KIDNEY FUNCTION

TEST

DR.MANISH SAHU
(M.D.BIOCHEMISTRY)
(Assistant Professor)
 Functions of Kidney
• Acid base balance.
• Blood pressure.
• Water balance.
• Electrolyte maintenance.
• Synthesis of hormones- VIT. D and ERYTHROPOIETIN.
• Excrete waste.
 What is kidney function test
• Renal function tests are use to detect the presence of
renal diseases and assess their progress.
 STEPS IN URINE FORMATION

GLOMERULAR FILTRATION

TUBULAR REABSORPTION

TUBULAR SECRETION
GLOMERULAR FILTRATION RATE
 GFR is the volume of water filtered or cleared out of the plasma
per minute.

 GFR is calcuated by measuring the urinary excretion rate of a

marker substance.

• Rate Of Urinary Excretion

of Any Solute = Rate Of Glomerular Filtration
+ Rate Of Secretion
- Rate Of Reabsorption

 Example for marker INULIN.

• Almost 180L/day plasma filtered by
glomerulus.
1) Ultrafiltration = G,AA,BICARBONATE,NA, K
2) Reabsorption = 178.5 L/day
3) Active secretion

So GFR or total urine output = 125 ml plasma/min or, 180 L/day

 Glomerular function test
 CLEARANCE(CL) TEST
• Amt.of plasma/blood required to completely clear of a
substance in unit time.
• Done by 24 hrs urine sample.

P Cl= UV/P
• U= Urine conc. of creatinine
• V= Vol. or output
• P= Plasma conc. of creatinine
 COCKCROFT-GAULT equation

• CrCl = (140-age) x weight(kg)

72 x S.Cr (mg/dl) x 0.85

 INTERPRETATION
If clearance is = >90% = Normal KFT.
60%-90%= mild renal impairment.
30%-60%= moderate renal impairment.
<30%= severe impairment.
<15% = renal failure.
IMPORTANCE:-
1. Can calculate GFR = Sensitive indicator.
2. Early detection of renal infection.
 INULIN
• Best
• Freely filtered
• No reabsorption
• No secretion
• Clearance SAME as GFR= 125 ml/min

• NOT affected by high protien diet

CREATININE
• Synthesize in body
• Freely filtererd
• No reabsortion
• Some amountof secretion
• Clearance is closure to GFR
• Male= 100-115 ml/min
• Female= 95-110ml/min

• NOT affected by high protien diet.

UREA
• Freely filtered
• 40% reabsorbed
• AFFECTED by high protien diet.
GLOMERULAR PERMEABILITY TEST
. U. PROTIEN test done by DIP STICK METHOD
 TUBULAR FUNCTION TEST
• SPECIFIC GRAVITY :- kidneys ability to concentrate urine.
• It is the test that shows the concentration of all chemical
particles in the urine.

• Compares the density of urine against the density of

distilled water.

Formula = Amt. of a substance

Equal amt. of water

Normal range = 1.010- 1.025

 Clinical applications

• Hyposthenuria ( low SG=1.001-1.010)

Diabetes insipidus

• Hypersthenuria(increased SG=1.025-1.035)
Diabetes Mellitus
Nephrotic synd.
Excessive water loss
Congestive heart failure
1. CONCENTRATION TEST-
 Overnight fluid deprevation.
 Then sample collected in the morning.
 Sp.gravity should be more then normal range.

2. DILUTION TEST-
 Give 1200 ml of water over 30 mins.
 Take 4 samples at 1hr interval.
 Sp.gravity should be less then normal range.
 CREATININE
 In the muscles creatine is converted to creatine
phosphate which becomes the source of a high energy
phosphate bond for the immediate reformation of ATP.

 Creatinine is the byproduct of muscle energy metabolism

and is produce at a constant rate according to the
muscle mass of the individual. It is the substance that is
easily excreted by the kidney.

 By JAFFE’S method we can estimate serum creatinine.

• NORMAL RANGE-- Male= 0.7-1.5 mg/dl.
Female= 0.4- 1.3 mg/dl.

Causes for INCREASED serum creatinine level-

• GN
• Stone
• Stricture
• Tumour
• Nephrotic synd.
• Chronic renal failure
 S.UREA
 Urea is the chief nitrogenous waste of body.
 Urea is the end product of protein metabolism.
 After filtration by glomeruli. It is partially reabsorbed by
the renal tubules.

REFERENCE VALUE:-
 S.urea = 10 - 45mg/dl
• Causes for INCREASED blood UREA:-
Pre-renal condition:
-Dehydration:- Severe vomiting, intestinal obstruction,
diarrhea, diabetic coma, severe burns, fever and severe
infections.

Renal diseases:
1. Acute glomerulonephritis
2. Nephrotic syndrome
3. Acute or chronic renal failure
4. Chronic pyelonephritis
• Post renal causes
1. Tumour
2. Stricture
3. Stone
4. Tuberculosis:- ureter, bladder, urethra
 SODIUM
• Most of the body's sodium is located in blood and in the
fluid around cells.
• Normal blood sodium 135-145 miliEquivalents/liter
(mEq/L) or 135-145 milimoles/liter (mmol/L) .
• The body obtains sodium through food and drink and loses
it primarily in sweat and urine.
• Normal kidneys maintain a consistent level of sodium in
the body by adjusting the NA amount excreted in the urine.
• When sodium consumption and loss are not in balance,
the total amount of sodium in the body is affected.
• Hypernatremia or hyponatremia can cause cells to
malfunction, and extremes can be fatal.
 IMPORTANCE

• Maintain red blood cells.

• Regulate and maintain normal fluid balance.
• Regulate and maintain acid-base balance.
• Maintain normal nerve and muscle function.
• The heart to beat normally.
• Transport substances across the cell membrane.
 Hypernatremia/Hyponatremia
• Dehydration. Kidney failure - the kidneys
• Vomiting. cannot get rid of extra fluid from the
• Kidney disease. body.

• Uncontrolled diabetes.
• Diabetes insipidus. Congestive heart failure -
• Extreme diarrhea. excess fluid builds up in the body.

• Dementia. Diuretics (water pills) - makes the

body get rid of more sodium in the
urine.
 POTASSIUM
• Potassium is the most abundant intercellular cation.

• Only10% of the body potassium is extracellular.

• Normal values are 3.5‐5.0 mEq/L or mmol/L

• The function of potassium is to maintain electrical

conduction in cardiac and skeletal muscles.
 INTERPRETATION
 The kidneys are responsible for approximately 90% of
daily potassium loss. Other losses occur mainly through
GI system.
 Hypokalemia - vomiting, diarrhea, adrenal gland
disorders.
 A low potassium level can make muscles weak, cramp,
twitching or even become paralyzed and abnormal heart
rhythms may develop.
 Hyperkalemia - decreased renal excretion, excessive
intake or from cellular break down.
 URINE ANALYSIS
PHYSICAL REPORT CHEMICAL REPORT

• Glucose- benedict test

• Volume
• Colour • Protien- heat coagulation test

• Odour • Blood- benzedine test

• Sp.gravity
• Bile salt- hay’s sulfur test
• pH
• Bile pigment- fauchet’s test
• Appearance
• Urobilinogen- ehrlich’s test

• Ketone bodies- rothra’s test

Thank

you