RENAL FUNCTION TEST

Sheella RB
 RENAL FUNCTIONS

• Excretion: metabolic waste, toxic

chemicals
• Regulation: homeostasis water and
electrolyte, homeostais acid base
• Secretion: hormones
• Gluconeogenesis
ANATOMY

Brunzel. Fundamentals of urine & body fluid.2004

 PHYSIOLOGY

• Receive 20-25% of cardiac output

• Convert 180 L (120-125 mL/min) filtered plasma/ day ➔ 600-1800

mL urin
 DECREASED RENAL FUNCTION
Prarenal: shock, heart failure,
Renal
Postrenal: obstruction, tumor

Onset:
Acute
Chronic

Asymptomatic, subclinical ！
 THE PURPOSES OF KIDNEY FUNCTION TESTS

• Screening
• Diagnostic
• Monitoring therapy and disease
• Prognosis
 LABORATORY TESTS TO EVALUATE RENAL FUNCTIONS

Assesment of Glomerular Filtration:

Ureum, Creatinine
Clearance
Cystatin C
Assesment of Tubular Reabsortive Function:
Specific gravity
Osmolality
Fluid deprivation test
Assessment of Tubular Secretory Function:
Para aminohippurate (PAH) and phenolsulfonphtalein (PSP)
clearance test
Ureum :

• blood urea Nitrogen/ BUN

• Ureum=2,14 x BUN
• : high protein intake, dehydration, GIT bleeding,
• : low protein intake
Creatinine

•From muscle creatine phosphate breakdown

•More stable than urea
•Related to muscle mass
•: athletes with large muscle mass, rabdomyolysis
•: elderly with less muscle mass
Cystatin C

•13 kDa protein

•Produced by all nucleated cells
•Constant production rate
•Filtered by glomerulus, no tubular secretion or reabsorption
•Serum concentrations are unaffected by muscle mass or diet
Clearance test:
Measured
Clearance= U x V x f (mL/min)
B
U: urine (mg/dL)
B: blood (mg/dL)
V: 24 hours urine volume (mL)
f : factor (1.73m2/surface area)
Inulin clearance test:
Rarely performed for clinical use
Reference method for GFR determination

Ureum clearance test (UCT):

Urine collection: 2 hours
UCT= (ureum urine / ureum plasma) x (urine volume/120) x (1.73/SA)

Creatinine clearance test (CCT):

Urine collection: 12 or 24 hours
CCT= (creatinine urine/ creatinine plasma) x (urine volume/1440) x (1.73/SA)
Advantage:
Rapid and easy performed
Disadvantage:
• Urine collection is incorrect
• Creatinine damaged in urine without preservatives
Calculated (eGFR/ estimated GFR)
It is recommended to report the eGFR value on the examination of creatinine or
Cystatin C levels

•Cockroft-Gault equation
C = (140- age) x W ♂
72x S
C: creatinine clearance (mL/min)
Age: years
S: creatinine serum (mg/dL)
W: weight(kg)
 ♀: 85% ♂
Limitations: obesity, children, elderly, pregnancy, etc
• MDRD (Modification of Diet in Renal Disease) equation → NKDEP,
NKF, K/DOQI, Pernefri

eGFR=(179xCr)-0,999 X (age)-0.175 x (ureum)-0.170 x (albumin)0,318 x (if

women)
Modification: GFR (mL/min/1.73 m2) = 186 x (Scr)-1.154 x (age)-0.203 x
(0.742 if women) x (1.212 if African American)

Limitation:
May be less accurate in some other ethnicities
• CKD-EPI equation

GFR = 141 x min(SCr/κ, 1)α x max(SCr/κ, 1)-1.209 x 0.993age x 1.018(if

female) x 1.159 (if African American)

Limitation:
Not widely use
Alternate approach to asses GFR:

• Microalbumin urine
Albumin urine: <30 mg/day
albuminuria = Albumin to creatinine ratio (ACR) >30 mg/g

• 2-macroglobulin
Single polypeptide chain
11.8 kDa
Marker of reduced tubular function than of glomerular function