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RENAL FUNCTION TEST BSC NURSING 2ND SEMESTERS
- 1. RENAL FUNCTION BIOCHEMISTRY Bsc Nursing3rd Semester MR.GOVINDA GAJBHIYE B.SC. NURSING, MSC NURSING, M.A CLINICAL PSYCHOLOGIST
- 2. Introduction Of RenalFunction Kidneys help maintain homeostasis by excreting waste products, regulating fluid balance, and producing hormones (erythropoietin, renin, calcitriol). Tip:- (erythropoietin is a hormone that stimulates red blood cell production, renin is an enzyme that initiates the renin-angiotensin-aldosterone system to regulate blood pressure, and calcitriol is the active form of Vitamin D that promotes calcium absorption for bone health)
- 3. Continue....... Tests detect kidneyabnormalities early and monitor renal disease progression. A Renal Function Test (RFT), or Kidney Function Test (KFT), is a group of blood and urine tests to assess kidney health and function.
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- 5. Examination of Urine Physicaland Chemical Examination In clinical biochemistry, urine is tested and report is given on a urine sample. The procedure is called urine analysis . If the kidneys are not functioning properly, waste products can accumulate in the blood, and fluid levels can increase to dangerous volumes, causing damage to the body or a potentially life-threatening situation. Numerous conditions and diseases can result in damage to the kidneys.
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- 7. 1. Glomerular FunctionTests These test how well the kidneys filter waste products. Blood Urea – Measures urea levels in blood (high in renal failure). Serum Creatinine – More reliable than urea for kidney function. Clearance Tests Inulin clearance – Gold standard for Glomerular Filtration Rate (GFR). Creatinine clearance – Commonly used to estimate GFR. Urea clearance – Less accurate, sometimes used.
- 8. 🔹 2. TubularFunction Tests These check the kidney tubules’ ability to concentrate and dilute urine, and maintain acid-base balance. concentration test – After water restriction, kidneys should concentrate urine. Urine dilution test – After excess water intake, kidneys should dilute urine. Acidification test – Measures kidney’s ability to excrete hydrogen ions. Phenolsulfonphthalein (PSP) test – Old test, measures tubular excretion function. Proteins in urine – Presence indicates tubular/glomerular damage.
- 9. Routine Clinical Test Urineexamination Physical Chemical Microscopic examination
- 13. Physical Characteristics ofUrine 1. Volume Average: 1.5 liters per day. Increased volume in excess water intake, → diuretics, diabetes mellitus, chronic renal disease. Decreased volume in excess sweating, → dehydration, edema, kidney damage.
- 14. 2. Appearance Clear: Normal,straw colored. Cloudy: On standing; due to phosphates or pus.
- 15. High color →Concentrated urine, oxidation of urobilinogen to urobilin. Yellow → Bilirubinuria in jaundice, B-complex intake.
- 16. Smoky: Blood presence Brownishred: Hemoglobinuria
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- 18. Black: Alkaptonuria, formicacid poisoning
- 19. Milky: Chyluria (lymphin urine)
- 20. Chyluria is arare condition where chyle (lymph and fats from the intestines) leaks into the urinary tract, causing urine to appear milky white. It is primarily caused by parasitic infections,
- 21. 3. Odor :-गंध, Normal Urine:- faint aromatic smell (volatile organic acids). Diabetic ketoacidosis: fruity odor (acetone).
- 22. 4. Color Normal: straw-colored(amber yellow) due to pigment urochrome. In jaundice: urine turns yellow (bilirubin present).
- 24. 1. Specific Gravity Normalrange: 1.015 – 1.025 Theoretical extremes: 1.003 – 1.032 Clinical significance: ↓ Specific gravity excessive water intake, chronic nephritis, → diabetes insipidus. ↑ Specific gravity diabetes mellitus, → nephrosis, excessive perspiration. In chronic renal failure, usually fixed at 1.010.
- 26. 🔹 1. Reaction(pH) Normal: Acidic (pH 4.5 – 6.5) Alkaline in: urinary tract infection, vegetarian diet, after meals. Acidic in: metabolic acidosis, diabetes mellitus, starvation.
- 27. 2. Protein (Proteinuria) Protein:- Absent (or < 150 mg/day) Normal: Absent presence indicates: kidney disease (nephritis, nephrotic syndrome), hypertension, diabetes.
- 28. Blood in Urine HematuriaSeen in nephritis and postrenal → hemorrhage. Hemoglobinuria Due to abnormal hemolysis. → Tests available: Hemastix strips (rapid detection).
- 30. Negative Yellow 🟡 🟡 Positive– Light Grean Spots Grean
- 31. Reducing Sugars (Glycosuria) (presence of glucose in urine) Benedict’s test: Used to know % of reducing sugars in urine. Procedure: Take ~1 mL Benedict’s reagent in a test tube. Add 4–5 drops of urine sample. Heat to boiling. Positive test → reddish-brown (orange, olive- green) precipitate.
- 35. Ketone bodies Normal totalketone bodies: < 1 mg/dL (0.1 mmol/L) Ketoacidosis: > 3 mmol/L Positive ketone bodies in urine = abnormal (seen in diabetes mellitus, starvation, vomiting, etc.).
- 37. Bile Pigments Appear inurine during obstructive jaundice. Brown / Tea-coloured Bile pigments (obstructive jaundice)
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- 39. 1. Cells RBCs (RedBlood Cells): WBCs (Pus cells): Epithelial cells:
- 40. Red Blood Cells(RBCs): Normally absent or 0–2/HPF (high power field). Presence indicates hematuria causes: → stones, infections, trauma, tumors, glomerular disease.
- 41. White Blood Cells(WBCs): Normally absent or 0–5/HPF. Increased in urinary tract infections (UTI), pyelonephritis, cystitis.
- 42. Epithelial Cells: Few squamousepithelial cells may be normal (from lower urinary tract).Increased in infection, inflammation, contamination.Renal tubular epithelial cells → indicate tubular damage.
- 43. 2. Casts (cylindrical structuresformed in renal tubules) Hyaline casts: Normal in small numbers, in ↑ fever, dehydration, exercise. RBC casts: Suggest glomerulonephritis. WBC casts: Suggest pyelonephritis, interstitial nephritis. Granular casts: Seen in chronic renal disease. Waxy casts: Seen in chronic renal failure. Fatty casts: Seen in nephrotic syndrome.
- 45. 3. Crystals Uric acidcrystals: Seen in gout, chemotherapy. Calcium oxalate crystals: Common, seen in renal stones. Triple phosphate crystals: Seen in alkaline urine, UTI with urea- splitting bacteria. Cystine crystals: Seen in cystinuria (genetic disorder).
- 47. 🔹 4. Microorganisms Bacteria:Suggest infection (UTI). Yeast cells: Seen in diabetes mellitus.Yeast cells in urine, known as candiduria, can indicate a urinary tract infection (UTI) Parasites: Trichomonas vaginalis may be detected.
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- 49. Yeast cells: Seenin diabetes mellitus, UTI
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- 51. KFT ( BLOODTEST)
- 53. Blood Tests inKFT 1. Blood Urea Normal range: 15–40 mg/dL (varies slightly by lab) Increased in: Renal failure, dehydration, high protein diet, GI bleeding. Decreased in: Severe liver disease, malnutrition, overhydration.
- 54. 2. Blood UreaNitrogen (BUN) Normal range: 7–20 mg/dL Increased BUN (High BUN / Uremia) 1. Renal causes (kidney-related):. Acute or chronic kidney disease Glomerulonephritis Renal failure Decreased BUN (Low BUN) Severe liver disease (urea not synthesized) Malnutrition, low protein diet Overhydration (dilutional effect) Pregnancy (due to increased plasma volume)
- 55. 3. Serum Creatinine Normalrange: Men: 0.6–1.2 mg/dL Women: 0.6–1.1 mg/dL Increased in: Acute/chronic kidney disease, urinary obstruction. Decreased in: Low muscle mass, pregnancy.
- 56. 🔹 4. UricAcid Normal range: Men: 3.4–7.0 mg/dL Women: 2.4–6.0 mg/dL Increased in renal failure, leukemia, chemotherapy. Gout ( arthritis)
- 58. 5. Electrolytes (SerumNa , K , Cl , HCO ) ⁺ ⁺ ⁻ ₃⁻ Sodium (Na ): 135–145 mEq/L ⁺ Potassium (K ): 3.5–5.0 mEq/L ⁺ Chloride (Cl ): 95–105 mEq/L ⁻ Bicarbonate (HCO ): 22–28 mEq/L ₃⁻ Abnormal levels suggest renal tubular dysfunction, acidosis, alkalosis, dehydration
- 59. 6. Calcium &Phosphorus Calcium: 8.5–10.5 mg/dL Phosphorus: 2.5–4.5 mg/dL Imbalance common in chronic kidney disease (CKD) due to altered Vitamin D metabolism.
- 60. 7. Glomerular FiltrationRate (GFR) Estimated from Serum Creatinine using formulas. Normal GFR: 90–120 mL/min/1.73m² <60 Chronic kidney disease (if → persistent).