Assessment of renal function can be done by,
Biochemical
and immunological laboratory tests
Imaging and
histological examination
Group I test:
a. Routine
urine examination
b. Serum
Creatinine
c. Blood
urea nitrogen
d. Uric acid
These tests are helpful to
differentiate pre-renal condition from renal and post renal conditions. They
also give idea about the excretory function of kidney by measuring urea,
creatinine, and uric acid. The normal ratio of urea nitrogen and serum
creatinine is 14-24. Ratio >40 is seen during pre-renal cause of kidney
disease where there is retention of BUN. In renal condition the ratio may be
normal or <10 in case of tubular damage. In post renal condition where there
is retention of urea and creatinine there will be proportional increase in both
and ratio will be >14.
a. Urinalysis:
This is the starting point of renal function assessment
Early morning samples are preferred
as they are concentrated. The clean catch MSU is desirable. It must be analyzed
within 1 hour of collection or refrigerated at 2-80C for not more
than 8 hours. If delayed in alalysis then bacterial multiplication will occur
and urease producing organism will degrade urea to ammonia that alkalinize the
pH. Loss of Carbondioxide by diffusion in air further elevates pH which cause
cast degeneration and red-cell lysis.
i. Physical characters
Visual Appearance:
Normal transparency – transparent
Turbid – UTI, proteinuria, fats (nephrotic syndrome)
Milky – chyluria
Smoky – hematuria
during acute glomerulonephritis
Colour:
Normal color urine – pale yellow
mainly due to urochrome pigment (derivative or urobilin)
Pink orange –
Haemoglobin, myoglobin, porphyrins
Blue-green – pseudomonas infection, riboflavin
Brownish black – homogentisic acid (on standing), melanin, RBC
Wine color - PKU
Odour:
Normal – Pungent due to aromatic
acids.
Ammonical – UTI (presence of
urea splitting microbes), contamination
Mousy – MSUD
Fruity smell – Diabetic
ketoacidosis
Volume:
Normal – 750-2,000 mL/day
average 1.5L per day.
Polyuria – >3L/day occurs in diabetes
mellitus and insipidus, chronic renal disease, acromegaly (over production of
GH) and myxedema (hypothyroid edema).
Anuria/oliguria
– <200 mL/day, found in nephritis, ESRD, urinary tract obstruction and ARF
pH
Normal – slightly acidic
around pH 6-7
Acidic – During acidosis, RTA, excretion
of non volatile organic acids like pyruvate, lactate, citrate
Alkalotic – UTI due to production ammonia form
ammonium by bacteria, ingestion of bicarbonate, Fanconi syndrome
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