Course Code: PDA303T

Course Title:
Pharmacotherapeutics II

Course Leader: Mr. Subeesh K Viswam

subeesh.pp.ph@msruas.ac.in

Faculty of Pharmacy M. S. Ramaiah University of Applied Sciences

 Course Details

Programme: Pharm D
Department: Pharmacy Practice
Head of the Department: Dr. E.Maheswari
Faculty: Pharmacy
Dean: Prof. (Dr.) V Madhavan (
dean.ph@msruas.ac.in)

Faculty of Pharmacy M. S. Ramaiah University of Applied Sciences

 Lecture 7
Kidney Function Test

At the end of this lecture, student will

be able to

Summarize the different kidney function

test
Interpret the kidney function test results

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 Biochemical Tests of Renal
Function
Renal tubular function tests
Osmolality measurements
Specific proteinurea
Glycouria
Aminoaciduria

Faculty of Pharmacy M. S. Ramaiah University of Applied Sciences

 Renal Tubular Function Tests
To ensure that important constituents such as
water, sodium, glucose and a.a. are not lost
from the body, tubular reabsorption must be
equally efficient
Compared with the GFR as an assessment of
glomerualr function, there are no easily
performed tests which measure tubular
function in quantitative manner
Investigation of tubular function:
1.Osmolality measurements in plasma and
urine; normal urine: plasma osmolality ratio
is usually between 1.0-3.0
2.Specific proteinuria
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 Assessment of glomerular integrity
Proteinuria may be due to:
1. An abnormality of the glomerular basement
membrane.
2. Decreased tubular reabsorption of normal
amounts of filtered proteins.
3. Increased plasma concentrations of free
filtered proteins.
4. Decreased reabsorption and entry of protein
into the tubules consequent to tubular
epithelial cell damage.
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 Proteinuria
Measurement of individual proteins such
as 2-microglobulin have been used in the
early diagnosis of tubular integrity
With severe glomerular damage, red
blood cells are detectable in the urine
(haematuria), the red cells often have an
abnormal morphology in glomerular
disease
Haematuria can occur as a result of
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lesions anywhere in the urinary tract
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 Proteinuria
The glomerular basement membrane does
not usually allow passage of albumin and
large proteins. A small amount of albumin,
usually less than 25 mg/24 hours, is found in
urine.
Urinary protein excretion in the normal adult
should be less than 150 mg/day.
When larger amounts, in excess of 250
mg/24 hours, are detected, significant
damage to the glomerular membrane has
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 Proteinuria
Quantitative urine protein measurements
should always be made on complete 24-hour
urine collections
Albumin excretion in the range 25-300
mg/24 hours is termed microalbuminuria

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 Proteinuria
Normal < 150 mg/24h.
TYPES OF PROTEINURIA
Glomerular proteinuria
Tubular proteinuria
Overflow proteinuria

Faculty of Pharmacy M. S. Ramaiah University of Applied Sciences

 Glomerular proteinuria
Glomerular proteinuriaGlomerular
proteinuria is due to increased filtration of
macromolecules (such as albumin) across
the glomerular capillary wall.
The proteinuria associated with diabetic
nephropathy and other glomerular diseases,
as well as more benign causes such as
orthostatic or exercise-induced proteinuria
fall into this category.
Most patients with benign causes of isolated
proteinuria excrete less than 1 to 2 g/day

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 Tubular proteinuria

Low molecular weight proteins such as 2-

microglobulin, immunoglobulin light chains,
retinol-binding protein, and amino acids
have a molecular weight that is generally
under 25,000 in comparison to the 69,000
molecular weight of albumin
These smaller proteins can be filtered across
the glomerulus and are then almost
completely reabsorbed in the proximal tubule.
Interference with proximal tubular
reabsorption, due to a variety of
tubulointerstitial diseases or even some
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 Overflow proteinuria
Increased excretion of low molecular
weight proteins can occur with marked
overproduction of a particular protein,
leading to increased glomerular filtration
and excretion.
This is almost always due to
immunoglobulin light chains in multiple
myeloma, but may also be due to
lysozyme (in acute myelomonocytic
leukemia), myoglobin (in
rhabdomyolysis), or hemoglobin (in
intravascular hemolysis
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 Biochemical Tests of Renal
Function
Urinalysis
Appearance
Specific gravity and osmolality
pH
Glucose
Protein
Urinary sediments

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 Urinalysis
Urinalysis is important in screening for
disease is routine test for every patient, and
not just for the investigation of renal diseases
Urinalysis comprises a range of analyses that
are usually performed at the point of care rather
than in a central laboratory.
Urinalysis is one of the commonest
biochemical tests performed outside the
laboratory.

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 Urinalysis using disposable strips
Biochemical testing of urine involves the use
of commercially available disposable strips
When the strip is manually immersed in the
urine specimen, the reagents react with a
specific component of urine in such a way
that to form color
Colour change produced is proportional to
the concentration of the component being
tested for.
To test a urine sample:
fresh urine is collected into a clean dry container
the sample is not centrifuged
the disposable strip is briefly immersed in the urine
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 Chemical Analysis
Urine Dipstick
Glucose
Bilirubin
Ketones
Specific Gravity
Blood
pH
Protein
Urobilinogen
Nitrite
Leukocyte Esterase
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 Urinalysis: Specific gravity
This is a semi-quantitative measure of concentration.
A higher specific gravity indicates a more
concentrated urine.
Assessment of urinary specific gravity usually just
confirms the impression gained by visually inspecting
the colour of the urine. When urine concentration
needs to be quantitated,

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 Urinalysis: Osmolality
Measurements in Plasma and
Urine
Osmolality serves as general marker of tubular
function. Because the ability to concentrate the
urine is highly affected by renal diseases.
This is conveniently done by determining the
osmolality, and then comparing this to the
plasma.
If the urine osmolality is 600mosm/kg or more,
tubular function is usually regarded as intact
When the urine osmolality does not differ
greatly from plasma (urine: plasma osmolality
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 Urinalysis
pH
-Urine is usually acidic
-Measurement of urine pH is useful in suspected drug
toxicity, abuse.., or where there is an unexplained metabolic
acidosis (low serum bicarbonate or other causes).
Urine sediments
-Microscopic examination of sediment from freshly passed
urine involves looking for cells, casts, fat droplets
-Blood: haematuria is consistent with various possibilities
ranging from malignancy through urinary tract infection to
contamination from menstruation.
-Red Cell casts could indicate glomerular disease
-Crystals
-Leucocytes in the urine suggests acute inflammation and
the presence of a urinary tract infection.
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 Urinary casts
Cylindrical structures produced by the
kidney and present in the urine in certain
disease states.
They form in the distal convoluted tubule
and collecting ducts of nephrons, then
dislodge and pass into the urine, where
they can be detected by microscope.
They form via precipitation of Tamm-
Hrsfall mucoprotein which is secreted by
renal tubule cells, and sometimes also by
albumin.
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 Red blood cell cast in urine
White blood cell cast in urine

Urinary casts. (A) Hyaline cast

(200 X); (B) erythrocyte cast (100
X); (C) leukocyte cast (100 X);
(D) granular cast (100 X)

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 Crystals

Urinary crystals. (A) Calcium oxalate crystals; (B) uric acid

crystals (C) triple phosphate crystals with amorphous
phosphates ; (D) cystine crystals.

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 Urine Volume
- Water homeostasis is determined by several
interrelated processes:
1. Water intake and water formed through oxidation of food
stuffs.
2. Extra-renal water loss: insensible water loss the via
faeces, and sweating.
3. A solute load to be excreted that is derived from ingested
minerals and nitrogenous substances.
4. The ability of the kidneys to produce concentrated or
dilute urine.
5. Other factors such as vomiting and diarrhoea become
important in various disease states;
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 Urine Volume

To maintain water homeostasis, the kidneys

must produce urine in a volume precisely
balances water intake and production to
equal water loss through extra renal routes.
Minimum urine volume is determined by the
solute load to be excreted whereas maximum
urine volume is determined by the amount of
excess water that must be excreted
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 Causes of Polyurea
Increased osmotic load, e.g due to glucose
Increased water ingestion
Diabetes insipidus: - Failure of ADH
production results in marked polyuria
(diabetes insipidus), which stimulates thirst
and greatly increases water intake
Nephrogenic diabetes insipidus: The
kidneys lack of response to ADH has similar
effect ( failure of the tubules to respond to
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 Summary

normal urine plasma osmolality ratio

is usually between 1.0-3.0
Diabetes insipidus is the Failure of
ADH production results in marked
polyuria
Measurement of individual proteins
such as 2-microglobulin have been
used in the early diagnosis of tubular
integrity
Obstruction to the flow of urine can
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