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Renal Function Tests: Dr. Arisha Sohail Dep. of Biochemistry Dimc

This document discusses tests used to evaluate renal function, including glomerular filtration rate (GFR) and urinalysis. It describes how GFR can be estimated using creatinine clearance tests involving measurements of serum and urine creatinine levels over a 24-hour period. However, creatinine clearance relies on an accurate urine collection and is impacted by muscle mass. Serum creatinine and blood urea nitrogen are also used to track GFR and kidney function over time, though they are influenced by additional factors. Urine tests examine features like protein, glucose, and cell counts.

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Arisha Sohail
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52 views

Renal Function Tests: Dr. Arisha Sohail Dep. of Biochemistry Dimc

This document discusses tests used to evaluate renal function, including glomerular filtration rate (GFR) and urinalysis. It describes how GFR can be estimated using creatinine clearance tests involving measurements of serum and urine creatinine levels over a 24-hour period. However, creatinine clearance relies on an accurate urine collection and is impacted by muscle mass. Serum creatinine and blood urea nitrogen are also used to track GFR and kidney function over time, though they are influenced by additional factors. Urine tests examine features like protein, glucose, and cell counts.

Uploaded by

Arisha Sohail
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Renal Function Tests

Dr. Arisha Sohail


Dep. Of Biochemistry
DIMC
Renal function tests
• Renal function tests
– Tests for GFR
– Urinalysis
– Tests for Renal Tubular Acidosis
– Tests of Kidney Concentrating Ability
Renal Function Tests
• Detect renal damage

• Monitor functional damage

• Help determine etiology


Laboratory tests of renal function
• glomerular filtration rate (GFR)
• plasma creatinine • urine protein
• plasma urea • urine glucose
• urine volume • hematuria
• urine urea • osmolality
• minerals in urine
Tests of renal function

• glomerular filtration
rate=GFR
• plasma creatinine= Pcr
• plasma urea-Purea
• urine volume= V
• urine urea- Uurea
• cystatin C in plasma?
Tests of Glomerular Filtration
Rate
• Urea
• Creatinine
• Creatinine Clearance
• eGFR
• Cystatin C
Glomerular Filtration Rate (GFR)
• Volume of blood filtered across glomerulus
per unit time

• Best single measure of kidney function


GFR

• Normally 100-130 ml/min


• Determined by:
• Net filtration pressure across glomerular
basement membrane
• Permeability and surface area of glomerular
basement membrane
GFR
• Patient’s remain asymptomatic until there has
been a significant decline in GFR
• Can be very accurately measured using “gold
standard” technique
GFR
• Ideal Marker
– Produced normally by the body
– Produced at a constant rate
– Filtered across glomerular membrane
– Removed from the body only by the kidney
filtered only, not reabsorbed or secreted
Candidate markers for GFR

Inulin
+ Filtered only
– Not made by body; must be injected
Creatinine
+ An endogenous product of muscle
metabolism; near-constant production
– Filtered, but a bit secreted
Urea
+ An endogenous product of protein intake
– Filtered and absorbed; synthesis varies with diet0
Urea
• Used historically as marker of GFR
• Freely filtered but both re-absorbed and
excreted into the urine
• Re-absorption into blood increased with
volume depletion; therefore GFR
underestimated
• Diet, drugs, disease all significantly effect Urea
production
Urea
• Product of protein catabolism
• Filtered
• Reabsorbed in proximal tubule
• If sodium is avidly reabsorbed, so is urea
• Serum urea concentration measured as
“Blood Urea Nitrogen (BUN)”
Urea
• Increase  Decrease
• Volume depletion  Volume Expansion
• Dietary protein  Liver disease
 Severe malnutrition
• Corticosteroids
• Tetracyclines
• Blood in G-I tract
Why does BUN increase?
 GFR, but also:
Increased renal reabsorption:
• ECV depletion
Increased hepatic urea synthesis
• High protein feeding
• Corticosteroid treatment (Prednisone, etc.)
• GI blood absorption
BUN: Uses
• Imperfect marker of  GFR
• Marker for adequacy of protein intake
• Marker for presence of uremic toxins in
chronic renal failure
• BUN:Cr ratio reflects ECV volume status:
– 10:1 = normal
– >20:1 if ECV contracted. Why???
 Proximal tubule Na and urea reabsorption!
Creatinine
• Product of muscle metabolism
• Some creatinine is of dietary origin
• Freely filtered, but also actively secreted into
urine
• Secretion is affected by several drugs
Serum Creatinine
• Increase  Decrease
• Male  Age
 Female
• Meat in diet
 Malnutrition
• Muscular body type  Muscle wasting
• Cimetidine & some  Amputation
other medications
Serum Creatinine Concentration
• Normally 0.7-1.4 mg/dl, depending on muscle
mass
• Inversely proportional to GFR
• Good way to follow changes in GFR
• BUT also elevated by  muscle mass, 
tubular secretion
Creatinine Clearance
• Measure serum and urine creatinine levels
and urine volume and calculate serum volume
cleared of creatinine
• Same issues as with serum creatinine, except
muscle mass
• Requirements for 24 hour urine collection
adds variability and inconvenience
Creatinine Clearance

• Therefore, it represents the volume of serum


completely cleared of creatinine per unit time

• Since virtually all creatinine is cleared via


glomerular filtration, it closely approximates the
GFR
Creatinine Clearance
• EXAMPLE:
UCr = 72 mg/dl
SCr = 2.0 mg/dl
V = 2 liters
time = 24 hours

72 mg/dl  2000 ml / day


CrCl   50 ml/min
2.0 mg/dl  24 hrs / day  60 min/hour
Limitations of Creatinine Clearance

• Only valid at steady state—[Cr]serum must be


stable

• Trimethoprim, cimetidine lower tubular Cr


secretion and lower CrCl without changing GFR:

• Becomes more inaccurate at low GFR


Another Problem with Creatinine
Clearance
• Must be done on a properly collected, timed
urine sample--patient error

• How can we check accuracy of any timed urine


collection?
Creatinine Excretion
• The amount of creatinine excreted per day is
stable for a given patient
• It is function of muscle mass: generally higher
in men vs. women, youth vs. elderly
• expressed per kg lean body mass as the
creatinine index
Proteinuria
• In health:
• High molecular weight proteins are retained in
the circulation by the glomerular filter
(Albumin, Immunoglobulins)
• Low molecular weight proteins are filtered
then reabsorbed by renal tubular cells
• To summarize:

• 1. Use the Creatinine Clearance as the best


estimate of GFR
• 2. Use the Serum Creatinine to follow renal
function over time
• 3. Use the Creatinine Index to check the
adequacy of a urine collection
• 4. Use the BUN to help assess GFR, volume
status, and protein intake

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