Professional Documents
Culture Documents
OF KIDNEY FUNCTIONS
Dr Boldizsár CZÉH
The kidneys are vital organs
Painless, non-invasive,
inexpensive.
FRESH SAMPLE!!
Urine in different colors
Gross appearance
Amount
– 800 – 1800 mL / die
– Polyuria > 2.5 L / die
– Oliguria < 400 mL / die, Anuria 100 ml / die
– Pollakisuria: frequent, but small amount, becasue of tumor or
infection
Color
– Normally yellowish
– Food, drugs
– Blood, myoglobin
Transparency
– Infection, blood, bacteria, fungi
Odor
typical urine smell
sweet: sugar
ammoniac
Urine sediment: microscopic examination
from freshly passed urine
Looking for cells, casts
(Tamm-Horsfall protein), fat
droplets
Red Cell casts : haematuria
= glomerular disease
White cell cast :
polymorphs + bacteruria =
pylonephritis
Lower UTI: polymorphs, but
no casts
Acute glomerulonephritis = Erythrocyte Leucocyte
haematuria, cells, casts cylinder cylinder
Chronic glomerulonephritis
= less sediment
Biochemical Tests of Renal Function
– Specific gravity and osmolality
– pH: normal pH 4.8 – 7.5
– Glucose
– Protein
– Bilirubin
– Keton bodies
Biochemical Tests of Renal Function
Glucose
– Increased blood glucose
– Low renal threshold or other tubular disorders
Proteinuria
– Normal < 200 mg / 24h. Urine sticks = > 300mg/L
– Causes: -
overflow (raised plasma Low MW Proteins,
Bence Jones, myoglobin)
glomerular leak
decreased tubular reabsorption of protein
protein with renal origin
Functional tests
Glomerular Function = GFR
Measurement of Glomerular Filtration Rate:
determination of clearance
1-2 % / day of
muscle creatine
converted to
creatinine.
Amount produced
relates to muscle
mass.
Freely filtered at the
glomerulus.
Some tubular
excretion.
Creatinine Clearance
Timed urine collection for In vitro interference:
creatinine measurement acetoacetate, ascorbic
(usually 24h) acid, fructose, pyruvate,
Blood sample taken within the cephalosporins, creatine,
proline, chronic lidocaine
period of collection. administration, bilirubin.
Problems: In vivo inhibition of
Practical problems of accurate creatinine secretion
urine collection and volume occurs with cimetidine or
measurement. trimethoprim.
Within subject variability =
11%
Interference in creatinine
measurement
Estimated GFR (eGFR)
Plasma Creatinine Concentration
Estimated GFR (eGFR)
Plasma Creatinine Concentration
Difficulties: Plasma creatinine can increase
Concentration depends on following protein loads.
balance between input and – Goulash effect. 80% rise in
output. creatinine after 300g of cooked
beef.
Production determined by – Less variability in early morning
muscle mass which is related to creatinine
age, sex and weight.
Strenuous exercise may increase
High between subject variability creatinine by 14%
but low within subject.
Muscle mass more difficult to
Concentration inversely related predict in oedematous patients and
to GFR. late pregnancy
– Small changes in creatinine Patients with muscle wasting
within and around the reference
limits = large changes in GFR. Patients with liver disease
Reference limits can be Drugs inhibiting tubular secretion
misleading can raise creatinine conc.
Effect of Muscle Mass on Serum Creatinine
Increased
Normal Normal Muscle
Reduced
Muscle Muscle Mass
Muscle
Mass Mass Mass
Creatinine
Input
Plasma
Pool
Content
Output
Kidney
TEST RESULT
Pre-renal Renal
TEST RESULT
Pre-renal Renal
Urine / Plasma
Osmolality > 1.5 : 1 < 1.1 : 1
Urine urea cc /
Plasma urea cc > 10 < 5
Postrenal ARF: conditions that block
urine flow distal to kidneys
– Caused by an obstruction below
the kidneys in the urinary tract
Calculi (stones)
Tumors or masses
Blood clots
Benign prostate hypertrophy (BPH)
Diabetes Mellitus
Hypertension
Vascular disorders
Infections
Nephrotoxic medications
Toxic agent exposure
Sickle cell anemia
Systemic lupus erythematosus
Chronic glomerulonephritis
Pyelonephritis
Obstructions of the urinary tract
Polycystic kidney disease
Three Stages of CRF
Stage 1
– Reduced renal reserve Stage 3
Characterized by a 40-75% loss of – End-stage renal
nephron function disease (ESRD)
Usually asymptomatic; normal BUN Final Stage
& Creatinine
Characterized by
Stage 2 a >90% loss of
– Renal Insufficiency nephron function
Characterized by a 75-90% loss of Characterized by
nephron function ↑BUN ↑Creatinine
↑BUN and ↑Creatinine and electrolyte
– Kidneys loose ability to concentrate imbalances
urine; client may report polyuria
or/and nocturia; Anemia develops
Uremic
symptoms
Requires Life-
long Dialysis
Nephrotic syndrome
Most common syndromes
associated with glomerular disease
Acute
Glomerulonephritis
Rapidly Progressive
Glomerulonephritis
Chronic
Glomerulonephritis
Nephrotic Syndrome
Pathophysiology of nephrotic syndrome
Increased glomerular
capillary permeability
Heavy proteinuria
Susceptibility Compensatory
Edema
to infection Increase in lipoprotein
synthesis
Hyperlipemia Hypercoagulability
Systemic biochemical manifestations,
complications
Anemia – Increased triglyceride
– Inadequate erythropoietin production levels
– Decreased life span of RBC Occurs in 30-70% in CFR
– Nutritional deficits – Increased blood sugars
S/SX: fatigue, shortness of breath Usually moderate; alterations
and even angina cellular use of glucose
Renal Osteodystrophy – Increased tendency to
– A syndrome of skeletal changes bleed
found in CRF from alterations in Altered platelet function and
calcium & phosphate metabolism and coagulation factors
elevated PTH levels: – Increased risk of Infection
↑ PTH reabsorbs calcium & Impaired leukocyte function
phosphorous from bone stores in an and immune responses
attempt to increase serum calcium
levels. – Reproductive Dysfunction
Long term effects: bone deformity Infertility and decreased libido
and weakness
Biochemical manifestations: electrolyte
imbalances
– Hyperkalemia
Kidney‟s can‟t excrete 80-90% of body‟s potassium like normal
Irritability, restlessness, weakness, diarrhea and abdominal
pain/cramping
– Hyperphosphatemia
Primarily excreted by kidneys; ↓UO = decreased excretion
– Hypocalcemia
The active form of Vitamin D is required for Ca2+ to be absorbed;
only functioning kidneys can activate Vitamin D
– Hypermagnesemia
Usually normal or slightly elevated
– Hyponatremia
Sodium levels maybe decreased due to hemodilution from fluid
overload.
Thank you!