of evaluation of
renal function
Transports urine
Toward bladder
Temporarily store
urine
Conduct urine
to exterior
B) Homeostatic regulation:
Water -Salt Balance
Acid - base Balance
C) Endocrine function:
Hormones
Formation of urine
Urine is formed by the help of nephrons
About 1 million nephrons are present in one kidney
Nephron contains bowmens capsule, proximal convoluted tubule,
loop of Henle , distal convoluted tubule and collecting tubule
blood supply high-1200ml/min
120-125ml/min is filtered which is known as glomerular filtration rate
(GFR)
Urine formation
ANALYSIS OF URINE
1)Volume
2)Colour
3)Osmolality & sp. Gravity
4)PH
5)Abnormal urinary constituents
6)Microscopic examination
7)Bacteriological examination
1)Volume
N
2)Colour
Light yellow
Brownish yellow conj. Bilirubin
4)PH
4.5 8.0 (slightly acidic)
Orthostatic proteinuria
Glomerular proteinuria( permeability) nephrotic syndrome , acute GN
Tubular proteinuria(tubular reabsorption of low mol. Wt. protein
affected) tubulointerstitial disorder and fanconis syndrome
2)Glycosuria
DM , renal glycosuria , alimentary glycosuria
Inborn error in metabolism other sugar also present in urine
3)Ketonuria
Ketone bodies in sever DM or prolong starvation( acetoacetic acid ,
beta hydroxyl butyric acid , acetone )
4)Bilrubinuria
Presence of conj. Bilirubin in urine hepatic or post hepatic jaundice
Exessive urobilinogen ( normal 1 -3.5 mg /daily ) haemolytic anemia
5)Haemoglobunuria
Intravascular hemolysis ( black water fever )
6)Porphobilinogen in urine
Acute intermittent porphyria
Red brown colour (burgundy wine ) IN STANDING URINE
7)Haematuria
Acute GN , renal stone , malignancy
8)Aminoaciduria
Congenital tubular disorder
Microscopic examination(centrifuged
sediment)
1) Cast
Renal tubule epithelium-----Tamm Horsfall protein ------coagulated
and washed out by tubular flow
Non cellular cast
Hyaline and granular
2)Crytal
When uric acid cystal and cysteine crystal present in excess have clinical
significance
3)Cells
Already covered
Bacteriological examination
Mid stream sample of urine for pus + bacteria
Urinary tract inf.
Analysis of blood
This sub. Excreted by kidney
1)Blood urea
20-40mg% , blood urea when 50% glomerular damage occur
2)Plasma creatinine conc.0.6 1.5 mg % , 50% GFR function
UV
C=
P
GFR
1) C inulin
Inulin
1)Not exist in body naturally
b)Freely filtered by glomeruli , no absorption or secretion
c)Biologically inert , non toxic
d)Not metabolise or store by kidney
e)Easily lab reading
GFR
C creatinine
3) C urea
Urea
end product of protein metabolism
Clearance depend on diet
Partially reabsorb by tubule
Method
Completely void urine and time recorded
After 1hr asked to void again measure conc. in urine
Blood sample collected at midpoint of test
UV
C=
P
75 ml / min
U V
C=
P
54 ml / min
C PAH
T m (PAH)
C IN
UV = RPF ( Pa Pv )
RPF = (Pa Pv ) / UV
Method
PAH continuous low dose infusion
So, RPF = Pa(PAH) - Pv(PAH) / U PAH . V
About 10% of total RPF perfuse to non excretory portion of kidney I.e
Renal capsule,renal pelvis
Uosm V
Posm
3 ml / min
in osmotic diuresis
3)Hyperosmotic urine
-C H20(T CH2O/free water reabsorption) volume of free water
needed to make urine iso osmotic with plasma negative
Cosm = V + T C H2O
Water deprivation, SIADH
3) Ultrasonography
Quick , non expensive , non invasive method
4)Computed tomography
Detect abnormality in and around of kidney
5)Radionuclide studies
Inj. Of radioactive compound which conc. and excreted by kidney(using
gamma camera)
Renal biopsy
Vim Silverman needle
UseTo diagnose proteinuria of unknown origin
Unexplained renal failuar
Systemic disease asso. With kidney
Light , electron , immunofluorescence microscopic study
SUMMARY
THANK YOU
Analysis of urine
1)Volume 2)Colour 3)Osmolality and Specific gravity 4)PH 5)Chemical analysis of abnormal urinary constituents6)Microscopic examination 7) Bacteriological examination
Formation of urine
Process of urine formation basically involves two steps
Glomerular filtration: formation of ultrafiltrate
waste materials of plasma are filtered
Renal Functions
Production of urine
Elimination of metabolic
end products
(Urea/Creatinine)
Elimination of foreign
materials (Drugs)
Control of volume &
composition of ECF
Water and electrolyte
balance
Acid/Base status
Endocrine Functions
Vit D, Erpo, Renin
Renal threshold
Renal threshold of a substance is the concentration in
blood beyond which it is excreted in urine
Renal threshold for glucose is 180mg/dL
Tubular maximum (Tm): maximum capacity of the
kidneys to absorb a particular substance
Tm for glucose is 350 mg/min