2. Complete the following table indicating the normal composition of filtrate (fluid
within renal tubular system) and urine.
Amount in filtrate
(g)
600
35
5
200
60
0
3. Glomerular function is used to assess renal function and in turn diagnose renal
impairment/failure.
a) Provide the names of two metabolites measured in plasma that can be used to
measure glomerular function, and discuss how reliable an indicator of renal function
they are.
Creatine is a substance derived from the turnover of creatine phosphate in muscle, a
store of high energy phosphate. The amount of creatine produced is related to
muscle mass and remains remarkably constant in an individual subject from day to
day.
Creatine is a useful indicator of glomerular function beacuse it is freely filtered by the
glomerulus but not reabsorbed by the tubules back into the blood. Thus a raised
plasma creatine level is indicative of impaired renal function. However, the main
drawback with creatine is that the glomerular filtration rate (GFR) needs to drop by at
least 50% before the plasma creatine levels increase above normal levels. Thus, a
normal creatine plasma level may not necessarily imply normal renal function.
Plasma urea concentration is also often measured along with creatine as an indicator
of renal function. However urea does not give as accurate an indication of renal
function as creatine. This is because urea, although filtered by the glomerulus,
undergoes significant tubular reabsorption by passive diffusion back into the blood.
This is more apparent in fluid depleted patient s whose GFR is low where the tubular
reabsorption of urea increases. Thus, plasma urea concentration may be increased in
patients with normal renal function, particularly if they are fluid-depleted.
b) What is the clinical significance of hyperkalaemia?
Hyperkalaemia (a plasma potassium ion concentration above 6mmol/l due to the
inability of the kidney to excrete K+ ions) is a symptom of acute renal failure.
Hyperkalaemia is a potentially life-threatening state as it reduces the threshold for
initiation of action potentials and disturbs the normal electrical conducting system of
the heart, potentially resulting in cardiac arrest due to severe arrhythmia.
c) What urinalysis results could indicate renal disease?
Proteinuria (albumin within urine, indicative of glomerulopathies caused by
deposition of material within the glomerulus, such as immune complexes
(Goodpasteurs syndrome, SLE, IgA nephropathy) or glomerulosclerosis
associated with diabetes and deposition of amyloid protein fibrils (amyloidosis).
Haematuria (presence of haemoglobin within urine, indicative of glomerulopathies as
with proteinuria).
Presence of crystals (e.g. calcium oxolate) within urine, indicative of kidney stones
b) Complete the table of how chronic renal failure graded, what the diagnostic
indicators are and clinical manifestations of each stage?
Severity is graded according to GFR and creatinine concentration into mild,
moderate, severe & end-stage renal failure (ESRF)
Severity
(grading)
Healthy
GFR (ml/min)
Creatine (umol/l)
100-130
<110
Clinical
manifestations
-
Mild
30-50
170
Hypertension
Moderate
10-30
350
Severe
<10
700
Anaemia (due to
reduced EPO
synthesis)
Anorexia
End stage
<5
1500
Metabolic acidosis,
hyperkalaemia,
coma, death
Chronic renal failure is often asymptomatic during its development and is often
diagnosed incidentally following a routine blood test or in a patient with hypertension.
By the time symptoms of chronic renal failure occur, most of the renal mass has been
destroyed.