RENAL FUNCTION

CLINICAL CHEMISTRY III

presented by: Jannica Dominique

Claros, RMT
 Topic Outline:
• RENAL FUNCTION
ANATOMY
PHYSIOLOGY

• ANALYTIC TECHNIQUES

• PATHOPHYSIOLOGY
 FUNCTIONS OF THE
KIDNEY
- URINE FORMATION
- FLUID-ELECTROLYTE BALANCE
- ACID-BASE BALANCE
- WASTE EXCRETION
- DRUG AND TOXIN EXCRETION
- HORMONE PRODUCTION
RNEAL ANATOMY

Kidneys - Paired, bean shaped organ located retroperitoneally

Cortex: outer region
Medulla: Inner region

Ureter - where newly formed urine pass from kidneys to the

bladder
Bladder - holds urine prior to excretion from the body
Urethra - passage of urine
NEPHRON
- basic unit of the kidney

Components:
Glomerulus
Bowman's capsule
Proximal Convuluted Tubule
Loop of Henle
Distal Convoluted Tubule
Collecting ducts
PHYSIOLOGY

BASIC RENAL PROCESSES:

Glomerular Filtration

Tubular Reabsorption

Tubular Secretion
COUNTERCURRENT MULTIPLIER SYSTEM
- differences in osmolality in the medulla
-opposiing flow of fluids creating pressure in the ascending
and descending limb

Anti Diuretic Hormone (ADH)

Aldosterone
NON PROTEIN NITROGENOUS
COMPOUNDS
- wastes formed dute to
metabolism/degradation of nutrients

UREA - from oxidative metabolism of protein

CREATININE - metabolic processes within the muscle
URIC ACID - purine metabolism
WATER, ELECTROLYTE AND ACID BASE
BALANCE
1. Role of ADH
2. Role of Aldosterone

ACID-BASE BALANCE IS ACHIEVED

THROUGH:
1. Conservation of bicarbonate
2. Removal of metabolic acids
ENDOCRINE FUNCTION

Hormones produced/acting upon the

kidneys:
Renin

Erythropoietin

1,25-Dihydroxy Vitamin D3

Prostaglandins
Analytic procedures for Kidney Function
- all of measurement employed for kidney function
relies on measurement of excretory products

Clearance: Volume of plasma from which a

measured amaount of substance can be
completely eliminated/unit of time
Clearance tests:
1. Creatinine clearance
2. Estimated GFR
3. Cockcroft and Gault Formula
4. MDRD
5. CKD-EPI
 PROTEINS MEASURED IN CASES OF
RENAL FAILURE/INJURY:

• Cystatin C
• Beta 2-Microglobulin
• Myoglobin
• Microalbumin
• Neutrophil Gelatinase-Associated
Lipocalin
Routine Analysis
Urinalysis

Factors to cconsider:
1. Specimen collection
2. Observation of physical characteristics
3. Turbidity
4. Volume
5. Specific Gravity

6. pH
CHEMICAL ANALYSIS
Analytes:
1. Glucose
2. Ketones
3. Proteins
4. Nitrite
5. Leukocyte Esterase
6. Bilirubin/Urobilinogen
7.Blood and Hemoglobin
SEDIMENTS
• Blood cells
• Epithelial cells
• Miscellaneous (sperm, prasites, yeast
cells)
• Bacteria
• Casts - made of Tamm-Horsfall protein
- formed in the loop of Henle
• Urine crystals
Pathophysiology
Glomerular Disorders

Acute Glomerulonephritis
- inflammation of the glomeruli
- decrease in lumen size of the capillaries
Chronic Glomerulonephritis

• scarring of the glomerulus

Nephrotic Syndrome
• increased permeability of the basement
membrane of the glomerulus
Tubular Disorders
• Renal Tubular Acidosis
Proximal RTA
Distal RTA
• Interstitial Nephritis
• Urinary tract Infection
Pyelonephritis
Cystitis
• Renal Obstruction
- commonly caused by renal calculis
TYPES OF KIDNEY STONES
• Calcium oxalate
- hyperparathyroidism, high urine calcium, Vitamin
D toxicity, Sarcoidosis, Osteoporosis
• Ammonium phosphate
- infectious processes
• Calcium phosphate
• Uric acid
-gout
• Cystine
- inheriited cystinuria
THANK YOU ! 