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Renal Function Test 2018
Renal Function Test 2018
(orange)
This divides into two types
1. Manual method and
2. Automated kinetic method
respectively.
Blank Standard Test
Sample - - 2ml
d/w 2ml 2ml 2ml
NaOH 1ml 1ml 1ml
Picric acid 1ml 1ml 1ml
Mix it well and incubate at room temperature
for 10 min.
Take the OD against the blank at 520 nm.
Calculation formula:
Clinical significance
Uric acid is a metabolism of purines, nucleic
acids and nucleo-proteins. Consequently,
abno-
rmal levels may be indicative of a disorder in
the metabolism or in some genetic diseases.
Causes of increase and decrease of uric acid
level
- High level of uric acidin your blood can
also indicate of a variety of conditions,
inluding:
- diabetes
- gout (acute arthritis)
- chemotherapy & radiation
- leukemia(bone marrow disorders)
- hypoparathyroidism
- kidney disorders(stones)
- multiple myeloma
- metastasized cancer
- low levels of uric acid in the blood may
inluding:
- wilson’s disease
- fanconi syndrome(cystinosis)
- alcoholism
- liver or kidney disease
- a diet low in purines
Methodology
1. chemical method
phototungstic acid method
2. enzymatic method
The reagent is based on Trinder’s reaction,
enzymatic and colorimetric method.
Raference range
serum/plasma
for women – 2.5-6.8mg/dl
for men – 3.6- 7.7mg/dl
Limitations
Limitations of uric acid testing are as follows:
- Methodological interference and in cases
of vitamin C, levodopa, and alphamethyldopa.
- Early purine rich diet
- several exercise increases uric acid
- Rapid degradation of uric acid,which
metabolism.
After filtered by glomeruli. It is partilly
GLDH
ASSAY PROCEDURE:
PIPETTE IN TUBES MARKED STANDARD TEST
WORKING REAGENT 1000μl 1000μl
STANDARD 20μl -
SAMPLE - 20μl
minute.
This is referred to as maximum urea
clearance.
Standard Urea Clerance:
the urea clearance drastically changes when
the volume of urine is less than 2ml/min.
This is known as standard urea clearance(C)
and the and the normal value is around
54ml/min.
Diagnostic importance:
A Urea clearance value below 75% of the
normal is serious. Since it is an indicator of
renal damage.
Blood urea level is found to increas only when
the clearance falls below 50% normal.
Normal level of blood urea:20-40 mg/dl.
Pre-renal condition:
-Dehydration: Severe vomiting, intestinal
obstruction, diarrhea, diabetic coma, severe
burns, fever and severe infections.
Renal diseases:
1. Acute glomerulonephritis
2. Nephrosis
3. Malignant hypertension
4. Chronic pyelonephritis
Urea concentration in serum may be low in
late pregnancy, in starvation, in diet grossly
deficient in protein and in hepatic failure.
Azotemia:=
Increase in the blood level of
Abs.S
Principle : Calcium combines specifically with
Arsenazo iii at a neutral pH to forma blue
purple coloured complex. Intensity of the
colour formed is directly proportional to the
amount of calcium present in the sample.
Abs.S
Potassium is the most abundant intercellular cation approximately 3500
mEq of potassium is contained in the body of a 70 kg adult. Only10% of
the body potassium is extracellular. Normal values are 3.5 ‐5.0 mEq/L or
mmol/L
neutral carriers.
Serum :
K+ : 3.3 – 5.1 mmol/L
Plasma :
K+ : 3.3 – 4.5 mmol/L
Urine :
K+ : 25 – 125 mmol/L (diet dependent)
Interpritation:
Hypokalemia can occur. The kidneys are
responsible for approximately 90% of daily
potassium loss. Other losses occur mainly
through GI system.
A low potassium level has many causes but
usually results from vomiting, diarrhea,
adhrenal gland disorders.
A low potassium level can make muscles feel
weak, cramp, twitch, or even become
paralyzed, and abnormal heart rhthms may
develop.
Hyperkalemia most common results from
decreased renal elimination, excessive intake
or from cellular break down.
Ammonia combines with α-ketoglutarate and
NADPH in the presence of glutamate
dehydrogenase (GLDH) to yield glutamate and
NADP+. The corresponding decrease in
absorbance at 340 nm is proportional to the
plasma ammonia concentration.
GLDH
α-ketoglutarate + NH₃+NADPH
glutamate+ NADP⁺
1. Assay conditions:
Wavelength: 340nm
*Cuvette: 1 cm light path
Constant temperature:25/30/37ºC
* Please try not to use flow cell. Exchangeable
cuvettes are suggested to avoid cargover in
manual photometers.
2. Adjust the instrument to zero with distilled
water.
3. Pipette into a cuvette:
WR blank standard Sample
Sample - - 0.1ml
Distilled water 0.1ml - -
Standard - 0.1ml -
Reagent 1.0ml 1.0ml 1.0ml
4. Mix, and allow to stand for 5 min. Read initial absorbance of sample and
blank (A1).
5. Then add:
GLDH (R2) = 0.01 mL 0.01 mL 0.01 mL
6. Mix, and incubate for 5 min. Read final absorbance of sample and blank
(A2).
CALCULATIONS:=
REFERENCE VALUES(2)
Plasma ammonia: 10 - 47 μmol/L
0.17 - 80 μg/dL
0.017 - 0,080 mg/dL
Glomerular filtration rate(GFR) is the volume
of fluid filtered from the renal(kidney)
glomerular capillaries in to the Bowman’s
capsule per unit time.
per tine
EX: milliliters per minutes(ml/min), compare
to filtration fraction
The rate at which plasma is filtered by the
kindney glomeruli.
An important measurement in the evaluation
of kidney fuction
GFR = 125 ml plasma/min or, 180 L/day
Plasma volume (70-kg young adult man)=
soecimen
Calculate the clearnce
eGFR=30849.2 X (serum creatinine)-
1.154(age)-0.203