tests
Dr. Nalini
Functions of kidneys :
Homeostasis
Secretion of hormones Renin,
Prostaglandin, Bradykinin
Red cell production
Calcium , phosphorus and bone
metabolism
Catabolism of peptide hormones
Synthesis of glucose
Excretory function
Renal function tests are done
Urine examination
Blood examination
Renal clearance tests
Miscelleneous
Urine examination
Normal aromatic
Bacterial infection foetid or
ammonical
Metabolic disorders
Colour :
RBC-
>5RBC/HPF
Dysmorphic-glomerular or tubular
origin
Isomorphic distal to renal
pappillae
Haematuria > 80% dysmorphic
RBCs-glomerular disease
Leukocytes
Polymorphs infections
Sterile pyuria-glomerulonephritis ,
stones, inadequately treated UTI,
acute viral haemorrhagic cystitis
Eosinophilluria-acute interstitial
nephritis
Tubular epithelial cells- acute tubular
necrosis, with
lipid droplets-oval fat bodies nephrotic
syndrome
Squamous epithelial cells-bladdder &
urethra
2. cast
Significant bacteuria->105
CFU/mm3
104- 105- significant poliuria,
partially treated UTI, catheter or
suprapubic samples
<10 4insignificant
Urine osmolality :
water deprivation
Blood examination :
Blood urea -5-40mg/dl
-filtered at glomerulus and
reabsorbed at tubules
-end product of protein nitrogen
catabolism
Serum creatinine filtered by glomerulus
,secreted by tubules
-product of enzymatic
degradation of muscle
creatinine
-formula -0.004xHt(cm)
Normal creatinine values:
Age Value
Upto 1 yr 0.6mg/dl
2-3yrs 0.7mg/dl
4-7yrs 0.8mg/dl
8-10yrs 0.9mg/dl
11-12yrs 1.0mg/dl
13-17yrs 1.2mg/dl
18-20yrs 1.3mg/dl
Arterial blood gas:
Diagnose acid base disorders.
PH of urine is acidic 4.5-8
Bicarbonate estimation
-premature :18-
26
-term-2yrs:20-26
->2yrs:22-26
Persistently low bicarbonte with urine PH
> 6 renal tubular acidosis
Anion gap
Serum electrolytes :
Serum sodium 135-145meq/l
Serum potassium 3.5-5.5meq/l
Serum calcium, serum phosphorus
Renal clearance tests :
Estimation of GFR :
Inulin clearance
Creatinine clearance
Ccr= Ucr V/Pcr
Ccr = clearance rate creatinine
Pcr = plasma concentration of
creatinine
Ucr= urine concentration of
creatinine
V = urine flow rate[volume in
ml/min]
Normal creatinine clearance in
various age groups:
Age GFR(ml/min/1.73mt
2)
preterm 47
Newborn 50
0-3mnths 60
3-6mnths 80
6-24mnths 100
2-12yrs 120
>12yrs 130
Equations for predicting GFR:
REFERENCE FORMULA
Creatinine based
Original schwartz 0.55Xht(cm)/Scr
CKiD study 0.413Xht
AIIMS delhi 0.42
Leger (0.641Xwt)/ScrX(0.00131Xht2)/Scr
Cystatin based
Filler 91.62XcysC-1.123
Grubb 84.69XcysCX1.680X1.384 if
<14yrs
Combined csystatin &
creatinine
CKiD study 39.1X(ht(mt)/Scr)0.516
X(1.8/cysC)0.294 X(30/BUN)0.169
X1.099m X(ht(m)/1.4)0.188
Tubular functions
Tubular proteinuria alpha and beta glolbulins
G lucose -10mg/100ml
Aminoacids Fanconi ,Cystinuria, Hartnups
Phosphaturia normally >85% reabsorbed
Tubular reabsorption of phosphate =
1 (urine PO4 S.Creatinine/Serum PO4urine
creatinine) 100
Tubular maximum of phosphorus (TMP) corrected
to GFR is appropriate
= S. PO4 U.PO4 S cr/U cr
Fractional excretion of sodium:
= (urine sodiumplasma Cr/plasma
sodiumurine Cr) x 100
<1 renal dysfunction
>1 sodium wasting
Hypercalciuria
>4mg/kg
Spot urine calcium/ creatinine values measured.
>0.86 -<7mon
>0.6 = 7mon -18mon
>0.2 19mon -6yrs
>0.22 older child
Transtubular potassium gradient
Urine dilution tests
- simple water loading test
Urine concentration tests
- water deprivation test
Miscellaneous :
Intravenous pyelography
Arteriography
Ultrasound KUB
Isotope perfusion studies
Renal biopsy
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