CLEARANCE

Learning outcomes
1. Define the concept of clearance, and be able to calculate
clearance values in their appropriate units.

Renal assessment and clearance

• The co-ordination of the three processes involved in urine formation
(Ultrafiltration, Reabsorption and Secretion) determines the amount of a
substance present in the urine.
• Therefore, one method for assessing renal function is to measure the
rate of excretion of a substance in relation to its plasma concentration.
• This value is the Clearance of the substance.
Definition of renal clearance:
 The millilitres of plasma cleared of a substance (s) in one
minute:
– Cs [mL/min]
 If the clearance for substance S is 125 ml/min.
This means that of the 625 ml of plasma that come to the
kidney in one minute, 125 ml (the fraction that is filtered) has all
of the S removed from it in that minute.
 The other 500 ml (the fraction that is not filtered) keeps its S
as there is no way for the S get into the urine as it is not
secreted.
@@@lnulin once in the kidney tubule—remains there stays
there
It has to cross the basement membrane

125 ml---100% of clearance

140ml of creritine---more than 100% percent because of
presence secretary active transport specially for the creatinine

2. Integrate the concept of clearance in comparing the renal

handling of different substances.

3. Recall methods of measuring the glomerular filtration rate

(GFR) using clearance and the experimental estimation of
GFR.
4. Apply the clinical estimation of GFR using the Cockcroft and
Gault relationship.
5. Discuss the limitations of use of endogenous compounds to
determine GRF.
6. Illustrate the clinical use of GFR values as an indicator of renal
disease.