BSMT 006 ANALYSIS OF URINE AND OTHER BODY FLUIDS November 19, 2019

006.2 RENAL FUNCTION Ms. Amapola Puaso, RMT MSMT

RENAL BLOOD FLOW

OUTLINE
I. Renal Physiology
 Blood enters the nephron through the afferent
II. Renal Blood Flow arteriole. Then, it flows through the glomerulus,
III. Glomerular Filtration and into the efferent arteriole.
IV. Renin-Angiotensin-Aldosterone System  Before returning to the renal vein, blood from the
V. Tubular Reabsorption
VI. Tubular Concentration
efferent arteriole enters the peritubular capillaries
VII. Tubular Secretion and the vasa recta and flows slowly through the
VIII. Renal Function Tests cortex and medulla of the kidney
a. Glomerular Filtration Tests  Based on the average body size of 1.73 m2 of
i. Creatinine Clearance Test
surface, the total renal blood flow us
ii. Inulin Clearance Test
iii. Cystatin C approximately 1200 mL/min
iv. Beta-microglobulin  Normal values for renal blood flow and renal
v. Radionucleotides function tests depend on body size. When dealing
b. Tubular Reabsorption Tests with greatly varying sizes, a correction must be
i. Osmolality
ii. Freezing Point Osmometers done in order to determine whether the observed
iii. Vapor Pressure Osmometers measurements represent normal function.

RENAL PHYSIOLOGY
 Each kidney contains approximately about 1-1.5
million functional units called nephrons.
 There are two types of nephrons:
o Cortical nephrons – makes up
approximately 85% of the nephrons,
situated in the cortex of the kidney,
responsible for the removal of waste
products and reabsorption of nutrients
o Juxtamedullary nephrons – Have longer
loops of Henle that extends deep into the
medulla of the kidney; functions to
regulate the concentration of urine
 The ability of the kidneys to clear waste products
selectively from the blood and simultaneously to
maintain the body’s essential water and electrolyte
balances is controlled by the following renal
functions: renal blood flow, glomerular filtration,
tubular reabsorption, and tubular secretion.

GLOMERULAR FILTRATION
 Glomerulus consists of a tuft of capillaries which is
referred to as the glomerular filtration barrier.
 It is located within the Bowman’s capsule which
forms the beginning of the renal tubule.
 Serves as a nonselective filter of plasma
substances with less than 70,000 molecular wight
 Several factors influence the filtration process:
o Cellular structure of the capillary walls and
Bowman’s capsule
o Hydrostatic pressure
o Oncotic pressure
o Renin-Angiotensin-Aldosterone System
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 BSMT 006 ANALYSIS OF URINE AND OTHER BODY FLUIDS November 19, 2019
006.2 RENAL FUNCTION Ms. Amapola Puaso, RMT MSMT

RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM
 The system regulates the blood flow to and
within the glomerulus. It responds to changes in
blood pressure and plasma sodium cintent that
are monitored by the juxtaglomerular apparatus.
 Decrease of blood flow due to lowered plasma
sodium content triggers the macula densa of the
distal tubule to set off the RAAS system.
 Juxtaglomerular cells secrete renin which then
reacts to the blood-borne substrate
TUBULAR REABSORPTION
angiotensinogen to produce the inert hormone
 When the plasma ultrafliltrate enters the
angiotensin I.
proximal convoluted tubule, the nephrons begin
 As angiotensin I passes through the alveoli of the
reabsorbing these essential substances and
lungs, angiotensin-converting enzyme (ACE)
water through cellular mechanisms.
changes it into the active form angiotensin II.
 The cellular mechanisms involved in tubular
 Angiotensin II corrects renal blood flow by:
reabsorption are:
o Causing vasodilation of the afferent
o Active transport – a substance must be
arterioles and vasoconstriction of the
bound to a carrier protein. Responsible
efferent arterioles
for the reabsorption of:
o Stimulating reabsorption of sodium
 Glucose
and water in the proximal convoluted
 Amino acids
tubules
 Salts in the proximal
o Triggering the release of sodium-
convoluted tubule
retaining hormone aldosterone by the
 Chloride in the ascending loop
adrenal cortex and water-retaining
of Henle
hormone antidiuretic hormone (ADH)
 Sodium in the distal
by the hypothalamus
convoluted tubule
o Passive transport – the movement of
molecules across a membrane as a
result of a difference in the
concentration on the opposite sides of
the membrane. Takes place on all
parts of the nephron except the
ascending loop of Henle
 The plasma concentration wherein the active
transport stops is termed as the renal
threshold. For glucose, the renal threshold is
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 BSMT 006 ANALYSIS OF URINE AND OTHER BODY FLUIDS
006.2 RENAL FUNCTION
160-180 mg/dL. At this level, glucose starts
appearing in the urine.
TUBULAR CONCENTRATION
 Renal concentration begins in the descending
and ascending loop of Henle, where the filtrate is
exposed to high osmotic gradient in the renal
medulla
 Water is removed by osmosis in the descending
loop of Henle, and sodium and chloride are
reabsorbed in the ascending loop.
 Excessive reabsorption of water is prevented by
the impermeability of the ascending loop to it.
 This selective reabsorption process is called the
countercurrent mechanism and serves to
maintain the osmotic gradient of the medulla.
 Maintenance of the osmotic gradient is essential
for the final concentration of the filtrate when it
reaches the collecting duct.
GLOMERULAR FILTRATION TESTS
 The standard tests used to measure the filtering
capability of the glomeruli are termed as
clearance tests.
 Clearance tests measures the rate at which the
kidneys are to remove a filterable substance
from the blood
CREATININE CLEARANCE TEST
 Creatinine is a waste product of muscle
metabolism that is produced enzymatically by
creatine phosphokinase from creatine.
 Considerations in using creatinine clearance test
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Ms. Amapola Puaso, RMT MSMT
o Some creatinine is secreted by the
tubules, and secretion increases as
blood levels rise
o Chromogens present in human plasma
react in chemical analysis
o Medications (cephalosporins,
gentamicin, cimetidine), inhibit tubular
secretion of creatinine
o Bacteria will break dwn urinary
creatinine if specimens are kept at
room temeperature for extended
periods
o A diet heavy in meat consumed during
the 24-hour urine specimen collection
will influence the results
o Measurement of creatinine clearance
is not a reliavble indicator in patients
suffering from muscle-wasting
diseases or persons involved in heavy
exercise or atheletes taking creatinine
supplement
o Accurate results depend on the
accurate completeness of a 24-hour
collection
o It must be corrected for body surface
area, unless normal is assumed, and
must always be corrected for children.
 The GFR is reported as millilitres cleared per
minute.
 To calculate one must know the following:
o Urine volume in mL/min (V)
o Urine creatinine concentration in
mg/dL (U)
o Plasma creatinine concentration in
mg/dL (P)
 The equation goes as follows:
 Example: Using the creatinine of 120 mg/dL
(U), plasma creatinine of 1.0 mg/dL (P), and
urine volume of 1440 mL obtained from a 24-
hour specimen (V), calculate the GFR:
⁄ ⁄
⁄
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 BSMT 006 ANALYSIS OF URINE AND OTHER BODY FLUIDS
006.2 RENAL FUNCTION
 When dealing with body sizes which deviates
greatly from the average 1.73 m2 of surface
such as in children, the following correction
must be done:
INULIN CLEARANCE TEST
 Inulin is an extremely stable substance that is
not reabsorbed or secreted by the tubules.
 It is not a normal body constituent, however,
and must be infused by IV at a constant rate
throughout the testing period.
 Therefore, although inulin was the original
reference method for clearance tests, current
methods are available that are endogenous
and can provide accurate GFR results
CYSTATIN C
 Cystatin C is a small protein produced at a
constant rate by all nucleated cells.
 It is readily filtered by the glomerulus and
reabsorbed and broken down by the renal
tubular cells.
 Therefore, no cystatin C is secreted by the
tubules, and the serum concentration can be
directly correlated to GFR.
 Measurement of serum cystatin C has been
shown to provide a good procedure for
screening and monitoring GFR.
 Immunoassay procedures are available for
measuring cystatin C
 Advantages of cystatin C measurement:
o Independent of muscle mass
o Can be performed on patients who
have difficulty in urinating
β2-MICROGLOBULIN
 β2-microglobulin dissociates from human
leukocyte antigens at a constant rate and is
rapidly removed from the plasma by
glomerular filtration.
 Enzyme immunoassays are available for the
measurement of β2-microglobulin
 Advantage of the test:
o Rise in plasma level has been shown to
be more sensitive indicator of a
decrease in GFR than creatinine
clearance
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 Disadvantage:
o Not reliable in patients who have a
history of immunologic disorders
RADIONUCLEOTIDES
 Injecting radionucleotides such as 125I-
iothalamte provides a method for determining
GFR through the disappearance of the
radioactive material.
 This procedure can be valuable to measure the
viability of a transplanted kidney
TUBULAR REABSORPTION TESTS
 Measurement of GFR is not a useful indication
of early renal disease, the loss of tubular
reabsorption capability is often the first
function affected in renal disease.
OSMOLALITY
 Osmolality refers to the number of particles in
a solution.
 Renal concentration is concerned with small
particles, primarily sodium and chloride
molecules.
 Particles with large molecular weight such as
glucose and urea do not contribute to the
evaluation of renal concentration.
 Therefore, osmolality is performed for a more
accurate evaluation of renal concentrating
ability.
 Methods used in measuring osmolality:
o Freezing point osmometers –
measurement of freezing point
depression
o Vapor pressure osmometers –
depression of dew point temperature
by solute parallels the decrease in
vapour pressure
REFERENCES
 PowerPoint
 Strasinger, S.K., Di Lorenzo, M.S. (2014) Urinalysis
and Body Fluids
“Consistency is the DNA of mastery”
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