CLINICAL CHEMISTRY

RENAL FUNCTION
Kidney

Functional
Unit:
Nephron
Kidney physiology

2 4 Kidney
1 3
process
Functions of the Kidney
 Urine formation
 Fluid and electrolyte balance
 Regulation of acid-base balance
 Excretion of waste products of protein metabolism
 Excretion of drugs and toxins
 Secretion of hormones
Stages of Urine Analysis
Bichemical test of renal function
 Specific gravity and osmolality
 Urine pH : 4.8-7.5
 Glucose
 Protein
 Bilirubin /Urobilinogen
 Ketone
Biochemical test (General)
1. Glucose
 Increased blood glucose
 Low renal treshold or other tubular diseases
2. Protein
 Overflow (raised plasma LW protein, presence of
Bence Jones Protein, Myoglobin)
 Glomerular leak
 Decreased tubular resorption of protein
 Protein with renal origin
Biochemical test (Specific)
1. Glomerular Function
 Glomerular Filtration Rate (GFR)
 Creatinine Clearance
 Urea
 Cystatin C test
2. Tubular Function
 Proximal tubular function (Phosphate, Amino acids,
Glucose, HCO3-)
 Distal tubular (Cl-, H+ and urine volume)
Glomerular filtration rate
 Measurement based on determination of clearance.
 Clearance = Volume of plasma from which a
measured amount of substance can be completely
eliminated into urine per unit of time
 Clearance= (U x V) / P where
U = urinary substance concentration
V = volume of urine in mL/min unit (24 hours urine)
P = plasma substance concentration
 Unit = volume/time (mL/min)
Creatinine & Creatinine clearance
Creatinine & Creatinine clearance

 Used to determine GFR ( glomerular filtration rate)

 Most accurate measures for kidney function
 Creatinine clearance (CCr) is calculated from the creatinine
concentration in the collected urine sample (UCr), urine flow
rate(V), and the plasma concentration (PCr). Since the product of
urine concentration and urine flow rate yields creatinine excretion
rate, which is the rate of removal from the blood, creatinine
clearance is calculated as removal rate per min (UCr×V) divided by
the plasma creatinine concentration.
 This is commonly represented mathematically as:
CCr = (UCr X V) / PCr
Creatinine & Creatinine clearance
 Corrected Creatinine clearance
CCr [Corrected] = CCr X 1.73
A
 1.73= normalization factor for body surface area in
square meters
 A= actual body surface area
 Males = 97 mL/min - 137 mL/min
 Females = 88mL/min -128 ml/min
Biochemical test (Specific)
3. Renal failure
 Serum studies
 Blood urea nitrogen (BUN)
 Creatinine
 Hematocrit
 Albumin
 Electrolytes (Mg2+, K+, Na+, Ca2+, Mg2+, Phosphate)
 Urine studies
 Urine Analysis (physical, microscopic examination & Biochemistry)
 Culture and Sensitivity
 Combination Studies
 Creatinine Clearance
Renal Failure classification
1. Acute renal failure (ARF)
 Sudden lost of kidney function.
 Divided into:
a. Pre-renal
 Reduced blood flow to kidney
 50-70% of ARF cases

b. Intrarenal
 Actualdamage to kidney
 50-70% of ARF cases

c. Post renal
 Obstruction of urinary excretion
 1-10% of of ARF cases
 Categories of Acute Renal Failure
Pre-Renal Primary Post-renal
Defect •Inadequate blood Kidney Urinary tract post
flow kidney
•Drop in blood
pressure
Causes Cardiovascular •Acute tubular •Lower urinary tract
system failure necrosis obstruction
•Obstructions •Rupture of urinary
•glomerulonephritis bladder
Examples •Hemorrhage •Injury •Stones
•Shock •Trauma •Malignancy
•Heart Failure •Autoimmune •Enlarged prostate
attack gland
BUN Increased Increased Decreased
Creatinine Normal Increased Normal
Renal Failure classification
2. Chronic renal failure (CRF)
 Progressive /irreversible lost of kidney function.
 Loose up to 80 % of functioning nephrons.
 Nephrons are destroyed and replaced with scar tissue;
remaining nephrons become hypertrophied and do not
function well.
 Causing factor (DM, hypertention, vascular disorders,
infection, nephrotic intoxication, sickle cell anemia, SLE,
chronic glomerulonephritis, phylonephritis, obstruction of
urinary tract, polycyctic kidney disease etc..)
 Will result in other systemic problems (Uremic syndrome)
Renal Failure classification
 Stages of CRF
 Stage 1(Reduced Renal Reserve)
 Characterize by a 40-75% loss of nephron function
 Usually asymptomatic; normal BUN & Creatinine
 Stage 2 (Renal Insufficiency)
 Characterize by a 75-90% loss of nephron function
 Increased BUN and increased Creatinine
 Kidneys loose ability to concentrate urine; client may report polyuria
or/and nocturia; Anemia develop.
 Stage 3(End-stage renal disease)
 Characterize by a >90% loss of nephron function
 Increased BUN and increased Creatinine with electrolyte inbalance
 Uremic symptoms
 Requires dialysis
Renal Failure (Glomerular disease)
 Syndrome associated
 Acute glomerulonephritis
 Rapidly progressive glomerulonephritis
 Chronic glomerulonephritis
 Nephrotic syndrome
Nephrotic syndrome (pathophysiology)
Nephrotic syndrome (complications)

 Anemia
 Erythropoietin deficiency
 Low production of RBC
 Renal osteodystrophy
 A syndrome of skeletal changes found in CRF from alterations
in calcium & phosphate metabolism and elevated PTH levels.
 Disturbance of Vitamin D activation for calcium absorption.
 Biochemical electrolyte imbalance
 Hyperkalemia, hyperphosphatemia, hypophosphatemia,
hypermagnesemia, hyponatremia.