Renal Function Test – Introduction to fundamental concepts of Biological Science including the organization and common characteristics of living matters, cell structures and functions, food production by photosynthesis, harvesting energy, mechanism of cells reproduction, genetics, evolutions, and Human Biology. Introduction to general chemistry including basic concepts about matter, atomic structure, chemical bonds, gases, liquid, and solids, solutions, chemical reactions, acid, bases, and salt;
organic and biochemistry including hydrocarbons and their derivatives, carbohydrates, lipids, proteins, enzymes, vitamins, and minerals, nucleic acids; principles of physics and applications to nursing including gravity and mechanics, pressure, heat and electricity; nuclear chemistry and nuclear physics, effects of radiation on human beings, and protection and disposal. The aim of the course is to acquire knowledge and skills in general biological science, general chemistry and physics.
Renal Function Test
Kidney function tests:
A kidney function test is a collective term for a variety of individual tests and procedures that can be done to evaluate how well the kidneys are functioning.
Urine Examination:
➤ Physical examination-
- Volume: Normal -800-2500 ml/day.
- Color: Normal -straw.
N.B: Cloudy urine: Due to presence of pus (pyuria)
Blackish urine: Due to presence of blood, as in acute glomerulonephritis. - Specific gravity: Normal:-1015-1030.
➤ Chemical examination:
- Test for protein.
- Test for carbohydrate.
- Test for ketonbody.
➤ Microscopic examination:
- Epithelial cell: They are present in UTI infection & glomerulonephritis
- Blood cell: They indicate haematuria of glomerular disease such as glomerulonephritis.
- Hyaline cast: Relatively nonspecific and may be seen in after severe exercise, febrile illness, chronic renal disease etc.
Clearance test:
➤ Creatinine clearance test (Endogenous): Normal about 140 ml/min.
➤ Urea clearance test. Normal about 70 ml/min.
➤ Inulin clearance test. Normal about 125 ml/min.
Blood analysis:
➤ Test for waste product e.g.- Urea, creatinine
➤ Test for electrolytes.
Radiological test:
➤ Intravenous Pyelography.
➤ Ultrasonography.
➤ Plain x-ray (KUB)
Another Answer
A. Routine examination of urine:
Physical examination:
➤ Volume: 1-2.5 L/day
➤ Colour: Straw
➤ Odour: Pungent
➤ Appearance: Clear/ transparent
➤ Sedimentation: Absent
➤ Specific gravity: 1.010-1.020
Chemical examination:
➤ pH-Litmus paper test Acidic (4.5-6.8)
➤ Protein – Heat coagulation test -> Trace (<30 mg/day)
➤ Sugar-Benedict test -> Negative
➤ Excess phosphate -> Nil
➤ Bile salts- Hay’s surface tension test -> Nil
➤ Bile pigment (bilirubin)- Fouchet’s test -> Negative
➤ Ketone bodies – Rothera’s test -> Negative
➤ Blood-Orthotolidin test -> Nil
Microscopic examination
➤ Cells
- RBC – Absent
- Pus cells-0-3/HPF (in male), 0-5 (in female)
- Epithelial cell – Occasional
➤ Casts-
- RBC casts Absent
- WBC casts – Absent
- Epithelial casts – Absent
- Granular casts – Absent
- Hyaline casts Absent
➤ Crystals and others-
- Urates Absent
- Uric acid – Absent
- Calcium oxalate – Absent
B. Blood analysis:
a) Blood urea (15-40 mg/dl)
b) Blood urea nitrogen (BUN) (7-21 mg/dl)
c) Serum creatinine (0.7-1.4 mg/dl) (No. 1 test in kidney function)
d) Serum uric acid (Men: 0.18-0.54 mmol/L; Women: 0.15-0.45 mmol/L)
e) Serum electrolytes (Na+- 134-145 mmol/1, K+- 3.6-5 mmol/1, Cl- 95-107 mmol/1 etc.)
f) Plasma protein concentration (6.4 – 8.3 g/dl)
C. Renal clearance test:
a) Creatinine clearance test (70-140 ml/min)
b) Urea clearance test (60-70 ml/min)
c) Inulin clearance test (125 ml/min)
D. Special test:
a) Water loading test
b) Water deprivation test
E. Imaging test:
a) Plain X-ray of KUB (kidney-ureter-bladder) region
b) Ultrasonography (USG)
c) Intravenous urography (IVU)
d) CT scan
e) MRI
f) Retrograde pyelography & cystoscopy
g) Renal arteriography & venography
F. Renal biopsy.
Clinical importance of physical examination of urine:
➤ Volume: May be polyuria, oligouria, anuria.
- Polyuria (> 3000 ml/day) found in:
✓ Diabetes mellitus
✓ Diabetes insipidus - Oliguria (< 500 ml /day) found in:
✓ Renal failure and cardiac failure
✓ Excessive loss of fluid in diarrhea, vomiting or bum
✓ Acute glomerulonephritis (AGN)
✓ Nephrotic syndrome
✓ Urinary tract obstruction - Anuria (< 50 ml/day) found in:
✓ Shock
✓ Bilateral obstruction of ureters
➤ Colour:
- Straw colour: Normal urine due to urochrome and urobilinogen
- Yellow: In jaundice (due to bilirubin or excess urobilinogen)
- Smoky: Presence of RBC
- Red: Due to hematuria or hemoglobinuria
- Milky: Due to chyluria
- Pinkish: Due to rifampicin (anti-TB drug)
➤ Appearance:
- Cloudy in presence of RBC, WBC, epithelial cells, excessive pus cell
- Turbid in urinary tract infection
➤ Specific gravity and osmolarity:
- Increase in:
✓ DM and cardiac failure
✓ Dehydration & SIADH - Decrease in:
✓ Diabetes insipidus
✓ Acute renal failure.
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