Renal function test

Estimation of serum creatinine

 cretinine
• creatine is synthesized primarily in the liver
• It is then transported through blood to the other
organs, muscle, and brain, where,
through phosphorylation, it becomes the high-energy
compound creatine phosphate.
• Creatine conversion to phosphocreatine is catalyzed
by creatine kinase; spontaneous formation of
creatinine occurs during the reaction.[5
• ]Cretinine is the breakdown product of creatine
phosphate in muscle and is usually produced at a
fairly constant rate by the body (depending on muscle
mass).
 Significance
• the glomerulus filtration rate (GFR) was most
often assessed by determining the urinary
creatinine clearance
 Normal values of creatinine

Serum or plasma creatinine

• in male is about (0.7 -1.2 mg/dl)
• in female is about (0.5 -1.0 mg/dl)
Urinary creatinine is about
• 14 – 26 mg/kg/day (1 – 3 g/day)
 Abnormalities of plasma creatinine

(A)- Low plasma creatinine:

• Creatinine production is determined by the
size of creatine pool hence a smaller muscle
mass leads to daily lower creatinine
production.
Physiologically
• Pregnancy
• Low muscle mass
 Pathologically
low plasma level of creatinine is found in
• wasting diseases,
• starvation, and
• in patients treated with corticosteroids due
to their protein catabolic effect.
 (B)- High plasma creatinine:-
1- Non renal
• a- High protein (meat) intake → temporary
increase of plasma creatinine.
• b- Exercise → transient increase of plasma
creatinine after vigorous exercises.
• d- Drugs e.g. salicylates and cimetidine which
reduce tubular secretion of creatinine →
elevating plasma creatinine level.
 2- Renal causes
• a- Diseases in which there is impaired renal
perfusion e.g. reduced COP (chronic obstructive
pulmonary ) and in case of renal artery stenosis.
pre-renal
• b- Diseases with loss of nephrotic functions e.g.
acute and chronic glomerulo nephritis.renal
• c- Diseases with increased pressure on the
tubular side of nephrons e.g. urinary tract
obstruction due to prostatic enlargement.post-
renal
 Cretinine
Estimation
1. Jaffe method(Manual method)
Disadvantage: non creatinine chromagen
interfere with the reaction e.g. protein ,
glucose, Ketones, Pyruvate, Bilirubin…….
2. Kinetic analyses modes(Automated method)
 reagents
• Saturated picrate acid
• Creatinine standard -1 mg%
• NaOH-5%
• Sodium tungstate solution – 10%
• H2SO4
 principle
• creatinine in urine reacts with picric acid in presence
of NaOH to give orange colored compound.
creatinine-picrate color read at specific wavelength.
(alkaline media) NaOH
creatinine + picrate acid creatinine
picrate orange
red comlex
 procedure
sample standard test
sample
standard
D/W or dist H2o
NaOH
Picric acid

mix
incubate at room temperature for 10 min
Read the absorbance test & Stand. against the blank
at W.L
 calculations
conc of sample= absorption of sample/
absorption of standard × conc of standard
Conc. = …………. mg/dl