GLOMERULAR FILTRATION
Clearance Test
- Measure rate at which the kidneys can remove a filterable substance from
the blood. Substance cannot be reabsorbed or secreted. Many require
accurately timed urine collection.
- Substances evaluated:
Urea earliest, no longer used, 40% is reabsorbed, results were
adjusted for this
Inulin
Polymer of fructose
No reabsorption or secretion
Original clearance reference method
Disadvantage: Requires infusion
Exogenous procedure = infusion
Endogenous procedure = body constituent
Not routinely used
Creatinine
Beta2 microglobulin
Cystatin C
Radioisotopes
Creatinine clearance
- Creatinine is current routine test substance
- Advantages:
Waste product of muscle destruction found at relatively constant
plasma level
Automated chemical tests
- Disadvantages:
Tubular secretion with high blood levels
Bacteria break down creatinine if urine is stored at room
temperature
Heavy meat diet during timed collection increases urine creatinine
Not reliable with muscle-wasting diseases
Gentamicin, cephalosporins, and cimetidine inhibit tubular secretion
- Normal values and additional notes:
Creatinine is produced as a result of muscle destruction; therefore,
normal values are based on size; the larger the person, the more
creatinine produced
Men: 107-139 mL/min
Women: 87-107 mL/min
Values are lower in older people
Nomograms are available to adjust for size
- Clinical significance:
Results are based on functioning nephrons
Beta2 microglobulin
- Small protein that dissociates from human leukocyte antigens at a
constant rate
- Rapidly removed from the plasma by kidneys
- Measured by enzyme immunoassay
- Sensitive indicator of decrease in GFR
- Unreliable in patients with immunological disorders and malignancies
Cystatin C
- Small protein produced by all nucleated cells; filtered by glomerulus
- Absorbed by the renal tubules and broken down; no cystatin C is secreted
- Serum levels directly reflect GFR
- Monitors pediatric patients, diabetics, elderly, and critically ill patients
- Immunoassay procedures available
Radioisotopes
- Exogenous procedure measuring plasma disappearance of an injected
isotope
- 125I iothalamate
- Provides simultaneous visualization of the kidneys
Osmolarity
-
Colligative Properties
-
Osmometry
-
TECHNICAL FACTORS
Lipemic serum
o Affects both instruments
o Insoluble lipids displace serum water
Lactic acid
o Elevates readings in both instruments
o Separate or refrigerate within 20 minutes
Volatile/ethanol
o Elevate results for freezing point osmometers, no effect on vapor
pressure instruments
NORMAL VALUES
Serum: 275 300 mOsm
Urine: depends on fluid intake or exercise
50 1400 mOsm
Ratio of serum to urine more accurate
Normal 1:1
Controlled fluid intake: 3:1
Tubular Secretion Renal Blood Flow