Renal Function Tests

Functions of the Kidneys.

1. Formation of urine.
a. Excretion of water soluble waste products of
metabolism, mainly the nitrogenous waste
products.
b. Excretion of toxic substances.
c. Control of blood volume and extra-cellular fluid volume
by regulating the re-absorption of water and electrolytes.
d. Re-absorption of essential metabolites filtered in the
glomerular filtrate.
2. Endocrine functions.
a. Secretion of erythropoietin and control of red blood cell
production.
b. Secretion of renin and maintenance of blood pressure.
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 Renal Function Tests
1. Urine routine examination: appearance, volume, sp
gravity, pH, glucose, protein and sediment.
2. Blood urea conc.
Blood urea nitrogen (BUN).
3. Serum creatinine conc..
4. Clearance tests to measure the GFR.
a. Inulin clearance test.
b. Creatinine clearance test.
c. Urea clearance test.
5. Serum electrolytes (Na, K, Cl, HCO).
6. Urinary total protein, Microalbumin.
7. Other Investigations.
USG of kidneys.
X-ray KUB, IVU, CT Scan.
Renal biopsy (FNAC).
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 Blood Urea
• Urea in blood is mostly derived from catabolism of
protein.
• It is freely filtered through glomeruli.
• It is passively reabsorbed from the filtrate.
• Its blood conc. may rise due to increased production,
decreased filtration or increased reabsorption.
• Normal blood conc. is 15 – 50 mg/dl of blood.
• BUN is the nitrogen derived from protein breakdown
only. It is calculated as:
Urea X 28/60 = BUN
BUN X 60/28 = Urea

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 Serum Creatinine
• Creatinine is derived from creatine.

• Its blood conc. depends on total muscle mass.

• It is filtered freely through glomeruli.

• It is not reabsorbed from the filtrate.

• Small amount of it is secreted by the tubules.

• Its blood conc. rises due to decreased filtration and

increased production.

• Normal blood conc 0.6-1.2 mg/dl of blood.

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 Clearance tests
• Clearance test measures the volume of plasma
completely cleared of a substance per minute. It
is a measure of GFR.
• Inulin clearance test is the most ideal but a little
difficult to perform. Most convenient and useful
is the creatinine clearance test.
• Clearance of a substance (GFR) is calculated
using the following formula:
Clearance (GFR) = Conc. in urine X 24 hrs urine
volume/ Conc. in blood X Collecting time in min.
• Normal creatinine clearance is:
Adults < 55 yrs: 95– 145 ml/min.
Clearance decreases progressively with age.

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 CSF

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 Examination of CSF
Introduction: Cerebrospinal fluid is formed
from plasma by the filtering & secretory activities
of the choroid plexus in the lateral ventricles. It
passes through the third & fourth ventricles into
the subarachnoid space between the pia mater
& arachnoid mater, & completely surrounds the
brain & spinal cord. CSF is reabsorbed into the
blood stream by the arachnoid villi which project
into the subarachnoid space.
In the adult the total volume of CSF is about 140
ml.

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 CSF STYDY
Functions of CSF:
The CSF supports the brain &
protects it against injury. It also has a
similar function to lymph & remove waste
products of metabolism.

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 Laboratory Examination Of CSF

It includes the following examination:

*A. Physical Examination

*B. Chemical Exam.
*C. M/E
*D. Bacteriological Examination.
*E. Other tests.

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 Physical Examination
* Appearance: Normal CSF is clear.

* Colour: Colourless.

* Clot: Normal CSF does not clot.

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 Cell Count
Normal: 0-5 lymphocytes/cmm.

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 Chemical Examination
1. Protein: Normal: 15- 45mg/dl.

2. Glucose: Normal: 50-70mg/dl.

3. Chloride: Normal: 710-750mg/dl.

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 Bacteriological Examination
Normal CSF is sterile.

1. Smear of centrifused deposit.

2. Culture.

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 Other tests
1. VDRL

2.Antigen detection

3.Immunologial tests &

Electrophoresis.

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 Meningitis
• Bacterial
1. 1st 06 wks
• Enteric gram neg
• Group B strept
• Meningococci
• Staph
• Pneumococci
• L.monocytogens
• Group A strept

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 Meningitis
2. Six wks to six yrs
• H. influnzae
• Meningococci
• Pneumococci
3. Over six yrs
Pneumococci
Meningococci
4. All ages: Tuberculosis

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 Meningitis
• Viral causes
1. Neurotropic viruses
Polio viruses
LCM
Arbo.encephalitis
2. Non-neurotropic viruses
Enteroviruses,Mumps,Herpes simplex,Infectios
mononucleosis,Varicela-zoster,measles

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 CSF
• 3.Fungal causes
Cryptococcosis
Aspergillosis
Histoplasmosis
Mucormycosis

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 CSF in normal health & common disorders
Normal Pyogeni Tubercul Viral Subarac Tumour
c ous Meningit hnoid
Meningit Meningit is Haemorr
is is hage
1.Press 60-100 Normal/i Normal/i Normal Increase Increase
ure(mm ncrease ncrease d d
H20) d d

2.Color Crystal Cloudy, Clear/Cl Clear Blood- Clear

Clear purulent oudy mixed/x
anthocro
mic
3.Cell Lympho Neutrop Mostly Lympho RBCs Normal
count/m cytes 0- hils Lympho cytes mostly
m3 5 often cytes upto 200
more upto 500
than
1000-
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 CSF in normal health & common disorders
4.Protein( 15-45 Increased Increased Increased Normal Increased
mg/dl) 500-2000 500-3000 500-2000 500-2000

5.Glucos 50-70 May Decrease Normal Normal Normal

e(mg/dl) disappear d 20-30
6.Chlorid 710-750 Normal <600 Normal Normal Normal
e(mg/dl)
7.Other Culture- Organism Tubercle Stain & Centrifug
bacilli in
Changes Sterile s on Culture- ed-
fibrin clot
Deposit gram and deposit No supernat
stain & on ZN stain organism ant is
culture & yellow
culture:PCR
may identify
the
organism

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 CSF
• Indication of CSF study
Meningitis
Subarachnoid haemorrhage
Malignancy
Demyelinating disease

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