The document discusses the interpretation of kidney function through laboratory tests. It describes the physiologic role and functional units of the kidney. Key points include:
- The nephron is the functional unit of the kidney, which filters blood to form urine and regulates electrolytes and acid-base balance.
- Glomerular filtration rate (GFR) and creatinine clearance are tests used to assess kidney filtration function. Creatinine clearance is estimated based on creatinine levels in serum and urine.
- Tubular function tests include urine concentration and acidification to evaluate the kidney's reabsorption and regulatory roles. Assessing these functions provides insight into renal disorders.
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.
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.
1. Liver function tests measure enzymes and proteins to evaluate liver health and detect liver damage or disease.
2. Elevated bilirubin, ALT, AST, alkaline phosphatase, and prolonged prothrombin time indicate potential liver issues like hepatitis, cirrhosis, or obstruction.
3. Abnormal albumin, globulin, ammonia, ferritin, and lactate dehydrogenase levels also suggest liver or other organ dysfunction and are used to diagnose and monitor conditions.
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.
This document discusses laboratory diagnosis of renal diseases. It covers renal function tests like glomerular filtration rate (GFR) and clearance tests which are used to detect early renal impairment. GFR is estimated using creatinine clearance tests or formulas using serum creatinine. Urine analysis and renal biopsy are also used to diagnose and characterize renal diseases by examining features under light and electron microscopy. Renal biopsy can identify conditions affecting the glomeruli, tubules, interstitium or blood vessels. Recent advances include use of genomics and proteomics in renal disease diagnosis and classification.
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.
This document discusses renal function tests. It begins by listing the key functions of the kidney, including excretion, homeostasis, endocrine and metabolic roles. It then discusses various biochemical tests used to assess kidney function, including tests of glomerular function like serum creatinine and clearance tests, as well as tests of tubular function. Causes of renal disease including pre-renal, renal and post-renal are outlined. Normal ranges for common renal function biomarkers like serum urea, creatinine and electrolytes are provided. The document concludes by describing changes seen in results of hemogram, urine analysis and specialized clearance tests in the setting of kidney disease.
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.
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.
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.
1. Liver function tests measure enzymes and proteins to evaluate liver health and detect liver damage or disease.
2. Elevated bilirubin, ALT, AST, alkaline phosphatase, and prolonged prothrombin time indicate potential liver issues like hepatitis, cirrhosis, or obstruction.
3. Abnormal albumin, globulin, ammonia, ferritin, and lactate dehydrogenase levels also suggest liver or other organ dysfunction and are used to diagnose and monitor conditions.
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.
This document discusses laboratory diagnosis of renal diseases. It covers renal function tests like glomerular filtration rate (GFR) and clearance tests which are used to detect early renal impairment. GFR is estimated using creatinine clearance tests or formulas using serum creatinine. Urine analysis and renal biopsy are also used to diagnose and characterize renal diseases by examining features under light and electron microscopy. Renal biopsy can identify conditions affecting the glomeruli, tubules, interstitium or blood vessels. Recent advances include use of genomics and proteomics in renal disease diagnosis and classification.
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.
This document discusses renal function tests. It begins by listing the key functions of the kidney, including excretion, homeostasis, endocrine and metabolic roles. It then discusses various biochemical tests used to assess kidney function, including tests of glomerular function like serum creatinine and clearance tests, as well as tests of tubular function. Causes of renal disease including pre-renal, renal and post-renal are outlined. Normal ranges for common renal function biomarkers like serum urea, creatinine and electrolytes are provided. The document concludes by describing changes seen in results of hemogram, urine analysis and specialized clearance tests in the setting of kidney disease.
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.
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 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 proteinuria, or increased protein in the urine. It defines proteinuria and outlines its causes, which can include primary kidney diseases, overflow of abnormal proteins, or secondary causes from non-kidney diseases. The document describes different types of proteinuria including glomerular, tubular, and overflow, and explains how to detect, evaluate, and differentiate between the types using urine tests like dipstick, sulfosalicylic acid, protein electrophoresis, and immunoassay. It provides guidance on classifying and further investigating persistent proteinuria to determine its underlying cause and renal pathology.
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.
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.
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.
Renal function tests are very useful for effective clinical evaluation of renal failure for effective management. So it is useful for medical and allied professional students and clinical practitioners.
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 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 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.
Kidney disorders, Laboratory Investigation and Renal Function TestsMadhukar Vedantham
The document discusses kidney disorders, including their presentation, common diseases, and laboratory tests used in evaluation and diagnosis. It covers the functions of the kidneys, risk factors and symptoms of kidney failure, treatment options like dialysis and transplantation. Common kidney diseases described include polycystic kidney disease, hypertensive nephrosclerosis, glomerulonephritis, urinary tract infections, kidney stones, and diabetic kidney disease. Laboratory tests for kidney function include urine analysis, renal function tests of glomerular and renal blood flow, and renal biopsy.
The document discusses chronic kidney disease (CKD). It defines CKD as kidney damage or decreased glomerular filtration rate (GFR) lasting at least 3 months. CKD is staged based on GFR levels and can progress to kidney failure requiring dialysis or transplant. The causes, risk factors, complications, diagnostic evaluation and management of CKD are described with a focus on pediatric patients.
This document discusses urea and creatinine, which are waste products excreted by the kidneys. It describes how urea is formed from ammonia in the liver and how defects in the urea cycle can cause metabolic disorders. It outlines methods for measuring blood urea and urine urea. Creatinine is formed from creatine in muscle and increased levels can indicate muscle or kidney issues. Methods for measuring serum and urine creatinine are provided. The document concludes by noting creatinine clearance is a sensitive indicator of kidney function.
This document discusses renal function tests. It begins by outlining the objectives of renal function tests which are to detect possible renal damage, assess severity, observe progress of renal disease, and monitor safe drug use. It then discusses causes of kidney disorders which can be pre-renal, renal, or post-renal. The main tests of renal function described are urine examination, tests of excretory function like creatinine clearance, and estimating blood urea nitrogen and serum creatinine levels. The document provides details on how to perform and interpret these tests.
The document provides information on analyzing urinary electrolytes to evaluate extracellular volume status. It defines fractional excretion of sodium (FENa) and notes it is not dependent on urine volume and easy to calculate. While FENa and fractional excretion of chloride (FECl) generally vary in parallel, UNa and UCl can differ by more than 15 meq/L in 30% of volume depletion cases. Measuring both UNa and UCl is recommended in these situations to better evaluate volume status. Interpretation requires considering the clinical context as urinary electrolyte values considered normal may indicate inappropriate renal wasting in certain conditions.
Urine analysis involves collecting a urine sample and using reagent strips or microscopic examination to test for various substances. Reagent strips can detect glucose, bilirubin, ketones, protein, blood, and other parameters. Microscopic examination looks for cells, casts, crystals, and other features. Normal urine composition includes urea, uric acid, creatinine, chloride, and phosphate. Abnormal results may indicate diseases like infections, kidney problems, or other disorders. Care must be taken to collect samples properly for accurate analysis and diagnosis.
The document provides an overview of urinalysis as a diagnostic tool. It discusses the history of urinalysis, how to perform and interpret a urinalysis. Key points include:
1) Urinalysis is a noninvasive test that provides information about kidney and urinary tract health through examination of urine color, clarity, pH, proteins, glucose, and microscopic analysis.
2) Specimen collection methods include random, clean-catch, catheterized, and time samples. Proper storage is important to preserve results.
3) A dipstick rapidly tests for various analytes like leukocyte esterase, nitrites, protein, glucose and others. Microscopic analysis identifies cells, casts, crystals
The liver performs many essential functions including metabolic, excretory, hematological, storage, protective and detoxification roles. Liver function tests evaluate these roles by measuring biomarkers like bilirubin, liver enzymes, clotting factors, and drug metabolism. Elevations in biomarkers can indicate liver inflammation, injury, blockage or cancer. A combination of clinical history and liver function tests are used to diagnose specific liver disorders.
This document discusses the estimation of serum urea concentration. It begins by stating the objective is to estimate urea levels in serum and gain experience using kits. It then provides background on urea, noting it is formed in the liver from protein catabolism and is the main nitrogenous waste excreted in urine. High serum urea levels occur if the kidneys fail to excrete urea properly. The document discusses normal ranges for serum urea and factors that affect levels, as well as abnormal conditions that cause high or low concentrations.
Proteinuria refers to an excess of proteins, such as albumin, in the urine. It can be caused by damage to the glomeruli or renal tubules in the kidneys that prevents the normal reabsorption of proteins from the urine. People at highest risk include those with diabetes, hypertension, obesity, or a family history of kidney disease. Tests like the urine albumin-to-creatinine ratio can detect proteinuria. Treatment focuses on controlling blood pressure and blood sugar through medications like ACE inhibitors that protect the kidneys from further damage.
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 the assessment of renal function through various tests and methods. It describes:
1. Tests to measure glomerular filtration rate (GFR) including inulin clearance, creatinine clearance, iohexol clearance, and cystatin C.
2. Other renal function tests including urine analysis, blood tests of blood urea nitrogen and creatinine, and combined analyses like fractional excretion of sodium.
3. Methods for evaluating GFR including predicting GFR from creatinine levels using the Schwartz formula and nuclear medicine techniques using radioactive tracers.
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 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 proteinuria, or increased protein in the urine. It defines proteinuria and outlines its causes, which can include primary kidney diseases, overflow of abnormal proteins, or secondary causes from non-kidney diseases. The document describes different types of proteinuria including glomerular, tubular, and overflow, and explains how to detect, evaluate, and differentiate between the types using urine tests like dipstick, sulfosalicylic acid, protein electrophoresis, and immunoassay. It provides guidance on classifying and further investigating persistent proteinuria to determine its underlying cause and renal pathology.
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.
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.
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.
Renal function tests are very useful for effective clinical evaluation of renal failure for effective management. So it is useful for medical and allied professional students and clinical practitioners.
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 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 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.
Kidney disorders, Laboratory Investigation and Renal Function TestsMadhukar Vedantham
The document discusses kidney disorders, including their presentation, common diseases, and laboratory tests used in evaluation and diagnosis. It covers the functions of the kidneys, risk factors and symptoms of kidney failure, treatment options like dialysis and transplantation. Common kidney diseases described include polycystic kidney disease, hypertensive nephrosclerosis, glomerulonephritis, urinary tract infections, kidney stones, and diabetic kidney disease. Laboratory tests for kidney function include urine analysis, renal function tests of glomerular and renal blood flow, and renal biopsy.
The document discusses chronic kidney disease (CKD). It defines CKD as kidney damage or decreased glomerular filtration rate (GFR) lasting at least 3 months. CKD is staged based on GFR levels and can progress to kidney failure requiring dialysis or transplant. The causes, risk factors, complications, diagnostic evaluation and management of CKD are described with a focus on pediatric patients.
This document discusses urea and creatinine, which are waste products excreted by the kidneys. It describes how urea is formed from ammonia in the liver and how defects in the urea cycle can cause metabolic disorders. It outlines methods for measuring blood urea and urine urea. Creatinine is formed from creatine in muscle and increased levels can indicate muscle or kidney issues. Methods for measuring serum and urine creatinine are provided. The document concludes by noting creatinine clearance is a sensitive indicator of kidney function.
This document discusses renal function tests. It begins by outlining the objectives of renal function tests which are to detect possible renal damage, assess severity, observe progress of renal disease, and monitor safe drug use. It then discusses causes of kidney disorders which can be pre-renal, renal, or post-renal. The main tests of renal function described are urine examination, tests of excretory function like creatinine clearance, and estimating blood urea nitrogen and serum creatinine levels. The document provides details on how to perform and interpret these tests.
The document provides information on analyzing urinary electrolytes to evaluate extracellular volume status. It defines fractional excretion of sodium (FENa) and notes it is not dependent on urine volume and easy to calculate. While FENa and fractional excretion of chloride (FECl) generally vary in parallel, UNa and UCl can differ by more than 15 meq/L in 30% of volume depletion cases. Measuring both UNa and UCl is recommended in these situations to better evaluate volume status. Interpretation requires considering the clinical context as urinary electrolyte values considered normal may indicate inappropriate renal wasting in certain conditions.
Urine analysis involves collecting a urine sample and using reagent strips or microscopic examination to test for various substances. Reagent strips can detect glucose, bilirubin, ketones, protein, blood, and other parameters. Microscopic examination looks for cells, casts, crystals, and other features. Normal urine composition includes urea, uric acid, creatinine, chloride, and phosphate. Abnormal results may indicate diseases like infections, kidney problems, or other disorders. Care must be taken to collect samples properly for accurate analysis and diagnosis.
The document provides an overview of urinalysis as a diagnostic tool. It discusses the history of urinalysis, how to perform and interpret a urinalysis. Key points include:
1) Urinalysis is a noninvasive test that provides information about kidney and urinary tract health through examination of urine color, clarity, pH, proteins, glucose, and microscopic analysis.
2) Specimen collection methods include random, clean-catch, catheterized, and time samples. Proper storage is important to preserve results.
3) A dipstick rapidly tests for various analytes like leukocyte esterase, nitrites, protein, glucose and others. Microscopic analysis identifies cells, casts, crystals
The liver performs many essential functions including metabolic, excretory, hematological, storage, protective and detoxification roles. Liver function tests evaluate these roles by measuring biomarkers like bilirubin, liver enzymes, clotting factors, and drug metabolism. Elevations in biomarkers can indicate liver inflammation, injury, blockage or cancer. A combination of clinical history and liver function tests are used to diagnose specific liver disorders.
This document discusses the estimation of serum urea concentration. It begins by stating the objective is to estimate urea levels in serum and gain experience using kits. It then provides background on urea, noting it is formed in the liver from protein catabolism and is the main nitrogenous waste excreted in urine. High serum urea levels occur if the kidneys fail to excrete urea properly. The document discusses normal ranges for serum urea and factors that affect levels, as well as abnormal conditions that cause high or low concentrations.
Proteinuria refers to an excess of proteins, such as albumin, in the urine. It can be caused by damage to the glomeruli or renal tubules in the kidneys that prevents the normal reabsorption of proteins from the urine. People at highest risk include those with diabetes, hypertension, obesity, or a family history of kidney disease. Tests like the urine albumin-to-creatinine ratio can detect proteinuria. Treatment focuses on controlling blood pressure and blood sugar through medications like ACE inhibitors that protect the kidneys from further damage.
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 the assessment of renal function through various tests and methods. It describes:
1. Tests to measure glomerular filtration rate (GFR) including inulin clearance, creatinine clearance, iohexol clearance, and cystatin C.
2. Other renal function tests including urine analysis, blood tests of blood urea nitrogen and creatinine, and combined analyses like fractional excretion of sodium.
3. Methods for evaluating GFR including predicting GFR from creatinine levels using the Schwartz formula and nuclear medicine techniques using radioactive tracers.
The document summarizes renal (kidney) functions. It describes the structure of the kidney including the cortex, medulla, lobes, pyramids and papillae. It discusses the main functions of the kidneys including urine formation, regulation of acid-base balance and gluconeogenesis. It provides details on the nephron, the functional unit of the kidney, including the renal corpuscle and renal tubules. It explains the processes involved in urine formation including glomerular filtration, tubular reabsorption and secretion. Daily totals of filtration, reabsorption and excretion are provided. Acute kidney injury and its staging are also summarized.
The kidneys are a pair of highly vascular organs located in the lower back that filter waste from the blood and regulate fluid balance. They each contain around 1-1.5 million nephrons, the functional units of the kidney. The kidneys receive a high blood flow and precisely regulate glomerular filtration rate, reabsorption, and secretion to produce urine with the proper electrolyte and water content. Various tests can evaluate renal function by measuring glomerular filtration rate, tubular handling, or the levels of substances such as creatinine, urea, and electrolytes. Acute kidney injury is characterized by a sudden deterioration of renal function over hours to days that impairs waste excretion and fluid/electro
- Renal plasma clearance tests can measure the glomerular filtration rate (GFR) and renal plasma flow rate.
- Clearance is defined as the volume of plasma cleared of a substance per minute. The clearance of inulin directly measures GFR, while clearance of para-aminohippurate (PAH) estimates renal plasma flow rate.
- Creatinine clearance is commonly used in clinical practice to estimate GFR, as creatinine is freely filtered, not reabsorbed or secreted, though it has some limitations compared to inulin.
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.
RENAL FUNCTION TESTS and RENAL FAILURE.pptxSeemaLekhwani2
This document discusses assessment of renal function through various tests. It begins by explaining the two main functions of the kidneys - formation of urine and production of hormones. It then describes the process of urine formation and defines three groups of renal function tests: tests of glomerular filtration capacity, tests of the glomerular filtration barrier integrity, and tests of tubular function. Specific tests are discussed in detail including clearance tests, plasma creatinine, proteinuria, concentration tests, and sodium excretion tests. Interpretation of results for evaluating renal function is provided.
Renal physiology and its anesthetic implicationsSathya Prabu
This document discusses renal anatomy, physiology, and function testing. It begins with an overview of renal anatomy including kidney location, blood supply, nephron structure, and juxtaglomerular apparatus. It then covers renal physiology such as blood flow, glomerular filtration, regulation of GFR, tubular reabsorption and secretion, and urine concentration and dilution. Finally, it discusses renal function testing including tests of glomerular filtration rate like creatinine clearance and measures of tubular function like the concentration and dilution tests.
The document discusses renal function tests (RFTs). It provides information on:
- The functions of the kidney including homeostasis, excretion, and hormonal functions.
- Common RFTs including urine analysis, serum creatinine, BUN, eGFR, and cystatin C. These tests are used to evaluate glomerular filtration rate and detect kidney problems.
- Additional details are given on clearance tests using inulin, creatinine and urea to estimate GFR. Urine analysis and tests of tubular function are also summarized.
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.
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.
The nephron is the functional unit of the kidney, which filters blood to form urine. The nephron contains a glomerulus that filters the blood and a renal tubule that reabsorbs most of the filtered water and solutes. Key functions of the nephron include filtering the blood at the glomerulus and reabsorbing various substances like water, glucose, amino acids, salts, and urea along different portions of the renal tubule under hormonal control. The kidney plays an important role in regulating fluid and electrolyte balance, excreting wastes, and producing hormones.
The excretory system removes waste from the body through various organs like the kidneys, lungs, gastrointestinal tract, and skin. The kidneys play a key role by filtering waste from the blood to produce urine. Urine volume is regulated by factors like water intake, salt intake, exercise, and hormones. Tests like urine analysis, kidney biopsy, and imaging scans are used to evaluate kidney function and diagnose issues like kidney disease. The countercurrent mechanism in the kidneys helps maintain a hyperosmotic medullary environment needed to concentrate urine.
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 summarizes renal clearance tests used to assess kidney function. It discusses how the kidneys maintain homeostasis, excrete waste, and produce hormones. Glomerular filtration rate is normally 120-125 mL/min, with over 99% of the filtrate reabsorbed. Clearance tests measure the rate of filtration for substances like creatinine and urea. Creatinine clearance is the most sensitive test of glomerular function, as creatinine is freely filtered and only marginally secreted. The normal creatinine clearance rate is 120-145 mL/min. A decreased clearance below 75% normal indicates impaired kidney function.
The kidneys are paired organs located behind the abdominal cavity that filter waste from the blood. Each kidney contains around 500,000-800,000 nephrons. Nephrons consist of a glomerular capsule, renal tubule with sections, and collecting duct. The kidneys function to excrete waste, regulate water/electrolyte balance and acid-base balance, and produce hormones like erythropoietin and renin. Urine is formed through glomerular filtration, tubular reabsorption and secretion. Biochemical tests assess renal function by measuring glomerular filtration rate using creatinine clearance and examining the urine for proteins, glucose, and sediments.
The document discusses kidney anatomy and function, including:
1) The kidneys filter blood and regulate water, electrolyte and acid-base balance through processes like glomerular filtration, tubular reabsorption and secretion.
2) The kidneys produce hormones like erythropoietin and renin, and metabolize other hormones.
3) Biochemical tests of renal function include measuring glomerular filtration rate using creatinine clearance, and levels of substances like urea, uric acid and albumin in blood and urine.
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Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
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Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
1. Interpretation
of
Kidney Function
ByBy
Dr. Moustafa RizkDr. Moustafa Rizk
Prof. of Clinical PathologyProf. of Clinical Pathology
Faculty of Medicine, University of Alexandria.Faculty of Medicine, University of Alexandria.
2. Objectives:Objectives:
Describe the physiologic role of the kidney.Describe the physiologic role of the kidney.
State the laboratory tests used to assessState the laboratory tests used to assess
glomerular function.glomerular function.
Discuss the concept of renal clearance and howDiscuss the concept of renal clearance and how
it is measured.it is measured.
State the laboratory tests used to assessState the laboratory tests used to assess
tubular function.tubular function.
Record laboratory biochemical findings in someRecord laboratory biochemical findings in some
renal disorders.renal disorders.
6. Interpretation of Kidney Function
Functional unit of the kidney is the
NEPHRON (pleural (NEPHRA)
1.2 x 106
nephra per kidney.
Each nephron about 50 mm long.
Combined lengths about 145 km (85 miles)
Renal corpuscle.
Proximal convoluted tubule (PCT)
Loop of Henle
Distal convoluted tubule (DCT).
13. Interpretation of Kidney Function
Glomerular Filtration Rate (GFR)
Kidneys receive 25% of the cardiac output
GFR = the amount of filtrate that forms in both
kidneys every minute.
In adults GFR is about :
105 ml.min-1
in females
125 ml.mi-1
in males
Daily volume of glomerular filtrate
150 L in females
180 L in males
15. Interpretation of Kidney Function
Tubular Reabsorption: One of the important
nephron functions
99% of glomerular filtrate reabsorbed.
1% leaves body: 1-2 L per day.
Cuboidal epithelial cells with microvilli.
Osmosis, diffusion, active transport.
Materials reabsorbed include:
Water
Glucose
Amino acids, urea.
Na+
, K+
, Ca2+
, Cl-
, HCO3
-
18. Interpretation of Kidney Function
Reabsorption of Selected Substances
Conserve valuable nutrients, e.g.
Amino acids
Glucose
Abnormally, glucose, amino acids, blood,
ketones, leukocytes, kidney stones, etc. might be
found in urine.
20. Interpretation of Kidney Function
Regulates blood volume and blood pressure
Adjust the amount of water lost or retained
Energy dependent NA+ extrusion
Antidiuretic hormone (ADH, or vasopressin)
Blood volume related to blood pressure
Regulation of blood pressure and blood flow
Renin-angiotensin-aldosterone pathway
Flow-rate through kidney can be adjusted.
21. Interpretation of Kidney Function
Renal Functions : Acid-Base balance
Stabilizes blood pH (in company
with buffer systems and regulation
of [CO2]
Regulates loss of H+ ions (acid)
Regulates loss of HCO-3 ions
(base)
Normal plasma pH
7.35-7.45
Acidosis
pH < 7.35
Alkalosis
pH > 7.45
22. Interpretation of Kidney Function
Regulates plasma concentrations of electrolytes
(e.g. Na+
, K+
, Cl-
, and other ions)
Water retained or lost in response to plasma osmolality
(normal plasma osmolality 290 mOsm/kg H2O).
ADH mechanism
Controls loss in urine
Contributes to plasma [Ca2+] regulator by vitamin D
(calcitriol) regulation
Renal activation of calcitriol increases Ca2+
uptake
from gut.
26. Interpretation of Kidney Function
Overall function of urine
production is to
maintain homeostasis
by regulating the
volume and
composition of blood.
Re-absorption of selected
substances
Acid-base balance
Electrolyte balance
Red blood cell formation
Regulate activated
vitamin D production
27. Interpretation of Kidney Function
Laboratory tests aiding in the evaluation
of kidney functions
1. General characteristics of urine.
2. Tests measuring glomerular filtration rate
Clearance tests (urea,inulin,creatinin)
Non protein nitrogenous compounds
3. Tests measuring tubular function
Urinary acidification test
Sodium and potassium excretion tests
Specific gravity of the urine
Osmolality of urine and serum
Concentration and dilution tests
28. •Volume: (N: 700 – 2500 ml / day)
•Specific gravity: (N: 1.015 – 1.025)
•Osmolality: The number of dissolved solutes
/ kg body H2O.
(N: 500 – 800 mosmol /
kg body H2O)
•Protein.
•Microscopic examination: (cells and casts)
A-A- Complete Urine Examination:Complete Urine Examination:
30. Interpretation of Kidney Function
Test to estimate Glomerular Filtration Rate
(GFR)
1. GFR at which ultrafiltrate of plasma is formed; is
a “true” physiological estimate of renal function.
It assumes no secretion from blood into tubule
and no reabsorption once it is in tubule.
2. Inulin: is an inert carbohydrate that is not
metabolized, secreted or reabsorbed; thus ideal
agent for GFR determination; thus is used mainly
for research since not practical.
32. Interpretation of Kidney Function
Creatinine Clearance (90-140 ml/min/1.73 m2
)
1. Creatinine is primarily excreted via glomerualr
filtration with about 10-15% eliminated by active
tubular secretion.
2. CrCl is estimate of GFR
3. Clinical uses for obtaining CrCl :
Assessing kidney function in patients with acute or
chronic renal failure
Monitoring patients on nephrotoxic drugs.
Determining dosage adjustments for renally
eliminated drugs.
33. Definition of Clearance ( C ):
( ml / min)
It is the hypothetical volume of
plasma, that is completely cleared
from a certain substance per unit time
(minute).
34. Interpretation of Kidney Function
Calculating Creatinine Clearance
Direct measurement:
CrCl = (UV) (Ucr) / (SCr) (1440) x 1.73 m2
/ BSA
- UV = 24 hour urine volume in ml.
- Ucr = urinary creatinine conc. in mg/dl.
- SCr = serum creatinine in mg/dl at midpoint of
urine collection.
- 1440 is number of minutes per day
- CrCl is in ml/min.
35. Criteria for an ideal GFR markerCriteria for an ideal GFR marker
Produced inside the body i.e. Endogenous.Produced inside the body i.e. Endogenous.
Constant production rate .Constant production rate .
Elimination only via glomerular filtration with noElimination only via glomerular filtration with no
reabsorption or secretion.reabsorption or secretion.
No laboratory interference for its measurment.No laboratory interference for its measurment.
36. 1- Inulin clearance:
- Reference clearance method.
- Not suitable for routine investigation.
- Exogenous material I.V. infused in such a
way to maintain plasma level steady during the
period of the test.
(N: 125 ml / min).
GFR can be measured by:GFR can be measured by:
37. 2- Creatinine clearance:
- It is widely used in routine work.
- An endogenous substance.
- Its value correlates fairly closely with inulin
clearance.
- Plasma creatinine is used as a day to day indication of
changes in GFR. It is superior to creatinine clearance
( error in all analysis based upon timed collection of
urine).
♂105 ± 20 ml/min
♀ 95 ± 20 ml/min
GFR can be measured by:GFR can be measured by:
N:
38. 3- Urea clearance:
• Not used nowadays.
• It is 70% of GFR because part of urea in the
glomerular filtrate diffuses back into the
tubular cells and the amount reabsorbed
varies inversely with urine flow rate.
39. Clearance ( C ) =
U X V
P
1.73
A
X = 75 ml/min
Clearance ( C ) =
U X√ V
P
X = 54 ml/min
1.73
A
• Maximum urea clearance:
If the volume of urine / min = > 2 ml/min
• Standard urea clearance:
If the volume of urine / min = < 2 ml/min
40. •Para-amino hippuric acid ( PAHA ) is a substance
that can be filtered at the glomeruli and excreted by
the tubules.
•Such substance when infused at a low plasma
concentration, its clearance is very high.
•It measures the effective renal blood flow (RBF).
(N: 650 ml/min).
4- PAHA clearance:4- PAHA clearance:
41. 5-Cystatin C ( New marker for GFR)5-Cystatin C ( New marker for GFR)
Specific and sensitive parameter for
glomerular filtration rate (GFR).
Independent of muscle mass, age and sex.
Only eliminated via filtration.
Not influenced by acute phase reaction.
Independent from urine collection, only one serum
sample.
quick, simple and reliable.
42. Assessment of Glomerular permeability
A. Selective proteinuria: the glomerular membrane has
still the ability to prevent filtration of proteins of large
MW and allow the filtration of small MW proteins
( Albuminuria).
B. Non selective proteinuria: as the damage proceeds ;
proteins of larger molecular sizes pass through the
membrane.
Selectivity is measured by comparing the clearance of 2
proteins of different MW; albumin or transferrin versus
larger IgG.
Selectivity ratio = Clearance of IgG
Clearance of albumin
Lower ratio <0.16 = more selective proteinuria.
43. Interpretation of Kidney Function
Creatinine (0.7-1.5 mg/dl)
Is normal metabolic product of creatine
and phosphocreatine which are
constituents of skeletal muscle.
The daily production of creatinine is
determined by person’s muscle mass; in
normal patients, the rate of creatinine
production equal its excretion.
44. Interpretation of Kidney Function
Cause of true changes in S. creatinine
Unlike BUN, SCr is not influenced by changes in
renal blood flow or diet
A rise in SCr almost always indicates worsening
renal function (decreased GFR)
Since creatinine is byproduct of muscle
metabolism, severely decreased muscle mass
(cachexia) may decrease SCr
Vigorous exercise may temporarily increase SCr by
0.5 mg/dly
45. Interpretation of Kidney Function
Cause of false serum creatinine
Depends on the test that lab uses.
If using Jaffe assay, larger amounts of non
creatinine chromogens (uric acid, glucose,
acetone, acetoacetate, pyruvic acid, ascorbic
acid) can increase the results of the test.
46. Interpretation of Kidney Function
Age-adjusted Standards for CrCl
CrCl declines with age at any given SCr.
An elderly with a “normal” SCr does not have
normal CrCl.
Estimate age-adjusted normal values of CrCl :
Males : CrCl = 133 - (0.64 X age)
Females : takes 93% of this value
47. Interpretation of Kidney Function
Blood Urea Nitrogen (BUN) (8-20 mg/dl)
Is concentration of nitrogen within urea in serum;
produced in liver.
Serum concentration depends on urea production
(liver) and tubular reabsorption as well as
glomerular filtration;
Thus by itself is not a useful indicator of GFR.
Used with other lab data; can assess hydration
status, renal function, protein tolerance, &
catabolic process
48. Interpretation of Kidney Function
Elevated BUN
Pre-renal causes
1. Decreased renal perfusion
Dehydration
Shock
Diuretics
Blood loss
Severe CHF
Note : BUN follows
sodium & water, if
increased reabsorption
of sodium & water then
BUN reabsorption also
increases
Note : BUN follows
sodium & water, if
increased reabsorption
of sodium & water then
BUN reabsorption also
increases
49. Interpretation of Kidney Function
Elevated BUN
Pre-renal causes
2. Increased protein breakdown
GI bleeding
High protein diets
50. Interpretation of Kidney Function
Elevated BUN
Renal causes of elevated BUN :
• Acute renal failure : drugs such as :
aminoglycosides, amphotricin B, cisplatin.
• Chronic renal failure : diabetes,
pyelonephritis. Chronic analgesics abuse
Post-renal causes of elevated BUN :
• Obstruction of ureter, bladder or urethra.
51. •GF passes through tubules;
where:
1.Reabsorption of water and solute.
2.Excretion of certain substances.
3.Exchange of ions across cell wall.
•As a result, urine is excreted carrying waste
products and maintaining body homeostasis.
•The urine finally excreted has an entirely
different composition from GF.
C- Tubular FunctionC- Tubular Function
TestsTests::
53. Interpretation of Kidney Function
Tests to assess tubular function
1. Urine concentration test (14-16 h water restrict)
• N. SG > 1.025 & > 800 mOsmol/kg
• Decreased RF < 1.020 & 400-600 mOsmol
• Severe Renal impairment , SG approaches
1.010 &< 400 mOsmol
54. Interpretation of Kidney Function
2. If failure to concentrate urine to 800 mOSmol/kg
We do DDAVD test IM. Injection
(1-deamino 8-D-Arginint Vasopressin test)
• To distinguish causes of polyuria (inability
to concentrate urine)
DDAVPDDAVP Fluid deprFluid depr
CentralCentral ResponseResponse No responseNo response
PsychogeniPsychogeni
cc
ResponseResponse ResponseResponse
RenalRenal No responseNo response No responseNo response
55. 3-Urinary acidification test:
[H+
] of urine is normally > [H+
] of blood & of GF.
In order to achieve this degree of acidification, the Kidney:
- Reabsorbs [HCO3-
].
- Excretes [H+
] partly as free [H+
] and partly as NH4
Salt or in combination with anions principally inorg Ph.
56. Interpretation of Kidney Function
Urine acidification test
• 0.1 g/kg body weight of ammonium chloride
(NH4Cl) given by mouth.
• Urine collected/h. for 8 hours – falls below
(pH<5.3) in at least one specimen.Blood
specimens are collected befor the test and
2 hours after ammonium chloride intake for
measuring total CO2 to ensure satisfactory
acidosis.
57. Sodium and Potassium excretion:
♦ Sodium excretion:
- About 70% of Na in the GF is reabsorbed by the PCT
(active reabsorption).
Serum Na:(N:135-145 mmol/L)
Urinary Na:(N: 40-220 mmol/d)
♦ Potassium excretion:
- About 90% of K in GF is normally reabsorbed in the PCT
while the DCT secretes K.
Serum K: (N: 3.5-5.5 mmol/L)
Urinary K: (N: 25-125 mmol/d)
58. Interpretation of Kidney Function
4. Na excreation
• Giving diet containing 20 mmol Na+
/day.
• Normally urinary sodium falls within a week
to the amount present in the diet.
• In diseased kidney, when dietary Na+
↑ →
Na+
and water retained, by contrast when
dietary Na+
↓ → Na+
depletion → ↓ GFR
→ aggravate the condition.
59. Renal diseases commonly present with
proteinuria.
Since glomeruli filter 5 - 7 g of protein / 24 h
and only < 150 mg is excreted in urine / 24 h,
therefore, tubular reabsorption must be very
efficient.
ProteinuriaProteinuria
60. ♦ Mechanisms of Proteinuria:
1- Overflow.
2- Glomerular:
due to glomerular permeability,
e.g. albumin.
3- Tubular:
due to tubular reabsorption,
e.g. β2-microglobulin.
ProteinuriaProteinuria
61. 1. Orthostatic: (proteinuria after standing or walking).
2. Transient: (during pyrexia, CHF or intense exercise).
3. Systemic diseases: e.g. DM, SLE, MM….etc.
4. Renal disease: acute & chronic GN and NS.
Causes of proteinuriaCauses of proteinuria::
- Mild 1.0 g /d
- Moderate 3.0 g /d
- Severe > 3 g /d
Grades of proteinuriaGrades of proteinuria::
62. ♦ Selective and non-selective proteinuria:
The concept of selectivity derives from the fact
that glomerular permeability to a plasma protein
depends largely on its MW; small molecules being
cleared more rapidly than large molecules.
Selective: High MW proteins ( IgG & α2-MG ) tend to
be retained.
Non-selective: Both high, moderate (albumin) & low
( transferrin) MW proteins are excreted.
ProteinuriaProteinuria
64. Interpretation of Kidney Function
Laboratory findings in tubular dysfunction
Plasma:
Metabolic acidosis (↓ pH & ↓ HCO3
-
).
↓ K+
↓ Phosphorus
↓ Uric acid
↑ Osmolality
Normal urea and creatinine.
Urine
↑ volume
↓ osmolality
↑ sodium content
65. Interpretation of Kidney Function
Acute Renal Failure
• Prerenal conditions (shock, hemorrhage, heart failure).
• Renal (acute tubular necrosis, glomerulonephritis).
• Post-renal (bladder obstruction).
60%of cases occur during or immediately
after surgery.
10%associated with obstetric problems.
30%medical conditions
66. Interpretation of Kidney Function
Early stage findings
• Scanty urine <50 ml/day.
• Usually bloody with ↑ specific gravity.
• Urine sodium >50 mmol/L.
• BUN ↑ by > 50 mg/dl/day.
• Creatinine, uric acid ↑
• Hypocalcemia.
• Metabolic acidosis.
67. Interpretation of Kidney Function
Second week findings
• Urine becomes clear after several days with a
small daily increase in volume.
• Daily volume of 400 ml indicates onset of
recovery.
• BUN continues to rise after onset of diuresis.
• Metabolic acidosis ↑
• Serum K ↑ (tissue injury – acidosis – failure of excretion).
• Na is ↓.
68. Interpretation of Kidney Function
Diuretic Stage
• Urine sodium is 50-70 mmol/L.
• Large urinary potassium excretion may
casue decreased serum potassium.
• Serum Na and Cl may ↑ due to dehydration
resulting from large diuresis if replacement
of water is inadequate.
69. Interpretation of Kidney Function
Chronic Renal Failure (CRF)
• It is the end result of progressive and
gradual destruction of the nephrons
e.g. chronic GN, chronic
pyelonephritis, chronic obstructie
uropathy.
70. Interpretation of Kidney Function
Chronic Renal Failure (CRF)
Biochemical features of renal failure
• Increased serum urea.
• Increased serum creatinine.
• Capacity of the kidney to concentrate urine is impaired.
• Capacity of the kidney to dilute urine remains unaffected.
• Serum sodium tends to be low especially if Na+
intake is
diminished but in severe case → sodium retention
occurs.
• Serum potassium: raised level is uncommon expect when
large load of K is given.
71. Interpretation of Kidney Function
Chronic Renal Failure (CRF)
• Metabolic acidosis.
• Decreased serum Ca due to:
Decreased serum albumin.
Improper activation of Vit. D.
• Increased serum phosphorus.
We can susbect that patient with CRF can maintain Na+
, K+
and water balance normal if that dietary load remains close
to normal daily requirement.
72. Nephrotic Syndrome (NSNephrotic Syndrome (NS))
Diagnostic criteriaDiagnostic criteria::
1.1.Proteinuria ( > 3 g / dProteinuria ( > 3 g / d).).
2.2.Hypoalbuminemia ( < 3 g/dlHypoalbuminemia ( < 3 g/dl).).
3.3.EdemaEdema..
EtiologyEtiology::
I- Primary NSI- Primary NS::
--Minimal change lesionMinimal change lesion..
--Membranous nephropathyMembranous nephropathy..
--Proliferative GNProliferative GN..
II- Secondary NSII- Secondary NS::
Secondary to systemic disease e.g. SLE,Secondary to systemic disease e.g. SLE,DMDM
and amyloidosisand amyloidosis..
73. Nephrotic Syndrome (NSNephrotic Syndrome (NS))
Biochemical findings:Biochemical findings:
Serum:Serum:
-- Hyperlipidemia: CHOL & TG.Hyperlipidemia: CHOL & TG.
-- Albumin.Albumin.
-- αα22 - macroglobulin &- macroglobulin & ββ- globulins.- globulins.
-- N.N. Urea & creatinine at presentation.Urea & creatinine at presentation.
Urine:Urine:
-- Proteinuria ( > 3 g/d ).Proteinuria ( > 3 g/d ).
-- Mild MP hematuria.Mild MP hematuria.
N.B: Patients with NS who have selective proteinurina respond to
steroid therapy more than those with non-selective proteinuria.
74. Interpretation of Kidney Function
Conclusions
• The urinary system is more than a waste disposal
system.
• It regulates plasma volume and composition from
minute to minute.
• This in turn results in constant composition for all
the other fluid compartments.
• The three fundamental mechanisms of kidney
function are filtration, secretion and reabsorption.