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RENAL LABORATORY TESTS

Basic Functional Unit of the Kidney:

Nephron

Proximal Tubules- majority of solutes are reabsorbed.


Descending Loop of Henle- permeable to water, so
water goes out.
Ascending Loop of Henle- Impermeable to water, so
water stays.
Distal Tubule Aldosterone retains sodium (Na).
Collecting Tubule water is conserved by ADH.

A1.TESTS MEASURING GLOMERULAR FILTRATION RATE


Tests which measure the rate of glomerular
filtration are generally called clearances.
General Formula for Clearance
C (ml/min) = U
x Volume (ml/min)
x 1.73
P
A
Where:
C- clearance of the substance expressed in ml/min.
U- concentration of substance in urine
P- concentration of substance in plasma (blood)
Volume (ml/min)- total volume of urine excreted in 24
hours converted to ml/min.
1.73- generally accepted body surface area of an
individual in square meters
A- body surface area of patient whose value is obtained
from a nomogram (height and weight are needed)
I. Creatinine Clearance Tests
-In product of muscle metabolism derived from creatine
-Most commonly used substance for assessment of GFR
-Normal values: 107-139 ml/min (men)
87-107 ml/min (women)

KIDNEY FUNCTION TESTS


A1. Tests measuring GFR
A2. Tests measuring Renal Blood Flow
A3. Tests measuring Tubular Function

II. Inulin Clearance Tests


-Normally not present in the plasma, therefore it is neither
secreted or reabsorbed by the renal tubules.
-Most accurate measure of GFR
-Not particularly pleasant to the patient, thus it is not
regularly used.

A1. Tests measuring Glomerular Filtration Rate (GFR)


I. Creatinine Clearance Tests
II. Inulin Clearance Tests
III. Urea Clearance Tests

III. Urea Clearance Tests


-Not commonly employed because of variable results
-1.33 constant for maximum urea clearance
-1.85 constant for standard urea clearance

A2. Tests measuring Renal Blood Flow


I. Amino Acids
II. Ammonia
III. Blood Urea Nitrogen (BUN)
IV. Blood Uric Acid (BUA)
V. Creatine
VI. Creatinine

A2. TESTS MEASURING RENAL BLOOD FLOW


Non Protein Nitrogens (NPN)
GENERAL INFORMATION
-All NPNs (urea, creatinine, uric acid and ammonia) are
increased in the plasma in renal impairment; referred to as
azotemia
-In cases of suspected renal impairment, the best laboratory
evaluation is for glomerular filtration rate (GFR).

A3. Tests measuring Tubular Function


I. Excretory Tests
Ia. Para-Amino Hippurate Test (PAH)
Ib. Phenolsulfonphthalein (PSP) Dye
Excretion Test
II. Concentration Tests
IIa. Specific gravity
IIb. Osmolality
IIc. Fishberg Concentration Test

I. AMINO ACIDS
II. AMMONIA
-Derived from the action of bacteria on the contents of the
colon
-Metabolized by the liver normally
-Increased plasma ammonia is toxic to the CNS

II. AMMONIA
Hyperammonia (increased ammonia)
a) Advanced liver disease (most common cause)
aa. Reyes syndrome
ab. Cirrhosis
ac. Viral hepatitis
b) Impaired renal function
ba. Blood urea is increased (increased excretion
into intestine, where it is converted to ammonia)
III. BLOOD UREA NITROGEN (BUN)
-Increased in impaired renal function
-Rises more rapidly than serum creatinine
-BUN/creatinine ratio is normally about 10:1-20:1
a)Colorimetric method:
-urea reacts with diacetyl monoxime to form a colored
complex
b)Enzymatic method:
-Urease hydrolyzes urea into ammonia which can be
measured spectrophotometrically or with an ISE
Inhibited by the anticoagulant sodium fluoride
Must NOT use this anticoagulant for ANY enzyme
analysis
IV. BLOOD URIC ACID (BUA)
-End product of purine metabolism
-Increased in gout, renal failure and leukemia
-Colorimetric method
a) Uric acid reduces phosphotungstic acid to
tungsten
blue which is measured spectrophotometrically
b) Interferents include lipids and several drugs
-Enzymatic assays
-are based on the uricase reaction in which allantoin
and H2O2 are produced and H2O2 is coupled to give a
colored product
V. CREATINE
Creatine

Phospocreatine+ADP

Creatine Kinase+ATP
-Can also be measured to evaluate renal function; NOT as
sensitive as GFR
-Reference ranges
a) Men = 0.9-1.5 mg/dL
b) Women = 0.7-1.3 mg/dL

Classic method is the Jaffe reaction


-Creatinine reacts with picric acid in alkaline solution to
forms a red-orange complex that absorbs light 490-540 nm
-Interferents: glucose, acetoacetate and ascorbic acid.
Falsely increased
a) Specimen collecting and handling
aa. Metabolism of nitrogenous constituents (sample
must be placed on ice, centrifuged and analyzed
immediately
ab. Poor venipuncture technique
(probing,incompletely filled evacuated tube)
b) Smoking (in the lab)

A3. TEST MEASURING TUBULAR FUNCTION


I. Excretory Tests
a. Para-Amino Hippurate Test (PAH)
b. Phenolsulfonphthalein (PSP) Dye Excretion Test
II. Concentration Tests
a. Specific gravity
b. Osmolality
c. Fishberg Concentration Test