Scribd
Upload
544 views31 pages

Renal Function Tests

Acute Renal Failure (ARF) occurs when the kidneys suddenly fail to excrete waste products. Causes include acute nephritis, renal ischemia, poisoning, and circulatory shock. Symptoms include reduced urine output, protein in the urine, and retention of sodium and water leading to edema. If left untreated, ARF can cause acidosis, coma and death within 10-15 days. Chronic Renal Failure develops over months or years as nephrons are progressively damaged, and causes accumulation of metabolic waste products in the blood. Tests of renal function include analysis of urine and blood for waste products and other biomarkers, measurement of clearance rates of substances like creatinine and inulin, and medical imaging of the

Uploaded by

Physiology by Dr Raghuveer
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
544 views31 pages

Renal Function Tests

Acute Renal Failure (ARF) occurs when the kidneys suddenly fail to excrete waste products. Causes include acute nephritis, renal ischemia, poisoning, and circulatory shock. Symptoms include reduced urine output, protein in the urine, and retention of sodium and water leading to edema. If left untreated, ARF can cause acidosis, coma and death within 10-15 days. Chronic Renal Failure develops over months or years as nephrons are progressively damaged, and causes accumulation of metabolic waste products in the blood. Tests of renal function include analysis of urine and blood for waste products and other biomarkers, measurement of clearance rates of substances like creatinine and inulin, and medical imaging of the

Uploaded by

Physiology by Dr Raghuveer
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 31

Acute Renal Failure

ARF is the condition when kidney suddenly fails to excrete water,electrolytes & waste products.

Causes of ARF
Acute nephritis- immune complex Damage to renal tissue by poisons like lead,mercury & carbon-tetrachloride Renal ischemia which is developed during ciculatory shock Severe transfusions reactions Sudden fall in B.P. during haemorrhage,dirrhoea,severe burn,cholera Blockage of ureter due to formation of calculi

Symptoms
Volume of urine out put is reduced (oligouria) & in severe condition Anuria(stopage of urine formation) Proteins +++ urine(proteinuria)-albumin++ RBC,WBC & casts +++urine Retention of Na & water- edema, ECFV Hypertension Acidosis If the Patient is not treated in time ,the acidosis becomes severe resulting in coma & death within 10 to 15 days

Chronic Renal Failure


When some of the nephrons loose function the unaffected nephrons can perform the functions. However when more & more nephrons starts loosing the function over the months or years,the CRF is developed

Causes of CRF
Chronic nephritis Hypertension Renal stones Development of cyst in kidney Atherosclerosis Slow poisoning

Symptoms
Excessive accumulation of metabolic end products like urea,creatinine in blood is called Uremia. Common features of uremia are Loss of appetite(anorexia) ,Lethargy Drowsiness ,Nausea& vomiting Pigmentation of skin,mascular twiching Convulsions,confusion & mental deterioration

Acidosis Hyperkalemia Edema Anemia Hyperparathyroidism-is developed due to deficiency of 1,25 di-OHCCF.This causes removal of calcium from bones causing osteomalacia

Dialysis
In physiologic sense refers to diffussion of solutes from an area of higher conc. To the area of lower conc.through a semipermeable membrane. This principal has been used to dialyse the blood of patients with renal failure specially those developing Uremia. Uremia develops>70% nephrons damaged

Haemodilysis
Intermittent dialysis may prolonge the life of many patients with CRF. it can partially replace excretory function of the kidneys but does not replace endocrine & metabolic functions

RENAL FUNCTION TESTS

FUNCTIONS of KIDNEY :
1) Excretory primary :by urine formation 2) Regulation of volume & electrolyte composition of ECF 3) Regulation of acid-base balance 4) Endocrine function produce & secrete: erythropoietin, renin, calcitriol(1,25-DHCC) 5) Site of neoglucogenesis not primary: in starvations- esp. from glutamine

Renal Function Tests :

collective term for a variety of individual tests and procedures that can be done to evaluate how well the kidneys are functioning.
Practically, divided into 3 groups 1) Analysis of urine & blood 2) Specific assessment of renal clearance 3) Additional special Tests

OBJECTIVES of RFT :
Early detection of possible renal damage & assessment of its severity Measure progression of the renal impairment & efficacy of corrective therapy Predict when renal replacement therapy may be necessary Monitor safe & effective use of drugs, which are principally eliminated through urine.

ANALYSIS OF URINE :
A) PHYSICAL :
1)Volume 1000-2500 ml/d Normal Polyuria >2.5L/d Chronic GN Oliguria<400ml/d seen in Ac GN, Terminal RF Anuria <100ml/d seen in Renal Failure

2) Appearance > clear Turbid (alkalinity d/t prolonged standing l/t ppt of Ca/Mgphosphates,phosphate , presence of pus d/t UTI)
3) Colour> straw/amber-yellow urochrome Brownish yellow (jaundice) Dark (alkaptonuria) Reddish brown (RBC/Hb/Mb-uria,Porphyria etc.)

4) Odour> mild aromatic volatile org. acids Unpleasant ammoniacal (prolonged standing) Acidotic fruity (DKA)

5) Sp. Gravivity & Osmolality >


1.003 to 1.030 & 50-1200 mOsm/kg (depends on state of hydration of the body) Early morning urine sample(=after overnight fast)if SG>1.018 & Osm>600 Normal SG is simplest to measure but unreliable(in presence of HMW substances) for evaluating renal concentrating ability. SG decreased,increased & fixed(1.010=CRF)

Applied aspect
12 hr water deprivation results in S.G. of urine to become 1025 with 1000 osmolarity. Failure to do this indicate abnormal renal functioning in S.G. is seen in = low water intake, DM, Albuminuria,Ac Nephritis In S.G. is seen in= Tubular Damage, Absence of ADH

B) BIOCHEMICAL : 1) Reaction > mild acidic pH avg.6


(=4.5-7.5) normal short PP alkaline tide Protein rich diet acidic Vegetable rich diet alkaline also in type II DTA, UTI by urease producing organisms, Acetazolamide therapy, alkali ingestion.

2) For abnormal urinary constituents : I) Proteins >


Normal upto 150 mg/droutinely undetected Proteinuria >150mg/d albumin predominates Glomerulonephritis, Pyelonephritis,Toxaemia of pregnancy, tubulo-interstial disorders

II) Reducing Sugars >


Normally absent glucose/fructose/galactose ++ DM,Renal Glycosuria,Alimentary Glycosuria Fructose,Galactose++in Metabolic disorders

III) Blood >Haematuria


Normally does not appear ++ Ac GN,Renal stones,Malignancy of UT

IV) Ketone Bodies >


Normally not present
++Prolonged starvation,Diabetic Ketoacidosis

V) Bile salts >


Only in early phases of obstructive jaundice By- Hays test & Petenkoffers test

VI) Urobilinogen > N ~1 - 3.5 mg/d


in persistent fevers, hepatobiliary diseases, haemolytic jaundice

VII) Bile-pigments >


Bilirubinuria=conj.Bilirubin hep/post-hep jaun VIII) Haemoglobinuria
Normally =absent ++indicate intravascular Haemolysis(Black water fever due to falciperum malaria)

C) MICROSCOPIC :
Imp findings in the urinary sediment includes---

I) Casts >>

proteinaceous plugs

Formation favoured by sluggish flow Various shapes c/t tubules in which formed cellular or non-cellular Types Hyaline, RBC, WBC, Granular, Broad waxy etc.

II) Crystals >>


Ca-oxalate/phosphate, Triple phosphate-common May be normally found risk of stone in future Urate or Cysteine crystals pathologic

III) Cells >>


RBCs, WBCs, pus cells, Sq.epithelial, Tubular epithelial cells

ANALYSIS of Blood :
There is no plasma constituent whose conc. depends solely on the functionality of kidneys. Frequently used are 2 normal metabolic wastes Excreted by kidneys accumulates in renal dysfunction blood levels I) Blood Urea = 20-40 mg% begin to rise only after 50% renal damage II) Plasma Creatinine >> 0.6 1.5 mg% More reliable as blood ureaq is subjected to variations Serum K+ =5mEq/L increased in oligoruria

Renal clearance TESTS:


Vol. of plasma that is cleared of a substance in unit time, by its urinary excretion ml/min Calculated as: C = UV/P Predominantly determine GFR: Relationship as GFR = C No reabs, No Secret INULIN
GFR > C
GFR < C

Much reabs, No Secret


No reabs, Much Secret

Gluc, AA, Na+, ClPAH, Diodrast

Renal clearance TESTS:


Correlated more directly with the status of kidney function employed to assess GFR,RPF & RBF

Various markers used : A) Exogenous >> 1) Inulin (gold standard but technically demanding) 2) Non-radiolabelled contrast media (e.g. Iohexol) 3) Radiolabelled compounds (e.g. 99m TcDTPA) B) Endogenous >> 1) Creatinine (marginally overestimates most widely used in clinical practice) 2) Urea (one of the 1st markers not used at present)

** Prediction of GFR from Plasma creatinine levels:


Approximation of bedside GFR with limited accuracy by Cockroft & Gault formula Most widely used & best validated for adults Ccr =(140-Age)x(Wt in Kg)/(Plasma Creatinine x72) [Correction factor for females = 0.85] value to such formulas for GFR prediction is likely to increase when an accurate plasma creatinine assay is performed along with inhibition of tubular secretion by cimetidine/probenecid.

Renal Imaging studies >>


Plain radiograph of abdomen IVP USG, CT Scan, MRI Scan Radionuclide studies Strictly speaking, these are not considered to be RFTs, but very useful in present day clinical practice for structural & functional assessment of kidneys.

You might also like