1.73M2
Description
Stage
25. Urine and Serum diagnostic indices
~10
>1%
~10
>1%
>20
<1%
Serum
BUN/Creat
Renal failure
index
<3<3>8Urine/Serum
(urea):
<20<20>40Urine/Serum
creatinine
<350<350>500Urine
osmolarity
----------------------------------<35%FEUrea
>2%>2%<1%FENa
------------------->20mEq/L<20mEq/LUrine Chloride
>20mEq/L>20mEq/L<20mEq/LUrine sodium
PostrenalRenalPrerenal
26. Urine concentrating ability:
specific gravity
• Provide important information
about tubular function and
hydration.
• Pre renal azotemia
– high urine specific gravity (>1.010)
and low or zero urinary sodium
• Renal azotemia
– Will have low urine specific gravity
or isosthenuria
• ATN, severe bilateral pyelonephritis,
interstitial nephritis, diuretic, or CKD 5
27. Uric Acid
• Metabolite of purine
metabolism
• Filtered by the
glomeruli and both
reabsorbed and
secreted by the renal
tubules.
• Increased in:
– Renal failure
– Gout
– Liver and
sweetbread
gourmets
– Lead poisoning
– Thiazide
diuretics
– High dose
aspirin
– Burns,
– Crush injuries
– Severe
hemolytic
anemia
– Myeloproliferative
disorders
– Plasma cell
myeloma
– Tumor lysis: post
chemotherapy
28.
29. Summary
• What test you should use to
screen a patient for renal
disease
• What can raise the BUN and
Creatinine other than kidney
disease
• How to determine prerenal
azotemia from acute tubular
necrosis (ATN).
31. Overview of Renal Function Tests
Patients presenting with renal disease frequently have a myriad of clinical presentations. These
range from actual kidney symptoms such as hematuria or to extrarenal symptoms such as
edema, hypertension and signs of uremia. However, most are asymptomatic. Frequently the first
sign of renal disease is seen on routine testing noting an elevated serum creatinine or an
abnormal urinalysis. This discussion is limited to renal function testing not urinalysis or urinary
sediment examination.
By performing renal function testing the physician can better manage the individual patient’s
health care. This includes:
• Quantification of renal function
• Medication usage/radiocontrast use
• Identification and quantification of the degree of renal impairment:
• Noting patients who require referral to Nephrologist:
o Stage 2 CKD and up
BUN and Creatinine
Both the BUN and serum Creatinine can reflect renal function. The BUN is very sensitive but not
as specific as the serum Creatinine. The elevation of the BUN (azotemia) can be affected by
either changes in increased protein catabolism (large meat protein meals, severe stress: MI,
fever, Upper GI bleeding) or impaired renal function (Pre renal, renal and post renal azotemia).
The serum Creatinine is more specific. It is the breakdown product of creatine phosphate
released from skeletal muscle at a steady rate. It is filtered by the glomerulus. A general rule of
thumb: if the serum creatinine doubles then the glomerular filtration rate (GFR) halves. The
serum creatinine and glomerular filtration rate are affected by muscle mass, aging, ethnic
background and medications.
Stage Description GFR
mL/min/1.73M2
Recommendation
1 Kidney damage
with normal or
↑GFR
>90 Diagnosis and
treatment;
treat comorbid
conditions Slow
progression of cvd
2 Kidney damage
with mild ↓GFR
60-89 Estimate progression
3 Moderate ↓GFR 30-59 Evaluating and
treating
complications
4 Severe ↓GFR 15-29 Preparation for
renal replacement
therapy
5 Kidney failure <15 or dialysis Renal replacement
therapy if uremic
32. Factors that increase the BUN and Creatinine other than reduced renal function:
BUN Creatinine
Increased protein catabolism:
o Increased dietary proteins
o Severe stress
o MI
o Fevers
o Rhabdomyolysis
o Upper GI bleeding
o Very high protein diet
o Anabolic steroid use
o Very large muscle mass
o Body builders
o Giants
o Acromegaly
o Rhabdomyolysis
o Crush injuries
o Athletes taking oral creatine
o Drugs
-Probenecid
-Cimetidine
-Triamterene
-Trimethoprim
-Amiloride
Creatinine clearance
Estimating the creatinine clearance is useful to stage the degree of renal impairment. This is
necessary to properly dose medications and to appropriately manage the stages of chronic
kidney disease. The creatinine clearance is a timed specimen. The creatinine in the urine is
measured and compared to a serum creatinine measured within 24 hours of the urine specimen.
Creatinine is both filtered at the glomerulus and secreted by the proximal tubule in the kidney.
Therefore, unlike inulin, excretion overestimates the true glomerular filtration rate to the secreted
portion. Errors can occur in the collection of the specimen. Therefore, careful instructions must
be given the patient. The patient must be educated to discard the first morning urine specimen, to
collect all other urination for the day of collection, through the night and the first specimen of the
following day. The amount of creatinine in the 24 hour collection can be compared to the
expected amount of creatinine production (in a steady state) based on the size of the patient:
Adult < 50 years of age (lean body weight)
» Male 20-35 mgs/kg daily creatinine excretion
» Females 15-20 mgs/kg daily creatinine excretion
Adult ages 50-90 (lean body weight)
» There is a progressive 50% decline in creatinine
excretion
For example: A 42 year old 60 Kg (lean body weight) female with a measured serum creatinine
of 2.2 mg/dL, urine volume of 2500mL/24 hours, urine creatinine of 100 mg/dL (1000mg/L).
(2500ml/day)(100mg/dL)
(1440min/day)(2.2mg/dL) = 81.16 ml/min
To assess adequacy of collection you would multiply by the expected milligrams of creatinine in a
24 hour timed collection. Here it is either 20 x 60 =1200mg/day 15 x 60 = 900mg/day; therefore,
her collection at 1000mgs is adequate.
Estimating GFR from serum values can be done using several formulas the Cockcroft-Gault
equation (using the serum creatinine, age, weight and gender) Modification of Diet in Renal
Disease (MDRD) equation (using age, serum creatinine, sex and African American or not). The
estimation equations may be less accurate in some patient populations. Those individuals with
normal or near-normal renal function, children, patients older than 70 years of age, other ethnic
33. groups, pregnant women, and those with unusual muscle mass, body habitus, and weight (
morbid obesity or malnourished).
Determining between pre renal azotemia and acute tubular necrosis (renal azotemia)
Pre renal azotemia results from a reduction in renal blood flow and is the most common form of
acute renal failure. The more common causes of pre renal azotemia are true volume depletion,
advanced liver disease, and congestive heart failure. The kidneys try to increase the renal blood
flow by saving sodium; hence, a low urinary sodium excretion with a high specific
gravity/increased urine osmolality. This yields a fractional excretion of sodium <1% and a fraction
excretion of urea of <35%.
Renal azotemia (ATN) is characterized by renal tubular injury. There are many causes ranging
from renal ischemia and exposure to exogenous and endogenous nephrotoxins. The net effect is
a rapid decline in renal function that may require a period of dialysis before spontaneous
resolution occurs. The major causes of ATN are severe prerenal disease causing renal ischemia,
exposure to nephtotoxins such as aminoglycosides, NSAIDS, radio contrast agents, cisplatin,
acyclovir, pentamidine, Heme Pigments, etc. The kidneys are damaged and therefore cannot
concentrate urine and waste sodium. The fractional excretion of sodium is >2% and the fractional
excretion of urea is >35%. (The fractional excretion of sodium may be affected by diuretics,
radiocontrast agents and urine volume. It is valid in oliguric acute renal failure. The
FEUrea is more reliable in these conditions.)
Table Correlating indices with Acute Renal Failure Classification
Prerenal Renal Postrenal
Urine sodium <20mEq/L >20mEq/L >20mEq/L
Urine Chloride <20mEq/L >20mEq/L -------------------
FENa <1% >2% >2%
FEUrea <35% ---------------- ------------------
Urine
osmolarity
>500 <350 <350
Urine/Serum
creatinine
>40 <20 <20
Urine/Serum
(urea):
>8 <3 <3
Serum
BUN/Creat
Renal failure
index
>20
<1%
~10
>1%
~10
>1%
34. Uric Acid
The Serum Uric Acid can correlate with decreasing renal function. It can also serve as a cause of
decreased renal function. Increase values may cause precipitation within the tubules and cause
intra tubular slugging and stone formation with blockage of urine flow. This blockage of urine flow
can cause renal damage and subsequent failure.
Summary:
Renal function tests should be ordered on patients who are at risk of kidney disease. They are
used to monitor renal function, stage chronic kidney disease, classify acute renal failure, and
dose medications. Knowing the various tests available and the idiocrancies of each test will
provide patients with a better health care plan and monitoring.
Equations:
Cockcroft-Gault:
(140 – Age) x Wt. Kg. (lean body wt.)
(serum Creatinine) x 72
• multiply by 0.85 for women
MDRD:
GFR (ml/min/1.73m2) =
186 x (Pcr)1.154 x Age0.203 x (0.742 if female) x (1.210 if African American)
FENa:
FENa (%)=(Urine sodium/plasma sodium)
(Urine creat./plasma creat.) X 100
FEUrea:
(UUN ÷ BUN) X (Serum Creat. ÷ Urine Creat.) X 100%
Renal Failure Index:
RFI=Urine sodium X Plasma creatinine
Urine creatinine
35. References:
1. K/DOQI Clinical Practice Guidelines on Chronic Kidney Disease. AJKD 2002: 39(2) S.1:
S1-S266.
2. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine.
Nephrol 1992: 62:249-256.
3. Walser, M. Assessing renal function from creatinine measurements in adults with chronic
renal failure. Am J Kidney Dis 1998: 32: 389.
4. Rodrigo, E, De Franscisco, AL, Escallada, R, et al. Measurement of renal function I pre-
ESRD patients. Kidney Int Suppl 2003; 11.
5. Levin, A. The advantage of a uniform terminology and staging system for chronic kidney
disease (CKD). Nephrol Dial Transplant 2003; 18:1446.
6. Rule, AD, Larson, TS, Bergstralh, EJ, Et al. Using serum creatinine to estimate
glomerular filtration rate: accuracy in good health and in chronic kidney disease. Ann
Intern Med 2004; 141:929
7. Frosissart, M Rossert, J, Jacquot, D, et al. Predictive performace of the modification of
diet in renal disease and Cockcroft-Gault equations for estimating renal function. J Am
Soc Nephrol 2005; 16:763
8. Esson, ML, Schrier, RW. Diagnosis and treatment of acute tubular necrosis. Ann Intern
Med 1002; 136: 744
9. Lameire, N, Van Biesen, W, Vanholder, R. Acute renal failure. Lancet 2005;365: 417
10. Rose, DR, Post, TW. Clinical Physiology of acid-base and electrolyte disorders. McGraw-
Hill 5th
Ed. 21-71.
Prepared by:
Carmella L. D’Addezio, DO, MS, FACOI, LTC, USAF, MC
301 Fisher St.
Keesler AFB
Biloxie MS 39543
(228) 377-8972