The document discusses renal function tests. It describes the key functions of the kidneys including homeostasis, waste excretion, retention of vital substances, and hormonal functions. It then explains the structure and function of nephrons, and discusses various tests used to evaluate renal function including urine examination, glomerular function tests like creatinine clearance, analysis of blood and serum, and tubular function tests. Creatinine clearance is described as a sensitive test to assess glomerular function by measuring the volume of plasma cleared of creatinine per minute.
Liver function tests for Pharm.D (Medicinal biochemistry & Clinical pharmacy)Soujanya Pharm.D
Introduction, Major functions of liver, Tests to assess liver function, Classification of liver function tests, Interpretation of results (Medicinal biochemistry & Clinical pharmacy)
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.
Liver function tests for Pharm.D (Medicinal biochemistry & Clinical pharmacy)Soujanya Pharm.D
Introduction, Major functions of liver, Tests to assess liver function, Classification of liver function tests, Interpretation of results (Medicinal biochemistry & Clinical pharmacy)
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 liver is the largest organ in the body
It is located below the diaphragm in the right upper quadrant of the abdominal cavity and extended approximately from the right 5th rib to the lower border of the rib cage.
Lipids are fatty substances that play an important role in a number of body functions. Apart from being structural components of the cells, Lipids also act as a source and mode of storage of energy for the body. The Lipid Profile Test measures the levels of specific types of lipids in the blood.
For more details, visit:
https://www.1mg.com/labs/test/lipid-profile-1909
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 liver is the largest organ in the body
It is located below the diaphragm in the right upper quadrant of the abdominal cavity and extended approximately from the right 5th rib to the lower border of the rib cage.
Lipids are fatty substances that play an important role in a number of body functions. Apart from being structural components of the cells, Lipids also act as a source and mode of storage of energy for the body. The Lipid Profile Test measures the levels of specific types of lipids in the blood.
For more details, visit:
https://www.1mg.com/labs/test/lipid-profile-1909
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.
Clinical symptoms and management of Arsenic poisoningSoujanya Pharm.D
This presentation includes Introduction & physical appearance of arsenic, usual fatal dose, toxicokinetics and mode of action of arsenic, Clinical (toxic) symptoms, diagnosis and management of Arsenic poisoning
Gut decontamination or methods of poison removal in clinical toxicology Soujanya Pharm.D
This presentation includes various methods of poison removal like emesis, gastric lavage (stomach wash), catharsis, activated charcoal, whole bowel irrigation.
This presentation includes definition, epidemiology, etiology, pathophysiology (life cycle), diagnosis, clinical features of uncomplicated & severe malaria and treatment of malaria.
Definition, Epidemiology, Etiology, Aspects of anxiety, Classification/types of anxiety, Pathophysiology of anxiety disorders, Management of anxiety disorders along with treatment algorithms
Definition, Patterns/types and mechanisms of drug induced liver disorders, assessment of drug induced liver disorders and its treatment (pharmacotherapeutics-3)
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
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
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
1. CLINICAL PHARMACY RENAL FUNCTION TESTS
PHARM. D 1
RENAL FUNCTION TESTS
T. SOUJANYA
16DC1T0021
2. CLINICAL PHARMACY RENAL FUNCTION TESTS
PHARM. D 2
RENAL FUNCTION TESTS
Kidney: The kidneys are the vital organs of the body, performing the
following major functions.
1. Maintenance of homeostasis: The kidneys are largely
responsible for the regulation of water, electrolyte and acid-base
balance in the body.
2. Excretion of metabolic waste products: The end products of
protein and nucleic acid metabolism are eliminated from the
body. These include urea, creatinine, uric acid, sulphate and
phosphate.
3. Retention of substances vital to body: The kidneys reabsorb
and retain several substances of biochemical importance in the
body.
e.g. glucose, amino acids etc.
4. Hormonal functions: The kidneys also function as endocrine
organs by producing hormones.
• Erythropoietin, a peptide hormone, stimulates haemoglobin
synthesis and formation of erythrocytes.
• 1,25-Dihydroxycholecalciferol (calcitriol), the
biochemically active form of vitamin-D is finally produced
in the kidney. It regulates calcium absorption from the gut.
• Renin, a proteolytic enzyme liberated by kidney, stimulates
the formation of angiotensin II which, in turn, leads to
aldosterone production. Angiotensin II and aldosterone are
the hormones involved in the regulation of electrolyte
balance.
Nephron: The main functional unit of kidney is nephron, each kidney
is composed of approximately 1 million nephrons. The blood supply to
kidneys is relatively large. About 1200ml of blood (650ml plasma)
passes through the kidneys, every minute. From this, about 120-125ml
is filtered per minute by the kidneys and this is referred to as
“glomerular filtration rate (GFR)”. The process of urine formation
basically involves 3 steps.
3. CLINICAL PHARMACY RENAL FUNCTION TESTS
PHARM. D 3
1. Glomerular filtration.
2. Tubular reabsorption.
3. Tubular secretion.
Purpose of renal function tests:
1. To diagnose the disease or disorders of kidneys and urinary tract
and other systematic diseases that effect the kidney functioning.
2. Urine examination is usually employed to diagnose most of the
kidney disorders.
Classification of renal function tests: Renal function tests may be
divided into 4 groups.
1. Urine examination: This is classified into 3 types.
a) Physical/macroscopic examination: It include volume,
colour, odour, reaction (PH
), specific gravity.
b) Biochemical examination: It include proteins, sugars,
ketone bodies, bile salts, bile pigments, blood.
c) Microscopic examination: It include cells, crystals, casts,
microorganism, parasites, contamination.
2. Glomerular function tests (clearance tests): All the clearance
tests (inulin, creatinine, urea) are included in this group.
3. Analysis of blood/serum: Estimation of blood urea, serum
creatinine, protein and electrolyte are often useful to assess renal
function.
4. Tubular function tests: Urine concentration test, urine dilution
test, urine acidification test.
1. Urine examination:
a) Physical/macroscopic examination:
i) volume:
Normal volume is 1000-2000/24hrs (depending upon water intake).
Increase in urine levels id known as polyuria (more than 2000ml/day).
This may be due to certain drugs, IV solutions, diabetes mellitus etc.
Decrease in urine levels is known as oliguria (less than 400ml/day).
4. CLINICAL PHARMACY RENAL FUNCTION TESTS
PHARM. D 4
Less than 100ml of urine in 24hrs is known as anuria. These conditions
may be due to dehydration, congestive heart failure, due to renal tract
obstruction.
ii) Colour:
The normal colour of urine is pale yellow to urochrome. Abnormal
colours are observed during diseased state. Various colours and
corresponding diseases are as follows.
• Red: haematuria
• Blue: cholera
• Yellow-brown: bilirubin
• Yellow-green: biliverdin
• Orange: excessive sweat, fever
• Black: melanin
iii) Odour:
Smell of urine is usually light pungent. Various other smells are also
observed.
• Aromatic: volatile fatty acids
• Ammonical: due to bacterial action
• Fruity odour: ketonuria
iv) PH
:
Normal PH
of urine is 6, it may be between 5-9 depending upon diet.
High PH
(classic renal alkalosis) is due to sodium carbonate containing
drugs, strict vegetarian. Lower PH
(classic renal acidosis) is due to
ammonium chloride containing drugs, starvation, ketosis, fever,
diabetes.
v) Specific gravity:
Normal value of specific gravity 1.001-1.040. Increase in specific
gravity is due to dehydration, fever, vomiting, diarrhoea, congestive
heart failure, diabetes mellitus. Decrease in specific gravity is due to
diabetes insipidus.
5. CLINICAL PHARMACY RENAL FUNCTION TESTS
PHARM. D 5
b) Biochemical examination:
i) Proteins:
Test Observation Inference
Sulphosalicylic acid
test: 3ml of urine +
sulphosalicylic acid
drop by drop
White precipitation is
formed
Presence of proteins
Heller's nitric acid
test: 3ml
concentration of
nitric acid + urine
sample drop wise
from sides of test tube
White ring is formed
at the junction of two
layers
Presence of proteins
Heat coagulation:
Boil 5ml of urine
sample for 5 minutes
Turbidity is observed Presence of proteins
Presence of proteins in urine is called proteinuria. Various causes of
proteinuria are severe exercise, high protein diet, pregnancy, kidney
disease, damage to lower urinary tract, fasting.
ii) Sugars:
Test Observation Inference
Benedict's reagent
test: 2ml of urine +
2ml of benedict's
qualitative reagent,
boil for 2ml and cool.
a) Green precipitate
b) Brick red
precipitate
c) Yellow precipitate
a) 1% glucose
b) 2% glucose
c) more than 2%
glucose
Fehling's reagent
test: 2ml of Fehling's
A and Fehling's B +
2ml of urine, boil for
2-5 minutes
Red or yellow
precipitate is formed
Presence of glucose
Presence of glucose in urine is called glucosuria, this may be due to
diabetes mellitus, hypertension, corticosterol drugs etc.
6. CLINICAL PHARMACY RENAL FUNCTION TESTS
PHARM. D 6
iii) Ketones:
Test Observation Inference
Rothera's test: 5ml
of urine + small
amount of
ammonium sulphate
+ 2 drops of sodium
nitroprusside + 2ml
of strong ammonia
solution and wait for
10 minutes
Permanganate colour
is observed
Presence of ketone
bodies
Presence of ketone bodies in urine is called ketonuria, this may be
due to starvation, excessive fatty acid metabolism, pregnancy.
iv) Bile salts:
Test Observation Inference
Sulphur powder
test: Take 5ml of
urine in a beaker and
sprinkle sublimed
sulphur powder
Powder sinks to
bottom
Presence of bile salts
Presence of bile salts in urine may be due to jaundice, obstruction
of biliary tract, liver diseases.
v) Bile pigments:
Test Observation Inference
Gmelin's test: 10ml
of urine + 2 to 3 drops
of dilute Hcl, filter it,
allow the filter paper
to dry and put a drop
of HNO3
Colouration of paper
in following order:
Green, blue, violet,
red, yellowish red
Presence of bile
pigments
Heller's nitric acid
test: 3ml of conc.
HNO3 + add urine
drop wise slowly
Fine ply of colours is
observed
Presence of bile
pigments
7. CLINICAL PHARMACY RENAL FUNCTION TESTS
PHARM. D 7
Apart from these tests Van den Bergh’s reaction, Fouchet's test are
also employed. Presence of bile pigments in urine may be due to
jaundice (haemolytic or obstructive), obstruction of biliary tract, liver
diseases.
vi) Blood:
Test Observation Inference
Benzidine test: 2ml
of urine + few ml of
H2O2 + pinch of
benzidine in acetic
acid
Green colour is
observed
Presence of blood
Presence of blood in urine is called haematuria, various causes of
haematuria are renal calculi, glomerulonephritis, severe urinary tract
infections, renal tract tumour.
c) Microscopic examination:
In this, the analysis is done simply by pouring the urine sample into
test tube and centrifuging it for 5 minutes, the top liquid part is
discarded and the sediment left at the bottom is mixed with 1 drop of
urine and is studied under a microscope.
i) Cells:
Few epithelial cells & RBC are observed occasionally in urine. This
may be due to fever or urinary tract calculi or acute renal damage or
glomerulonephritis.
ii) Crystals:
Various crystals are found in the acidic urine like uric acid crystals,
calcium oxalate crystals, cysteine crystals etc. Crystals found in basic
urine are carbonate and phosphate crystals.
iii) Casts:
Urinary casts are cylindrical structures produced by the kidney and
present in the urine in certain disease states. They form in the proximal
convoluted tubule & collecting duct of nephrons, then dislodge and
8. CLINICAL PHARMACY RENAL FUNCTION TESTS
PHARM. D 8
pass into the urine, where they can be detected by microscopy. These
casts are of 2 types.
Cellular casts Acellular casts
RBC casts
WBC casts
Epithelial casts
Hyaline casts
Fatty casts
Waxy casts
Pigment casts
2.Glomerular filtration tests (clearance tests):
a) Creatinine clearance: Creatinine is an excretory product derived
from creatine phosphate (largely present in muscle). The excretion of
creatinine is rather constant and is not influenced by the body
metabolism or dietary factors. Creatinine is filtered by the glomeruli
and only marginally secreted by the tubules. The value of creatinine
clearance is close to GFR, hence it's measurement is a sensitive and
good approach to assess the renal glomerular function.
Definition: Creatinine clearance may be defined as the volume (ml) of
plasma that would be completely cleared of creatinine per minute.
Procedure: In the traditional method, creatinine content of a 24 hour
urine collection and the plasma concentration in this period are
estimated. The creatinine clearance (C) can be calculated as follows:
C = U×V
P
Where;
U = Urine concentration of creatinine (mg/dl or mmol/L)
V = Volume output in ml/min (24hr urine volume divided by 24×60)
P = Plasma concentration of creatinine (mg/dl or mmol/L)
Reference values: The normal range of creatinine clearance is around
120-145ml/min. These values are slightly lower in women. In recent
years, creatinine clearance is expressed in terms of body surface area.
Diagnostic importance: A decrease in creatinine clearance value
(<75% normal) serves as sensitive indicator of decreased GFR, due to
9. CLINICAL PHARMACY RENAL FUNCTION TESTS
PHARM. D 9
renal damage. This test is useful for an early detection of impairment
in kidney function.
b) Urea clearance: Urea is the end product of protein metabolism.
After being filtered by the glomeruli, it is particularly reabsorbed by
the renal tubules. Hence, urea clearance is less than the GFR and further
it is influenced by the protein content of diet. For these reasons, urea
clearance is not as sensitive as creatinine clearance for assessing renal
function. Despite this fact, several laboratories traditionally use this
test.
Definition: Urea clearance is defined as the volume (ml) of plasma that
would completely cleared of urea per minute. It is calculated by the
formula:
Cm = U×V
P
Where;
Cm= Maximum urea concentration
U = Urea concentration in urine (mg/ml)
V = Urine excreted per minute in ml.
P = Urea concentration in plasma (mg/ml)
The above calculation is applicable if the output of urine is more
than 2ml/min. This is referred to as maximum urea clearance and the
normal value is around 75ml/min.
Interpretation of result:
• If urea concentration is >70%, renal function is normal.
• If urea concentration is between 40-70%, renal function is mildly
impaired.
• If urea concentration is <20%, renal function is severely
impaired.
3. Analysis of blood/serum: Estimation of serum creatinine and blood
urea are useful. These tests are less sensitive than the clearance tests.
Serum creatinine is a better indicator of urea.
10. CLINICAL PHARMACY RENAL FUNCTION TESTS
PHARM. D 10
a) Blood urea:
Urea is major nitrogenous end product of protein and amino acid
catabolism, produced by liver and distributed throughout intracellular
and extracellular fluid. Urea is filtered freely by the glomeruli. The
reference value for serum urea is 10-40mg/dl.
Many renal diseases with various glomerular, tubular, interstitial or
vascular damage can cause an increase in urea concentration. High
protein diet causes significant increase in plasma urea concentration
and urinary excretion.
b) Serum creatinine:
Creatinine is formed from creatine in muscles. It is released in blood
and is excreted by kidneys in urine. Normal range of serum creatinine
is 0.6-1.5mg/dl. Glomerular filtration is reduced in renal failure. This
causes retention of creatinine in blood. Hence, serum creatinine is
raised in renal failure. Serum creatinine is a better indicator of
glomerular function than serum urea.
4. Tubular function tests:
a) Urine concentration test:
This is used to assess the renal tubular function. This test includes
the measurement of specific gravity which depends on concentration of
solute present in urine. Normal specific gravity value is 1.020.
b) Urine dilution test:
Urine dilution test is done to assess the ability of kidneys to
eliminate water. This function is tested by measuring urinary output
after ingesting a large volume of water. This test is not advisable for
patients with adrenal insufficiency.
c) Urine acidification test:
Urine acidification test is done to check the ability of kidney to
produce acidic urine which is the function of tubules. For this test,
patient is asked to empty the bladder. The PH
of urine is measured
11. CLINICAL PHARMACY RENAL FUNCTION TESTS
PHARM. D 11
which should be between 4.6-5.0. In patients with renal tubular
acidosis, PH
does not fall below 5.3 even after dose of ammonium
chloride.
Reference/Bibliography:
1. A text book of Biochemistry by U. Satyanarayana; U.
Chakrapani. Page no. 459-463.
2. A text book of Clinical pharmacy practice; Essential concepts and
skills by Dr. G.Parthasarathi.
3. www.slideshare.net