RENAL FUNCTION TEST

FUNCTIONS OF KIDNEY Classification of RFTs:

Regulation • Urine Analysis
o Physical examination
o Homeostasis, water, acid and base
o Chemical examination
Excretion o Microscopic examination
• Test for Glomerular Function
o Urea, creatinine o Renal clearance test
Endocrine o Blood analysis of urea and
creatinine
o Renin, Erythropoietin, 1, 25 o Proteinuria and heamaturia
dihydroxycalciferol • Test for Renal Plasma Flow
Objectives of RFTs: o Para-aminohipurrate test
• Test for Tubular Function
o To detect possible renal damage o Urine concentration Test
o Assessment of its severity o Urine dilution test
o To observe the progress of renal disease o Glycosuria
o To monitor the safe and effective use of drugs o Amino aciduria
which are excreted in the urine o Acid load test
o Phenosulfonpthalein test
Physical examination
▪ Volume Protein
✓ Normal output = 800-2, 500
ml/day • It is increased amount of protein in the urine
✓ Polyuria > 2, 500 ml/day • Proteinuria – increased glomerular
✓ Oliguria <500 ml/day permeability or reduced tubular reabsorption
✓ Anuria: complete cessation of urine • Most common type of proteinuria is due to
▪ Appearance albumin
✓ Normal urine is transparent pale Blood or Hematuria
yellow or amber colour
✓ Blood • Renal stone, cancer, tuberculosis trauma of
✓ Colour (haemoglobin, myoglobin) kidney or acute glomerulonephritis
✓ Turbidity (infection, nephrotic
Test for Glomerular Function
syndrome)
▪ pH • Renal clearance
o However, depending on the acid- • Blood analysis of urea and creatinine
base status, urinary Ph may range • Proteinuria and hematuria
from as low as 4.5 to as high as 8.0
▪ Gravity Renal clearance
o Normal – 1.016-1.022
• The renal clearance of a substance is
▪ Osmolarity
defined as the volume of plasma from which
o Average is 300 – 900 mosm/kg
the substance is completely cleared by the
▪ Odor
kidneys per minutes.
o Normal – aromatic scent
o Foul smell – bacterial infection • Depends on the plasma concentration of the
substance and its excretory rate, which in
Chemical examination turn, depends on the GFR and renal plasma
flow.
• Chemical examination includes the detection
• GFR can be measured by determining the
of the following
excretion rate of a substance which is
o Glucose
filtered through the glomerulus but
o Protein
subsequently, is neither reabsorbed nor
o Blood
secreted by tubules.
Glucose
C = (U x V)/P
• Normal urine contains small amount of
• C is the clearance of the substance in
glucose which cannot be detected by routing
ml/minutes
test
• U is the concentration of the substance in
• Excretion of detectable amounts of reducing
urine (mg/L)
sugar in urine is called glycosuria. It may be
• P is the concentration in plasma (mg/L)
benign or pathological.
• V is the volume of urine passed per minute.
Lower GFR Indicates: • Creatinine frome plasma directly related to
the GFR.
• Acute tubular necrosis
• Glomerulonephrosis Clinical Interpretation
• Shock, Acute nephrotic syndrome
• Normal: 90 – 120 ml/mints
• Acute and chronic renal failure.
• Decreased filtrate rate – acute and chronic
Selected substrate should be damage to the glomerulus, reduced blood
flow
✓ Freely filtered by glomerulus
✓ Should not be reabsorbed or secreted Urea Clearance Test
✓ Should not be metabolized by the kidney
• Normal value – 75 ml/min
✓ Should not be toxic
✓ Should not be ffected by dietary intake • Its less sensitivity
o Conc. Of urea by dietary protein,
2 types of substance are used for GFR fluid intake, infection, surgery, etc.
o Approximately 40% of the filtered
➢ Endogenous – creatinine and urea
urea is normallly reabsorbed by the
➢ Exogenous – Inulin
tubules.
Creatinine Clearance Test
Inulin Clearance Test
• Creatinine is freely filtered at the glomerulus
• Fructose polymer inulin satisfies the criteria
and is not reabsorbed by the tubule.
as an ideal marker of glomerular filtration
• A small amount of creatinine is secreted by
rate.
the tubules.
• Normal value – 120 ml/min
• Creatinine clearance is determined by
• Disadvantages:
collecting urine over 24-hr period and a
o Need intravenous administration
sample of blood is during the urine collection
o Difficulty of analysis
period.
Blood Analysis o Modifications required for children &
obese subjects
• Blood analysis may be more sensitive when o Can be modified to use Surface
the renal failure is advance. area
• Impairement of renal function results in
elevation of blood urea and creatinine. Proteinuria
• Increase end products of these substances
➢ The glomerular basement membrane does
called Azotaemia.
not usually allow passage of albumin and
Use of Formulae to Predict Clearance large proteins. A small amount of albumin,
usually less than 25 mg/24 hours, is found in
• Formulae have been derived to predict urine.
Creatinine Clearance (CC) from Plasma ➢ When larger amounts, in excess of 250
creatinine. mg/24 hours, are detected, significant
• Plasma creatinine derived from music mass damage to the glomerular membrane has
which is related to body mass, age and sex. occurred.
• Cockcroft & Gault Formula ➢ Quantitative urine protein measurements
CC = k[((140-Age) x weight (Kg))]/ should always be made on complete 24-hour
Creatinine (𝝁mol/L) urine collections.
k = 1.224 for males & 1.04 for females
 ➢ Albumin excretion in the range 25-300
mg/24 hours is termed microalbuminuria
Normal <200 mg/24 h. • This test requires a water deprivation for 14
hrs and has replaced the previous 24 hrs
Causes:
water deprivation test.
o Overflow (raised plasma Low MW Proteins, • The test should not be performed on a
Bence Jones, myoglobin) dehydrated patient.
o Glomerular leak
Urine Dilution Test
o Decreased tubular reabsorption of protein
(RBP, Albumin) This test is very simple, but because it is less
o Protein renal origin sensitive than the water deprivation test as test of
renal damage, its use is not often required.
Method
After an overnight fast the patient (who is not allowed
to smoke) empties his bladder completely and is
given 1000 ml of water to drink. Urine specimens are
collected for the next 4 hours, the patient emptying
bladder completely on each occasion.
Interpretation
Unless there is renal functional impairment, the
patient will excrete at least 700 ml of urine in the 4
hours and at least one specimen will have a specific
Test for Tubular Function gravity less than 1.004.

• Assessment of the concentration and dilution Urinary Acidification Test

ability of the kidney can provide the most This procedure tests the ability of the renal tubules to
sensitive means of detection early form an acidic urine and to excrete ammonia. It is
impairment in renal function since the ability useful if there is doubt whether a patient acidosis
to concentrate or dilute urine is dependent (confirmed by plasma analysis) is due to pre-renal
upon: cause , or kidney damage as in renal acidosis.
o Adequate GFR
o Renal Plasma Flow Method
o Tubular mass
The patient fatsts from midnight until the conclusion of
o Healthy tubular cells
the test, zero time. The patient empties his bladder
o Vasopressin hormone
completely. The urine is collected. The patient takes
Urine Concentration Test 0.1 g (1.9 m mol) of ammonium chloride/kg body
weight and drinks a liter of water. A standard dose of
• The ability of the kidney to concentrate urine 5 g is sometimes used. In children the dose should be
is a test of the tubular function that can be proportional to the body surface area. At 2 hours, 4
carried out readily with only minor hours and 6 hours; complete urine specimens are
inconvenience to the patient. collected.