KIDNEY FUNCTION TEST
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This is responsible for the reabsorption of: Sodium Chloride Bicarbonate and other ions Glucose Amino acids Proteins Urea and Uric Acid
Proximal Convoluted Tubule
Renal Function Panel:
Glucose BUN Creatinine Sodium Potassium Chloride Phosphorus Calcoum Albumin CO2
Elimination of Waste products Maintenance of blood volume Maintenance of electrolyte balance Maintenance of acid-base balance Endocrine function (EPO secretion)
Functions of the Kidneys
Measure of clearance of normal molecules that are not bound to protein and are freely filtered by the glomeruli neither reabsorbed nor secreted by the tubules
Glomerular Filtration Rate
GFR is considered the best ___
Overall indicator of level of Kidney function
Removal of substance from plasma into urine over a fixed time Expressed in mL/minute
Clearance
Plasma concentration is _____ to clearance
Inversely proportional
Formula for Clearance:
(Urine/Plasma) x (Volume/1440) x (1.73/A)
Reference Method
Inulin Clearance Not routinely done
Reference Method
Inulin Clearance Not routinely done
Reference Value of Inulin Clearance
Male = 127 mL/min Female = 118 mL/min
Provides an estimate of the amount of plasma that must flowed through the kidney glomeruli per minute Excellent measure of renal function
Creatinine Clearance Creatinine is freely filtered by the glomeruli but not reabsorbed
Provides an estimate of the amount of plasma that must flowed through the kidney glomeruli per minute Excellent measure of renal function
Creatinine Clearance Creatinine is freely filtered by the glomeruli but not reabsorbed
Reference Value of Creatinine Clearance
Male: 85-125 mL/min Female: 75-112 mL/min
• High Cardiac Output • Pregnancy • Burns • CO poisoning
Increased Creatinine Clearance
• Impaired Kidney Function • Shock, Dehydration • Hemorrhage • Congestive Heart Failure
Decreased Creatinine Clearance
Can demonstrate progression of renal disease or response to therapy Not give reliable estimates of the GFR since it is freely filtered by the glomeruli but variably reabsorbed by the tubules
Urea Clearance
Volume depletion decreases Urea Clearance by both:
Reduced Filtration Increased Reabsorption
Produced at a constant rate by all nucleated cells Freely filtered at glomerulus, not secreted by the renal tubules but reabsorbed
Cystatin C
Increases more rapidly than creatinine in the early stages of GFR impairment
Cystatin C
Reference Value of Cystatin C
Adult: 0.5-1.9 mg/L (>65 yo): 0.9-3.4 mg/L
Low molecular weight glycoprotein Functions as Prostaglandin D Synthase Isolated primarily from CSF; Freely filtered at Glomerulus, then reabsorbed completely and catabolized by the proximal tubule
Beta Trace Protein
Major end product of Protein and Amino Acid Catabolism Synthesized in Liver from CO2 and Ammonia from deamination of AA Glomerulus: Freely filtered PCT: Substantially reabsorbed **First Metabolite to Elevate in Kidney Disease Easily removed by Dialysis
Blood Urea Nitrogen
Reference Value of BUN
8-23 mg/dL