Renal Function test (RFT)

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1 Renal Function test (RFT) creatinine &GFR T.A Khadija Balubaid KAU-Faculty of Science- Biochemistry department Clinical biochemistry lab (BIOC 416) 2013

2 Creatinine Creatinine is a break-down product of creatine phosphate and creatine, that it is a waste product of energy metabolism in muscle. its filtered from the blood by kidneys and then excreted into the urine.(100% execreted) Production of creatinine depends on an individual's muscle mass, which is usually constant. Its level considered a sensitive renal function marker. In renal failure, the level of creatinine is elevated in blood and decreased in urine because kidney unable to excrete creatinine in urine.

3 Serum creatinine: Elevated blood creatinine is a more sensitive indication of impaired kidney function than the BUN: Its level only effected by muscle mass which is usually constant creatinine level is very little affected by liver function BUN/Creatinine ratio: BUN-creatinine ratios increase with renal disease. Effected by other factors as: liver function, muscle mass, dietary protein

4 - High BUN-to-creatinine ratio: Sudden acute kidney failure. Urinary tract blockage (kidney stone). Very high ratio may be caused by bleeding in the digestive tract or respiratory tract. Low BUN-to-creatinine ratio: Low protein diet Severe muscle injury.

5 Glomerular Filtration Rate (GFR): Glomerular Filtration Rate (GFR): It is the rate (volume per minute) at which the filtration of blood is performed by the glomerulus and transferred to Bowman's space. It is determined practically by measuring creatinine clearance. Creatinine clearance: It is the volume of blood plasma that is cleared of creatinine per unit time (expressed in ml/min). It measures GFR. Normal range: ( man: 120ml/min & women:100ml/min )

6 If GFR less than 60 ml/min: for 3 months the patient has chronic kidney disease CKD. If GFR is less than 10 ml/min: this stage is called end-stage kidney disease or end-stage renal disease (ESRD). End stage means kidneys can t filter chemicals and minerals out of blood. In this stage patient needs dialysis or kidney transplant. However, because a small amount of creatinine is released by the filtering tubes in the kidneys, creatinine clearance is not exactly the same as the GFR. In fact, creatinine clearance usually overestimates the GFR. This is particularly true in patients with advanced kidney disease.

7 According to the value of GFR, kidney disease is classified to five stages: Stage of kidney disease Normal Mild reduced Moderately reduced severely reduced Kidney failure Glomerular Filtration Rate (approximate percent of kidney failuar)

8 Creatinine clearance calculation: First way :Creatinine clearance can be calculated without a 24 hour urine collection using Cockcroft equation which require (serum creatinine concentration, sex, age, and weight) Cockcroft equation: Creatinine clearance = (140 age) x weight x constant serum creatinine Weight in Kg, in, If serum creatinine is measured in mg/dl: Serum creatinine must be multiplied by factor 72 Constant = 1 for men, constant = 0.85 for women If serum creatinine is measured in μmol/l: Constant = 1.23 for men, constant = 1.04 for women

9 The second way: This way is using 24-hour urine collection. Creatinine clearance (ml/min) = urine creatinine (mg/dl) x urine volume (ml) serum creatinine (mg/dl) x 1440 min Urine Volume is the total urine volume in 24 hour by ml and 1440 is a number of minutes in 24 hours. Cystatin C: It is a protein secreted by most cells in the body and small amounts excreted in the urine. It may be used as an alternative to creatinine and creatinine clearance for monitoring kidney dysfunction. It is a better marker of the GFR. A reduction in GFR causes a rise in the concentration of cystatin C.

10 Principle: Alkaline The rate of formation of colored complex is directly related to creatinine conc. Sample: Serm or urine

11 Kit components

12 Procedure:

13 Calculations Can you calculate creatinine clearance for your sample? Normal range of creatinine clearance : Male: 97 to 137 ml/min. Female: 88 to 128 ml/min

14 What Abnormal Results Mean Abnormal results (lower than normal creatinine clearance) may indicate: Acute tubular necrosis Bladder outlet obstruction Congestive heart failure Dehydration End-stage kidney disease Glomerulonephritis Kidney failure Renal ischemia (too little blood flow to the kidneys) Renal outflow obstruction (usually must affect both kidneys to reduce the creatinine clearance) Shock

15 Considerations Factors that may interfere with the accuracy of the test are as follows: The creatinine clearance appears to decrease with age (each decade corresponds to a decrease of about 6.5 ml/min./1.73 m2). Incomplete urine collection Pregnancy Vigorous exercise Drugs that can interfere with creatinine clearance measurements include: cimetidine, trimethoprim, and drugs that can damage the kidneys, such as cephalosporins.

16 Case study An 87-year-old retired tailor appears in his physician s office complaining of the slow onset of ankle and shin swelling, mild shortness of breath, and fatigue. Urinalysis performed in the office reveals marked proteinuria, and the patient is seen for further evaluation and work-up. The serum urea-n was 35 mg/dl, creatinine 3.8 mg/dl, sodium 136 mmol/l, potassium 5.6 mmol/l, chloride 104 mmol/l, and bicarbonate 20 mmol/l. Total serum protein was 4.3 g/dl with albumin 1.4 g/dl. Given a serum creatinine of 3.8 mg/dl, a urine creatinine concentration of 210 mg/dl and a 24 hour urine volume of 288 ml, calculate the creatinine clearance in this patient. Interpret the creatinine clearance you have obtained for this patient. What other blood/serum tests may be abnormal? What is the differential diagnosis for this patient? Are the increased SUN and creatinine values typical for this disease?

What is creatinine? The kidneys maintain the blood creatinine in a normal range. Creatinine has been found to be a fairly reliable indicator of kidney

What is creatinine? The kidneys maintain the blood creatinine in a normal range. Creatinine has been found to be a fairly reliable indicator of kidney What is creatinine? Creatinine is a chemical waste molecule that is generated from muscle metabolism. Creatinine is produced from creatine, a molecule of major importance for energy production in muscles.

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