ANATOMY

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ANATOMY PHYSIOLOGY OF KIDNEY
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RENAL ANATOMY
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RENAL PHYSIOLOGY
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Proximal convoluted tubule
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Proximal convoluted tubule
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Loop of henle
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Distal convoluted tubule
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NaKH

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EVALUATION OF RENAL FUNCTION
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Measurement of Glomerular Filtration Rate (GFR)

• GFR is essential to renal function
• Most frequently performed test of renal function.
• Measurement is based on concept of clearance -
• The determination of the volume of plasma from
  which a substance is removed by glomerular
  filtration during its passage through the
  kidney

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Determination of Clearance

• Clearance (U xV)/P
• Where U is the urinary concentration of
  substance x
• V is the rate of urine formation (mL/min)
• P is the plasma concentration of substance x
• Units volume/unit time (mL/min)

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Inulin GFR

• Gold Standard
• Complex procedure
• Bolus dose followed by constant infusion
• Timed urines, with bloods taken midpoint of
  collection periods, for inulin assay.
• GFR is taken as the mean for each period.

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Isotopic GFR

• 99mTc-DTPA 51Cr-EDTA
• Single bolus injection with blood taken for
  isotopic counting at intervals

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Creatinine Clearance

• Timed urine collection for creatinine measurement
  (usually 24h)
• Blood sample taken within the period of
  collection.
• Problems -
• Practical problems of accurate urine collection
  and volume measurement

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Plasma Creatinine Concentration

• Difficulties -
• Production determined by muscle mass- related to
  age, sex and weight.
• Concentration inversely related to GFR.
• Small changes in creatinine within and around the
  reference limits large changes in GFR

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Cystatin-C

• Small size - freely filtered at glomerulus
• Constant production rate by all nucleated cells
• No known extra-renal excretion routes
• Not influenced by muscle mass, diet or subjects
  sex

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Blood urea level

• Untill 75 renal function is lost
• Metabolism of proteins synthesised in liver
• May be rised when
• High protein intake
• Excessive protein catabolism steroids
  ,tetracyclines
• Absorption of blood from GIT
• Low level reduced dietary intake

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Renal blood flow

• PAH clearance
• Normal values 500-600 ml /min

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Urinary Concentration

• Urine specific gravity
• Water deprivation test

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Urinary Acidification

• Done in suspected cases of RTA
• Urine pH
• Sod. Bicarbonate loading test
• Ammonium chloride loading test

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