Renal function test:-(kidney function test)
In general, the kidney performs the following vital functions in the body-
1. Excretion of waste products
2. Regulation of Acid-base balance
3. Regulation of salt-water balance
4. Formation of renin and erythropoietin
Renal function test are broadly divided into four groups-
1. Urine analysis
2. Concentration and dilution test
3. Blood chemistry
4. Renal clearence test
In addition renal biopsy is performed to confirmed the diagnosis of renal disease.
Normal constituents of urine:-
Characteristics of normal urine-
1. Color:-
Normal urine is clear or straw colored. The color is light when large amount of water is consume. It is highly colored in jaundice due to excretion of bile pigment.
2. Odour:-
Freshly voided urine has a mild aromatic odour.
3. Volume:-
The average daily output of urine is 1.5 ltr.
The urine output decrease in-
i. Hot climate
ii. After heavy sweating (perspiration)
iii. After vomiting and diarrhoea
The urine output increase in-
i. Taking large amount of water
ii. Cold climate
iii. After taking alcohal
4. Specific gravity:-
The specific gravity of normal urine is 1.010-1.030.
5. Reaction (Ph):-
Normal urine is slightly acidic with Ph of 6. It is acidic after a heavy protein diet and in fever.
Characteristics of abnormal urine:-
The various characteristics of abnormal urine are as follow-
1. Color:-
Various chemical constituents imparts different color to urine-
i. Colorless- dilute urine (polyuria)
ii. Dark amber color- Concentrated urine (oliguria)
iii. Yellow color:- bile pigment (jaundice)
iv. Orange-red color- (rifanpicin)
v. Red to reddish brown- hemoglobin with urine (hematouria)
vi. Milky - Presence of fat (chyluria)
vii. Cloudy (turbid)- Pus cells with urine
viii. Black on standing- Alkaptonuria
2. Volume:-
i. Urine output more than 2 ltr per day is called polyuria.
ii. Urine output between 300ml-500ml per day is called oliguria.
iii. Urine output between 30ml-50ml per day called anuria.
3. Odour:-
i. Smell of acetone indicates uncontrolled diabetes or starvation.
ii. Smell of burned sugar or maple sugar indicates urinary disease.
4. Specific gravity:-
High specific gravity indicates diabetes mellitus and also in excessive fluid loss. Eg- Dehydration low specific gravity occurs in diabetes insipidus or CRF.
5. Ph:-
Acidic urine indicates metabolic acidosis. Alkaline urine indicates metabolic alkalosis.
Normal constituents of urine:-
Inorganic constituents-
Sodium- 4gm
Potassium- 2gm
Calcium - 0.1-0.2gm
Magnesium - 0.05-0.2gm
Sulphur - 1gm
Phosphorus - 2-2.5gm
Chlorine- 9-16gm
Organic nitrogenous constituents-
Urea - 30gm
Uric acid- 0.5-0.8gm
Creatinine - 1.2-1.8gm
Ammonia- 0.3-1gm
Organic non-nitrogenous constituents-
Oxalic acid - 15-20gm
Citrate - 0.2-1 or 2 gm
Ketone bodies - 3-15gm
Abnormal constituents of urine-
Substance like protein, sugar, ketone bodies and blood and not excreted in normal urine. They are excreted in urine in pathological conditions. So they are called abnormal constituents of urine.
The presence of abnormal constituents in urine helps in diagnosis of various systemic and renal disease.
Abnormal constituents ---- Disease
Protein - Proteinuria
Albumin - Albuminuria
Pentose - Pentosurea
Ketone bodies - Ketosis
Bile salts - Jaundice
Blood - Haematouria
Pus - Pyurea
Glucose - Glycosurea
PROTEIN:-
Normally urine virtually has no protein of all the proteins, albumin is readily excreted because of its smaller size. So, urinary excretion of protein is referred as albuminuria.
Cause-
1. Violent exercise
2. Pregnancy
3. High fever
4. Renal disease like nephritic and nephrotic
5. Ascites and abdominal tumour
NEPHRITIS (BRIGHT's DISEASE):-
It is the inflammation of the kidney. It is also known as glomerulonephritis.
It is convenient to classify glomerular disease in two broad groups-
1. Primary glomerulonephritis
2. Secondary glomerulonephritis
1. Primary glomerulonephritis :-
It is condition in which the glomerulus are predominent site of involving.
2. Secondary glomerulonephritis:-
It includes certain systemic and hereditary which secondarily affects the glomerulus.
Clinical feature:-
i. Proteinuria
ii. Haematouria
iii. Hypertension
The following are 6 major glomerular syndrome commonly found in glomerular disease-
Nephritic and nephrotic syndrome
Acute renal failure and chronic renal failure
Asymptomatic proteinuria and haematouria
1. Acute nephrotic syndrome:-
This is acute onset of haematouria, proteinuria, hypertension, oedema and oliguria.
2. Nephrotic syndrome:-
It is characterized by massive proteinuria, hypoalbuminaemia, oedema, hyperlipidaemia, lipidouria and hypercoagulability of blood.
Difference between Acute nephritic and nephrotic syndrome:-
Glucose:-
Normal urine does not contain glucose. The abnormal condition in which glucose is excreted in urine is called glycosuria.
Causes of glycosuria:-
1. Diabetes mellitus
2. Renal glucosuria
3. Alimentary glycosuria
4. Glycosuria of pregnancy
5. Advanced glomerulonephritis
1. Diabetes mellitus: (DM)
It is defined as hetrogeneous metabolic disorder characterized by common features of chronic hyper glycaemia with disturbance of carbohydrate, protein and fat metabolism.
Classification-
It is of two types-
i. Insulin dependent diabetes mellitus (IDDM)- (juvenile onset diabetes)(JOD) - Type 1 deabetes mellitus
ii. Non-Insulin dependent diabetes mellitus (NIDDM)Type 2 diabetes mellitus
Cause of diabetes mellitus:-
i. The basic phenomena in type 1 diabetes mellitus is distruction of β-cells mass, usually leading to absolute insulin deficiency.
ii. The basic metabolic defect is either a delayed insulin secretion related to glycose secretion. (Impaired insulin secretion) or the peripheral tissues are unable to respond to insulin. (Insulin resistance)
Clinical feature:-
1. Polyuria (increased urination)
2. Polydypsia (increased thirst)
3. Polyphagia (increased appetite)
4.Weight loss
5. Patient may be asymptomatic
Complication:-
1. Diabetic retenopathy
2. Diabetic nephropathy
3. Diabetic neuropathy
Normal glucose level-
Fasting - 70-110mg/dl
Postprandial 120-150mg/dl
Pentosuria:-
It is abnormal defect of sugar metabolism, causing abnormal excretion pentose in urine.
Ketone bodies:-
Ketone bodies are-
1. Acetoacetic acid
2. 𝞫-hydroxy-butyric acid
3. Acetone
Cause of ketone bodies:-
1. Diabetes mellitus
2. Starvation
Ketosis:-
It is also known as diabetes ketoacidosis (DKA).
It is complication of Type-1 diabetes mellitus.
A metabolic state resulting from a profound lack of insulin which leads to inability in glucose production from the liver. Result in hyperglycaemia to conversion of fatty acid into ketone.
Jaundice:- (Icterus)
It refers to the yellow pigmentation of the skin sclera be increase in the bilirubin level in blood. Which results in Hyper bilirubinaemia.
Normal bilirubin level in blood is 0.3-1.3 mg/dl. The presence of bile salt in urine indicates jaundice.
Bile salts are sodium taurocholate, sodium glycholate, pattasium taurocholate, pattasium glycolate.
Haematouria:-
Excretion of blood in urine is called haematouria. It indicates hemorrhage in urinary tract.
Cause of haematouria:-
1. Injury to the kidney or urinary tract
2. Infection of urinary tract
3. Tumour in urinary tract
4. Parasitic infection
Normal constituents of urine:-
Characteristics of normal urine-
1. Color:-
Normal urine is clear or straw colored. The color is light when large amount of water is consume. It is highly colored in jaundice due to excretion of bile pigment.
2. Odour:-
Freshly voided urine has a mild aromatic odour.
3. Volume:-
The average daily output of urine is 1.5 ltr.
The urine output decrease in-
i. Hot climate
ii. After heavy sweating (perspiration)
iii. After vomiting and diarrhoea
The urine output increase in-
i. Taking large amount of water
ii. Cold climate
iii. After taking alcohal
4. Specific gravity:-
The specific gravity of normal urine is 1.010-1.030.
5. Reaction (Ph):-
Normal urine is slightly acidic with Ph of 6. It is acidic after a heavy protein diet and in fever.
Characteristics of abnormal urine:-
The various characteristics of abnormal urine are as follow-
1. Color:-
Various chemical constituents imparts different color to urine-
i. Colorless- dilute urine (polyuria)
ii. Dark amber color- Concentrated urine (oliguria)
iii. Yellow color:- bile pigment (jaundice)
iv. Orange-red color- (rifanpicin)
v. Red to reddish brown- hemoglobin with urine (hematouria)
vi. Milky - Presence of fat (chyluria)
vii. Cloudy (turbid)- Pus cells with urine
viii. Black on standing- Alkaptonuria
2. Volume:-
i. Urine output more than 2 ltr per day is called polyuria.
ii. Urine output between 300ml-500ml per day is called oliguria.
iii. Urine output between 30ml-50ml per day called anuria.
3. Odour:-
i. Smell of acetone indicates uncontrolled diabetes or starvation.
ii. Smell of burned sugar or maple sugar indicates urinary disease.
4. Specific gravity:-
High specific gravity indicates diabetes mellitus and also in excessive fluid loss. Eg- Dehydration low specific gravity occurs in diabetes insipidus or CRF.
5. Ph:-
Acidic urine indicates metabolic acidosis. Alkaline urine indicates metabolic alkalosis.
Normal constituents of urine:-
Inorganic constituents-
Sodium- 4gm
Potassium- 2gm
Calcium - 0.1-0.2gm
Magnesium - 0.05-0.2gm
Sulphur - 1gm
Phosphorus - 2-2.5gm
Chlorine- 9-16gm
Organic nitrogenous constituents-
Urea - 30gm
Uric acid- 0.5-0.8gm
Creatinine - 1.2-1.8gm
Ammonia- 0.3-1gm
Organic non-nitrogenous constituents-
Oxalic acid - 15-20gm
Citrate - 0.2-1 or 2 gm
Ketone bodies - 3-15gm
Abnormal constituents of urine-
Substance like protein, sugar, ketone bodies and blood and not excreted in normal urine. They are excreted in urine in pathological conditions. So they are called abnormal constituents of urine.
The presence of abnormal constituents in urine helps in diagnosis of various systemic and renal disease.
Abnormal constituents ---- Disease
Protein - Proteinuria
Albumin - Albuminuria
Pentose - Pentosurea
Ketone bodies - Ketosis
Bile salts - Jaundice
Blood - Haematouria
Pus - Pyurea
Glucose - Glycosurea
PROTEIN:-
Normally urine virtually has no protein of all the proteins, albumin is readily excreted because of its smaller size. So, urinary excretion of protein is referred as albuminuria.
Cause-
1. Violent exercise
2. Pregnancy
3. High fever
4. Renal disease like nephritic and nephrotic
5. Ascites and abdominal tumour
NEPHRITIS (BRIGHT's DISEASE):-
It is the inflammation of the kidney. It is also known as glomerulonephritis.
It is convenient to classify glomerular disease in two broad groups-
1. Primary glomerulonephritis
2. Secondary glomerulonephritis
1. Primary glomerulonephritis :-
It is condition in which the glomerulus are predominent site of involving.
2. Secondary glomerulonephritis:-
It includes certain systemic and hereditary which secondarily affects the glomerulus.
Clinical feature:-
i. Proteinuria
ii. Haematouria
iii. Hypertension
The following are 6 major glomerular syndrome commonly found in glomerular disease-
Nephritic and nephrotic syndrome
Acute renal failure and chronic renal failure
Asymptomatic proteinuria and haematouria
1. Acute nephrotic syndrome:-
This is acute onset of haematouria, proteinuria, hypertension, oedema and oliguria.
2. Nephrotic syndrome:-
It is characterized by massive proteinuria, hypoalbuminaemia, oedema, hyperlipidaemia, lipidouria and hypercoagulability of blood.
Difference between Acute nephritic and nephrotic syndrome:-
Glucose:-
Normal urine does not contain glucose. The abnormal condition in which glucose is excreted in urine is called glycosuria.
Causes of glycosuria:-
1. Diabetes mellitus
2. Renal glucosuria
3. Alimentary glycosuria
4. Glycosuria of pregnancy
5. Advanced glomerulonephritis
1. Diabetes mellitus: (DM)
It is defined as hetrogeneous metabolic disorder characterized by common features of chronic hyper glycaemia with disturbance of carbohydrate, protein and fat metabolism.
Classification-
It is of two types-
i. Insulin dependent diabetes mellitus (IDDM)- (juvenile onset diabetes)(JOD) - Type 1 deabetes mellitus
ii. Non-Insulin dependent diabetes mellitus (NIDDM)Type 2 diabetes mellitus
Cause of diabetes mellitus:-
i. The basic phenomena in type 1 diabetes mellitus is distruction of β-cells mass, usually leading to absolute insulin deficiency.
ii. The basic metabolic defect is either a delayed insulin secretion related to glycose secretion. (Impaired insulin secretion) or the peripheral tissues are unable to respond to insulin. (Insulin resistance)
Clinical feature:-
1. Polyuria (increased urination)
2. Polydypsia (increased thirst)
3. Polyphagia (increased appetite)
4.Weight loss
5. Patient may be asymptomatic
Complication:-
1. Diabetic retenopathy
2. Diabetic nephropathy
3. Diabetic neuropathy
Normal glucose level-
Fasting - 70-110mg/dl
Postprandial 120-150mg/dl
Pentosuria:-
It is abnormal defect of sugar metabolism, causing abnormal excretion pentose in urine.
Ketone bodies:-
Ketone bodies are-
1. Acetoacetic acid
2. 𝞫-hydroxy-butyric acid
3. Acetone
Cause of ketone bodies:-
1. Diabetes mellitus
2. Starvation
Ketosis:-
It is also known as diabetes ketoacidosis (DKA).
It is complication of Type-1 diabetes mellitus.
A metabolic state resulting from a profound lack of insulin which leads to inability in glucose production from the liver. Result in hyperglycaemia to conversion of fatty acid into ketone.
Jaundice:- (Icterus)
It refers to the yellow pigmentation of the skin sclera be increase in the bilirubin level in blood. Which results in Hyper bilirubinaemia.
Normal bilirubin level in blood is 0.3-1.3 mg/dl. The presence of bile salt in urine indicates jaundice.
Bile salts are sodium taurocholate, sodium glycholate, pattasium taurocholate, pattasium glycolate.
Haematouria:-
Excretion of blood in urine is called haematouria. It indicates hemorrhage in urinary tract.
Cause of haematouria:-
1. Injury to the kidney or urinary tract
2. Infection of urinary tract
3. Tumour in urinary tract
4. Parasitic infection
Renal function test result example-
The main function of kidneys is to filter the waste material, expel the waste material as urine, and keep water and electrolyte balanced in the body. The Best Kidney function test in Delhi is a group of blood tests that are performed to measure how efficiently your kidneys are working and how well your kidneys clear waste from your system. It is also known as Renal Function Test.
ReplyDelete