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.
KFT are used for evaluating kidney functions. there are several routine tests such as urea, creatinine and uric acid. Calculation of eGFR is recommended by national kidney organization whenever creatinine serum is measured.
KFT are used for evaluating kidney functions. there are several routine tests such as urea, creatinine and uric acid. Calculation of eGFR is recommended by national kidney organization whenever creatinine serum is measured.
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.
Renal function test (RFT), also known as kidney function test is a group of tests used to assess the functions of kidney.
It is used screen for, detect, evaluate and monitor acute and chronic kidney diseases.
These are simple blood and urine tests that are used identify kidneys problems.
Tests of renal function have utility in-
Identifying the presence of renal disease
Monitoring the response of kidneys to treatment
Determining the progression of renal disease
RFT is ordered, if your doctor
thinks your kidneys may not be working properly which is known from signs and symptoms
and if you have other conditions that can harm the kidneys, such as diabetes or high blood pressure
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.
Renal function test (RFT), also known as kidney function test is a group of tests used to assess the functions of kidney.
It is used screen for, detect, evaluate and monitor acute and chronic kidney diseases.
These are simple blood and urine tests that are used identify kidneys problems.
Tests of renal function have utility in-
Identifying the presence of renal disease
Monitoring the response of kidneys to treatment
Determining the progression of renal disease
RFT is ordered, if your doctor
thinks your kidneys may not be working properly which is known from signs and symptoms
and if you have other conditions that can harm the kidneys, such as diabetes or high blood pressure
The kidneys play a vital role in the excretion of waste products and toxins such as urea, creatinine and uric acid, regulation of extracellular fluid volume, serum osmolality and electrolyte concentrations, as well as the production of hormones like erythropoietin and 1,25 dihydroxy vitamin D and renin.
Specimen collection requirements are dependent on the procedure or test requested. Generally, for serum creatinine and blood urea nitrogen (BUN) levels, no additional patient preparation is required, and a random blood sample suffices. However, the effect of recent high protein ingestion may increase serum creatinine and urea levels to a significant extent. Also, hydration status can have a considerable impact on BUN measurement.
For timed urine collections such as the 24-hour urine creatinine clearance, it is essential that urine be collected accurately over the required period as under or over collection will affect final results. Hence, a 5 to 8-hour timed collection is preferable to a 24-hour collection.
There are several clinical laboratory tests that are useful in investigating and evaluating kidney function. Clinically, the most practical tests to assess renal function is to get an estimate of the glomerular filtration rate (GFR) and to check for proteinuria (albuminuria).
Tests of renal function can be used to assess overall renal function by direct measurement or estimation of the glomerular filtration rate. Estimation of the GFR is utilized to determine the presence of renal impairment.
Kidneys play a vital role in the excretion of waste products and toxins from blood such as urea, creatinine and uric acid and maintain the acid-base balance and the overall homeostatic mechanism of the body.-They are several clinical laboratory tests that are useful in investigating and evaluating kidney function
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A feeding plate is a prosthetic device used for newborns with a cleft palate to assist in feeding and improve nutrition intake. From a prosthodontic perspective, this plate acts as a barrier between the oral and nasal cavities, facilitating effective sucking and swallowing by providing a more normal anatomical structure. It helps to prevent milk from entering the nasal passage, thereby reducing the risk of aspiration and enhancing the infant's ability to feed efficiently. The feeding plate also aids in the development of the oral muscles and can contribute to better growth and weight gain. Its custom fabrication and proper fitting by a prosthodontist are crucial for ensuring comfort and functionality, as well as for minimizing potential complications. Early intervention with a feeding plate can significantly improve the quality of life for both the infant and the parents.
This document is designed as an introductory to medical students,nursing students,midwives or other healthcare trainees to improve their understanding about how health system in Sri Lanka cares children health.
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TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
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International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
CANSA support - Caring for Cancer Patients' Caregivers
Renal function test
1. RENAL FUNCTION TEST
Khadga Raj Aran
M. Pharm, Ph.D. Research scholar
(Pharmacology)
DEPARTMENT OF PHARMACOLOGY,
ISFCP, MOGA, PUNJAB- 142001
2. INTRODUCTION
phrons.
The kidneys are two bean shaped organs lying on each side of the vertebral column slightly above the
level of umbilicus.
Each kidney contains approx. 1 million
A Nephron consist:-
OUTER LAYER
(the cortex)
-glomeruli
-PCT & DCT
-CD
INNER LAYER
(the medulla)
-Straight portion of tubules
-LOH
-vasa recta
-terminal CD
3. FUNCTION OF KIDNEY
1 Excretion of waste products: Kidney excretes metabolic waste products
such as urea, creatinine and uric acid.
2 Maintans homeostasis :Kidney maintains water and electrolyte balance
with the help of antidiuretic hormone (Water Balance ) and renin – angiotensin –
aldosterone mechanism (Electrolyte balance) and maintains acid base balance by
reabsorbing sodium bicarbonate .
4. Formation of urine as the waste product
Excretion of end products of protien and nucleic acid metabolic substances
Regulation of salt & water balance
Regulation of acid-base balance
Production of Hormones
5. Why test renal function?
To asses the functional capacity of kidney.
Early detection of possible renal impairment.
Severity and progression of the impairment.
Monitor response to treatment.
Monitor the safe and effective use of drugs which
are excreted in the urine
6. When should we assess renal function?
Older age
Family history of Chronic Kidney disease (CKD)
Decreased renal mass
Low birth weight
Diabetes Mellitus (DM)
Hypertension (HTN)
Autoimmune disease
Systemic infections
Urinary tract infections (UTI)
Nephrolithiasis
Obstruction to the lower urinary tract
Drug toxicity
7. 1. Urineanalysis
2. Tests for assessment of glomerularfunction
3. Tests to measure renal plasmaflow
4. Tests for assessment of tubularfunction
9. MACROSCOPIC EXAMINATION
Color
Normal-pale yellow in color due to pigments urochrome,urobilin, Cloudiness may be caused
by excessive cellular material or protein, crystallization or precipitation of salts upon standing at
room temperature or in the refrigerator.
If the sample contains many red blood cells, it would be cloudy as well as red.
Normal Deep yellow---- conc. Of urochrome pigment
Red Blood, Hemoglobulinuria, myoglobinuria, beetroot
Orange rifampicin
Yellow Concentrated urine, ( dehydration, jaundice, B complex,
sulfasalazine)
Green Methylene blue
Black Severe hemoglobinuria, methyldopa
Brown Bilirubin, phenothiazides
10. VOLUME
Normal- 800 ml -2.5 L/day
Oliguria- Urine Output < 300ml/day
Seen in
Acuteglomerulonephritis
RenalFailure
Polyuria- Urine Output > 2.5 L/day
Seen in
Increased wateringestion
Diabetes mellitus andinsipidus.
Anuria- Urine output < 100ml/day
Seen in renal shut down
pH
Urine pH ranges from 4.5 to 8
Normally it is slightly acidic lying
between 6 – 6.5.
After meal it becomes alkaline. 4
resulting in alkaline reaction.
11. Principles of Chemical Tests
pH –
The pH is a measure of the degree of acidity or alkalinity of the urine.
A pH below 7 indicates an acid urine; pH above 7 indicates an alkaline
urine. Normal, freshly-voided urine may have a pH range of 4.5 - 8.0.
The pH of urine may change with diet, medications, kidney disease,
and metabolic diseases such as diabetes mellitus. Colors on the pH
reagent pad usually range from yellow-orange for acid pH to green-
blue when pH is alkaline.
Protein - Protein in the urine is called proteinuria. This is an important
indicator of renal disease, but can be caused by other conditions as
well. At a constant pH, the development of any green color on the
protein reagent pad is due to the presence of protein. Colors range
from yellow for negative to yellow-green or green for positive.
12. Glucose - The presence of glucose in urine is called glycosuria. This
condition indicates that the blood glucose level has exceeded the renal
threshold. This condition may occur in diabetes mellitus. The reagent
strip is specific for glucose and uses the enzymes glucose oxidase and
peroxidase, which react with glucose to form colors ranging from green
(low concentration) to brown (high concentration.
Ketone – Ketones present in the blood is known as ketonuria. This
occurs when the body metabolizes fats incompletely causing ketones to
be excreted in the urine. Ketonuria may be present in diabetes, starvation
or fasting. Since ketones will evaporate at room temperature, urine
should be tightly covered and refrigerated if not tested promptly.
Bilirubin – Bilirubin in the urine is known as bilirubinuria.
Bilirubin is a breakdown product of hemoglobin which produces an
extremely yellow to amber color in urine and may be an indication of
liver disease, hepatitis or bile duct obstruction.
14. 2. TEST FOR ASSESSMENT OF GLOMERULAR FILTERATION
Renal clearance test
Blood urea and
serum creatinine
Proteinuria Haematuria
RFT
15. Renal clearance of a substance is defined as the volume of plasma
from which the substance is completely cleared by the kidneys per
minute
Clearance test
• Creatinine clearance
• Urea clearance
• Inulin clearance
1. Creatinine clearance test: A test that helps determine whether the
kidneys are functioning normally. Creatinine is produced from the
metabolism of protein as when muscles burn energy.
• Creatinine freely filtered in the glomerulus
• Not reabsorbed by the tubules
16. Creatinine Clearance =U x V
P
U = Urinary Creatinine(mg/L)
P = Plasma creatinine (mg/L)
V = Volume of urine per minute
• ↓ Creat. Clearance is very sensitive indicator of decreased
GFR
• ↓ GFR may be caused by Acute or Chronic damage to glomerulus
or any of its components
• ↓ Blood flow to glomerulus may also produce decreased
creat.clearance
17. 2. Urea Clearance Test
Expression of the number of ml of blood or plasma which are completely
cleared of urea by the kidney per minute.
Maximum clearance: when urine output is 2 ml/min.
𝑼×𝑽𝑷
U = concentration of urea
in urine (in mg/dL)
V = Volume of urine in
ml/min
P = Concentration of urea in blood (in mg/dL)
18. Interpretation of results for urea clearance
Urea clearance of 70% indicates of normal functioning.
In Acute Renal Failure: Urea clearance is usually less than ½.
In Chronic Nephritis: Urea clearance falls progressively and reaches to ½ or less of
the normal before the blood urea conc. Begins to rise.
In Terminal Uraemia: Urea clearance falls to about 5% of the normal value.
In Nephrotic Syndrome: Urea clearance is usually normal until the onset of renal
insufficiency sets in and produces same change as chronic nephritis.
1. If Urea clearance is >70%, renal function is normal.
2. If Urea clearance is between 40-70%, renal function is mildly impaired.
3. If Urea clearance is <20%, renal function is severely impaired.
19. 3. Inulin Clearance Test
• Method of choice when accurate determination of GFR is required.
• Inulin is polysacharide of Fructose. Freely filtered
by glomerulus
not reabsorbed
not secreted or metabolically altered by the renal tubule.
• Normal value : 120 ml/mt.
Disadvantages : need for its IV adminstratio
technically difficulty of analysis
20. 3. Tests to measure renal plasma flow
i. Para-amino hippurate (PAH)
PAH clearance is a method used in renal physiology to measure
renal plasma flow, which is a measure of renal function.
PAH is completely removed from blood that passes through the
kidneys (PAH undergoes both glomerular filtration and tubular
secretion), and therefore the rate at which the kidneys can clear PAH
from the blood reflects total renal plasma flow.
PAH is filtered at glomeruli & secreted by the tubules.
PAH is completely removed during a single blood circulation through
kidneys at low blood conc.(2mg or less/100ml) of plasma.
PAH clearance at low blood levels measures renal plasma flow (RPF).
21. ii) Filtration Fraction(FF)
Filtration fraction is the fraction of plasma passing through the
kidneys which is filtered at the glomerulus and is obtained by
dividing the Inulin clearanceby PAH clearance.
NORMAL
RANGE:-
0.16 to 0.21 in an adult.
FF= GFR
RPF
Glomerular filtration rate (GFR) to the renal
plasma flow (RPF)
22. 4. Test to Measure Tubular Functions
A. Urine concentration test.
Determines the concentration ability of renal tubules.
Procedure
1. No food or water after meal at 6 PM.
2. Next day at 7 AM, collect urine and discard it.
3. At 8 AM, collect urine specimen.
4. Measure the osmolality of urine
Interpretation
Urine osmolality >850 mOsm/kg water (renal
concentration ability normal).
23. Lower osmolality of urine indicates
Chronic renal failure
Acute tubular necrosis
Nephrogenic diabetes insipidus etc.
B. Phenolsulphthalein (PSP) test
Patient is given 600 ml water initially. Phenolsulphthalein test dye 6 mg
in 1 ml saline is given intravenously and urine samples are collected
at 15, 30, 60, 120 minutes.
If the 15 minute urine contains 25% or more, the test is normal.
If it is lesser than 25%, it indicates impaired renal excretory function.
24. C. Urine Dilution
• Urine dilution test is done to assess the ability of kidneys to eliminate
water.
• In Urine Dilution test, after emptying the bladder, 1200 ml of water is
given. Urinary specific gravity should be fall to 1.005or osmolality
lesser then the 100ml/kg
• Urine collected hourly for next 4 hours
• In renal tubular disease, there will be a fixed specific gravity
• This test is not advisable for patients with adrenal insufficiency
25. D. Urine Acidification
• Urine acidification test is done to check the ability of kidney
to produce acidic urine which is the function of tubules.
• To excess the ability of kidney to reabsorb bicarbonate and
excrete hydrogen ions.
• Ammonia Chloride (100mg/kg) in gelatine capsule is given
Urine is collected hourly for 8 hours. pH of urine normally
falls between 4.6 to 5.3
• In patients with renal tubular acidosis , ph does not fall below
5.3 even after dose of ammonium chloride
26. Thanks for your Patience
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