Red Sea University

Biochemistry dept. Lab

Renal Function Test

 Function of the Kidney
1) regulation of water and inorganic ion balance .
2) removal of metabolic waste product from the blood
and their excretion in urine
3) removal of foreign chemical from the blood and their
excretion in the urine .
4) gluconeogenesis .
5) secretion of hormone :
 Erythropoietin , control erythrocyte production
 Renin , control formation of angioteinsin which
influence blood pressure and sodium balance .
 1,25 –dihydroxyvitamin D3 , which influnce calcium
balance .
Renal Function Test – RFT

• RFTs means measurement of NPN & electrolyte.

Non protein nitrogenous ( NPNs ) :
Are substances contains nitrogen but it’s not protein.
-Its compose about 15 molecules ,but the most important one
are the following:-
1. Urea 45%
2. Amino acids 20%.
3. Uric acid (urate)20%.
4. Creatinine 5%.
5. Creatine (1-2)%.
6. Ammonia(0.2)%.
 RFT –Renal Function Test
• Urea ,Creatinine and uric acid which are most
NPN waste substance and the measure of
these substances have diagnostic significances
in diagnosis of renal diseases which reflects
the kidney function.
• Electrolyte can by used as seconded line as
renal function test
• RFT = urea , creatinine , uric acid , sodium Na ,
potassium K , Chloride Cl , calcium Ca ,
magnesium Mg , phospharous ph .
 Urea
Def:-
Is the main end product of protein metabolism .
About half of total NPNs in the blood
Synthesis:-
Its synthesis in the liver from CO2 and the
ammonia arising from the domination of
amino acid.
 Diseases Correlations:-
• The level of urea in the plasma is depend on the :
 renal function .
 protein content of diet .
 amount of protein catabolism.

( A ) Causes of high level of blood urea :-

Classify in to 3 causes :-
1- Pre renal hyper uremia .
2- renal hyper uremia .
3- post renal hyper uremia .
 1- Pre renal hyper uremia:-
 Reduced renal flow due to :-
a. Congestive heart failure .
b. Shock.
c. Hemorrhage.
d. Dehydration.
 Level of protein metabolism due to:-
a. High protein intake .
b. Increase protein catabolism such as
fever,stress,GIT hemorrhage.
 2- Renal hyper uremia

1- Acute and chronic renal failure.

2-Glomerular nephritis.
3-Tubular necrosis .
4. Any other intrinsic renal disease
 3- Post renal hyper uremia

1-Obstruction of renal flow in UT by renal

stones.
2-Tumors of bladder or prostate .
3-Sever infection .
(B) Decreased level of blood urea :-
1.Decreased protein intake .
2.Sever liver disease. Path.
3.Malnutrition ,malabsorption.
4.Urea cycle defect (enzymes).
5-Pregnancy or infancy . (physiological)
6.Hydration. (Water over load)
Method of estimation B.urea
In direct method (Enzymatic method)
Use urease reagent as specific enzyme .known
as Berthelot reaction.
• normal range :
15 – 50 mg/dl .
international unit is mmol/l .
 Creatine & creatinine

Is a non-protein waste product of creatine or

break down product of creatine ,which is an
important part of muscle.
*Production of creatinine is continuous and the
level of it is vary according to person’s size and
muscle mass. the production varies with age and
sex.
* 1 to 2% of muscle creatine spontaneously
converts to creatinine daily and released into
body fluids at a constant rate.
 *** Diseases Correlations
Causes of high level of s.creatinine:-

1. Acute tubular necrosis.

2. Dehydration .
3. Glomerular nephritis.
4. ARF or CRF .
5. Muscular diseases (Gigantism)
6. Hypertensive pregnant .
7. Urinary tract obstruction .
8. Congestive heart failure .
9. Shock.
Causes of low level of s.creatinine:-
1.Musclar atrophy (late stage ).
2.In adequate dietary protein .
*****Methods of estimation S.Creatinine

1. Jaffe end point reaction .

2. Kinetic reaction .
3. Enzymatic reaction

Reference value :
• Creatinine in male = 0.9-1.3 mg/dl .
• Creatinine in female = 0.6-1.1 mg/dl .
• Creatinine in Children = 0.3 to 0.7 mg\dl
 Clearance
Is the volume of plasma from which the
kidney can remove all of given substance in
certain period of time (minute).
-To calculate clearance you have to measure the
analyte in serum and urine and measure the
volume of urine ,then calculate the clearance .
CL= U(mg/dl) X U volume(ml)
P (mg/dl) X T (minute)
 ****Characteristic of cleared substance :-
It vary with body size and proportional to the surface area
STD surface area 1.73m2.

1. Filtered at the glomerular and not reabsorbed .

2. Not secreted.
3. Not affected by diet.
4. Not bound to plasma protein .
5. Not attack by tubular cell.
6. Not coasted.
7. Produced at constant ratio.
 Uric Acid (Urate )
* Is the end product of Purine metabolism in
human .
*Biochemistry:-
** Purine bases include adenine and guanine
which are present in the nucleus of the cells
specifically in DNA and RNA .
**Purine is used by the body to synthesis the
nucleic acid .
 *** Diseases Correlations
Hyper urecaemia
High level of serum uric acid more than upper N.R
*Causes:- Three major causes :-
1- Gout .
• Is a disease found in males , age 30-50 years .
• Pain and inflammation of the joints causes by precipitation of sodium
urate . , 30% of causes hyperuricemia due to over production of uric acid ,
drug or alcohol , Above 6 mg/dl . , Susceptible to renal calculi .

2- Increase nuclear breakdown .

increase dietary intake or like in patient on chemotherapy (multiplemyloma
,lymphoma )
3- Renal disease .
 Renal glomerular dysfunction.
 toxemia of Pregnancy
 Lactic acidosis
 Ketosis
 Hypo uricemia

less common .
1- sever liver disease
2- Some drug “ allpurinol
3- Xanthine uria (complete deficient of xanthine
oxidase) (Wilson’s disease) .
 Factors affect Uric Acid level:

** Familial incidence (hereditary trait).

**Sex and age incidence (very rare in
children ).
** Precipitating factors: alcohol (decrease
renal excretion)
** high meat diet.
 Methods of estimation
1. Chemical method .
• Caraway method .
2. Enzymatic methods .
uricase
Reference value
males ; 3 - 7 mg/dl
females ; 2 - 6 mg/dl
children ; 2 - 5 mg/dl