MONITORING

RENAL FUNCTION
INTRODUCTION:
 The composition of blood is largely determined by what
the kidneys retain and excrete.
 The kidneys filter dissolved particles from the blood
and selectively reabsorb the substances that are
needed to main the normal composition of body fluids.
 When the renal system fails, a variety of indirect
cardiopulmonary problems develop, including
hypertension, CHF, pulmonary edema, anemia, and
changes in acid-base balance.
THE
NEPHRON
URINE FORMATION
 URINE- it is composed of water, certain electroyles, and various waste product that
are filtered out of the blood stream

3 Process:
1. Glomerular Filtration
- nonselective passive process
- blood cells cannot pass out to the capilliaries
2. Tubular Reabsoption
- reabsorption refers to the return of substances to the bloodstream
- reabsorbtion is passive, most is active
3. Tubular Secretions
- removes a substance from the blood
- reverse of reabsoption
REGULATION OF URINE CONCENTRATION AND
VOLUME
 Antidiuretic hormone (ADH) is produced by the pituitary gland
to control the amount of water that is reabsorbed through the
collecting ducts in response to thr increased plasma
osmolarity.

 The increase in osmolarity is sensed by osmoreceptors in the

hypothalamus.

 ADH increases permeability to water of the distal convoluted

tubule and collecting duct, which are normally impermeable to
water.
REGULATION OF ELECTROLYTE
CONCENTRATION
1. SODIUM IONS

 Normal Value: 135-145 mEq/L

 Directly affect the osmolality of the fluids
 When the sodium concentration increases, there is a
corresponding increase in the extracellular fluid
osmolality, and vice versa.
 Its concentration is controlled by the kidneys by primarily
regulating the amount of water in the body
 When levels are too high, the amount of water in the body
increases by:
 secretion of ADH
 Stimulation of thirst
2. POTASSIUM IONS
Normal Value: 3.5-5 mEq/L
In response to high levels, the kidneys work to return the
concentration to normal by 2 negative feedback control
mechanisms:
a. Direct effect of excessive K on epithelial cells of the renal
tubercles cause an increased transport of K out of the
peritubular capillaries and into the tubules of the nephrons,
where it is passed in the urine
b. Excessive K causes the adrenal cortex to release increased
quantities of aldosterone. Aldosterone stimulates the
tubular epithelial cells to transport potassium ions into the
nephron tubules, and into urine
CALCIUM, MAGNESIUM AND
PHOSPHATE IONS
Normal Value of Ca: 4.5-8 mEq/L
Normal Value of Mg: 1.3-2.5 mEq/L
Normal Value of PO4: 1.4-2.7 mEq/L
Elevated levels of any one of these ions in the extracellular fluid cause the
tubercle to decrease reabsorption and to pass the substances into the
urine.
When any one of these substances is low in concentration, the tubules
rapidly reabsorb the substance until its concentration in the extracellular
fluids return to normal.
ROLE OF THE KIDNEYS IN
ACID-BASE BALANCE
The Renal System regulates the excretion of hydrogen ions and
reabsorption of bicarbonate ions.
The rate of secretion is directly proportional to the hydrogen ion
concentration in the blood.
When extracellular fluids become too acidic, the kidneys excrete hydrogen
ions into the urine.
When extracellular fluids become too alkaline, the kidneys excrete basic
substances (primarily sodium bicarbonate) into the urine.
BLOOD
CHEMISTRY
1. BLOOD UREA NITROGEN (BUN)
 Urea is a waste product of protein metabolism and is synthesized in the liver from
amino groups & ammonia generated during catabolism.
BUN levels thus depend not only on renal function but also on diet,& liver function

NORMAL BUN:
10 to 2o mg/dL

2. CREATININE
Creatinine is a waste product of creatine metabolism and produced in muscle tissues.
The quantity of creatinine produced is proportional to the body’s muscle mass
Decreased creatinine levels are seen in muscle wasting.
Creatinine serum level usually remain nearly constant, reflecting the balance between
its production & filtration by the renal glomerulus
NORMAL CREATININE:
0.7 to 1.5 mg/dL
3.BUN TO CREATININE RATIO
Can help determine the cause of increases in analytes.
An increase in BUN to creatinine ratio can be observed in conditions causing decreased in blood
A decresed ratio may be observed with liver disease and malnutrition
NORMAL RANGE:
10:1 and 20:1

4.GLUMERULAR FILTRATION RATE (GFR)

Used to screen for early kidney damage
A calculation based on the serum creatinine level and the patient’s age, gender, height, weight, and race
A measure of how well the kidneys are processing waste
NORMAL GFR:
90 to 120 mL/min/ 1.73m2

5.CREATININE CLEARANCE
Dertermines how efficiently the kidneys are clearing creatinine from the blood and serves as an estimate of
kidney function
Creatinine clearance test compares the creatinine in a 24-hour sample of urine to the creatinine level in your
blood to show how much waste products the kidneys are filteting out eacg minute
NORMAL CREATININE CLEARANCE:
FEMALE : 88-128 mL/min
MALE: 90 to 137 mL/min
 Serum Measurement Normal Renal Failure

Blood urea nitrogen (BUN) 10-20 mg/dL Increased

Creatinine 0.7-1.5 mg/dL Increased

BUN to Creatinine Ratio 10:1 Normal or Increased

Glomerular Filtration Ratio 90 to 120 mL/min/1.73 m2 <15 mL/min/1.73 m2

(GFR)

Creatinine Clearance Female: 88 to 128 mL/min Decreased

Male: 90 rto 137 mL/min

RENAL FAILURE
 COMMON CAUSES OF RENAL
DISORDERS
1. Congenital Disorders
 Include unilateral renal agenesis, renal dysplasia, and polycystic disease
of the kidney.
2. Infections
3. Obstructive Disorders
Persons suffering from these are prone to infections, susceptible to
calculus formation, and permanent kidney damage.
4. Inflammation and Immune Responses
5. Neoplasms
CLASSIFICATION OF RENAL
DISORDERS
1. PRERENAL CONDITIONS
 Hypovolemia
 Decrease of GI tract fluid
 Hemorrhage
 Fluid Sequestration (ex. Burns)
• Septicemia
• Heart Failure
• Renal Artery Atherosclerosis
2. RENAL ABNORMALITIES
 Renal Ischemia
 Injury to the glomerular membrane caused by nephrotaxic agents
 Acute Tubular necrosis
 Intratubular obstruction

- Uric Acid Crystals

- Hemolytic Reactions
 Acute inflammatory conditions

- Acute pyelonephritis
-Necrotizing papillitis
3. POSTRENAL CONDITIONS
 Uretal Obstruction
 Bladder Outlet obstruction
CARDIOPULMONARY DISORDERS
CAUSED BY RENAL FAILURE
1. HYPERTENSION AND
EDEMA
- Kidneys lose their ability to excrete sodium
2. METABOLIC ACIDOSIS
-
3. RENAL ACID- BASE DISTURBANCES CAUSED BY
ELECTROLYTE ABNORMALITIES