nullLaboratory investigation of renal function*prepared by xuejingwangLaboratory investigation of renal functionDepartment of Clinical Laboratory
Peking University First Hospital
Xue jing WangContents*prepared by xuejingwangContentsRenal physiology and function
Laboratory investigations of renal function
glomerulus 肾小球
renal tubule 肾小管
assessment and monitoring for early renal injury
How to select tests
Renal anatomy and physiology*prepared by xuejingwangRenal anatomy and physiologyRenal anatomy*prepared by xuejingwangRenal anatomyA renal vein
B renal artery
C ureter 输尿管
D cortex
E pelvis 肾盂
F renal capsule 包囊null*prepared by xuejingwangGlomerulus
Loop of Henle
Collecting tubuleNephron 肾单位*prepared by xuejingwangNephron 肾单位Glomerulus
Proximal convoluted tubule 近曲小管
Henle’s loop
Distal convoluted tubule
Collecting duct
Peritubular capillary
管周毛细血管Urine production*prepared by xuejingwangUrine productionRenal blood flow*prepared by xuejingwangRenal blood flowRenal functions*prepared by xuejingwangRenal functionsGlomerulus: Removal of metabolic waste products; Removal of foreign chemicals
Proximal convoluted tubule: Reabsorption of useful substance such as glucose, low molecular protein, amino acid etc, excretion of unwanted substance
Henle’s loop: countercurrent multiplier system (逆流倍增系统), help to concentrate and dilute urine
Distal convoluted tubule and collecting duct: Regulation of water, inorganic ion and acid-base balance
Others: endocrineGlomerulus function examination *prepared by xuejingwangGlomerulus function examination Glomerulus filtration membrane*prepared by xuejingwangGlomerulus filtration membraneEndothelium 内皮细胞
Basement membrane
Foot processesSize barrier 分子屏障*prepared by xuejingwangSize barrier 分子屏障LMWP: <50kD
RBP, a1-MG,B2-MG
MMWP:50-70kD
albumin, transferrin
HMWP:>90kD
Ig, TH proteinCharge barrier(电荷屏障)*prepared by xuejingwangCharge barrier(电荷屏障)Sulfate heparin(硫酸肝素)
Sialytic acid(唾液酸)null*prepared by xuejingwang
Glomerular filtration rate(GFR,肾小球滤过率): the volume of blood filtered per minute
单位时间内从肾小球滤出的血浆量
Renal Clearance(肾脏清除率): the volume of plasma from which a measured amount of substance can be completely eliminated into urine per unit of time
每分钟肾脏能将多少毫升血浆中的某物质通过尿液加以清除 C=UV/P
null*prepared by xuejingwangA glomerulus filtration C tubule reabsorption D renal plasma flowSubstances reabsorption*prepared by xuejingwangSubstances reabsorptionCreatinine and Creatinine Clearance
肌酐和肌酐清除率*prepared by xuejingwangCreatinine and Creatinine Clearance
肌酐和肌酐清除率Endogenous metabolic product synthesized with a constant rate, metabolite of phosphate creatine, which provides energy to muscle.
Freely filtered through glomerular
Slightly secreted by proximal tubule
Stable serum level under general situation
Readily available colorimetric method for measurement
Formula for creatinine clearance(Ccr)*prepared by xuejingwangFormula for creatinine clearance(Ccr) Ucr(μmol/L)
Ccr(ml/min)= –––––––––––– × urine volume(ml/min)
Scr(μmol/L)
×1.73/A
logA(m2)=0.425log(weight)kg+0.725log(height)cm-2.144
Ccr: creatinine clearance
Ucr: urine creatinine concentration
Scr: serum creatinine concentration
A : body surface areanull*prepared by xuejingwangReference interval: age, sex
Clinical significance: a sensitive test
help to judge filtration function
help to instruct drug administration
Precaution
sample collection and storage
Ccr is higher than GFR in renal failure patients( proximal tubule secretion)Urea 尿素*prepared by xuejingwangUrea 尿素main metabolite product of protein(about 45% of NPN 非蛋白氮)
freely filtered by glomerulus
40% reabsorbed by tubules
Reference interval:2.8~7.1 mmol/L
Clinical significance
pre-renal factors
renal disease: not a sensitive markerUric Acid 尿酸*prepared by xuejingwangUric Acid 尿酸metabolite of nucleic acid
fully filtered by glomerular
completely reabsorbed by tubule
Clinical significance
gout 痛风
hyper-metabolism of nucleic acid
renal diseaseCr,Urea and Ccr*prepared by xuejingwangCr,Urea and Ccrnull*prepared by xuejingwangSerum Cystatin C
胱氨酸蛋白酶抑制剂C
MW13.4Kd, pI9.3, 120aa,
produced by all the cells
Constantly generate, not affected by inflammation and neoplasm
Electrophoresis band locates at post-r region
Now has automatic measurement assay
Cystatin C in healthy body*prepared by xuejingwangCystatin C in healthy bodyBefore 5 months, concentration of cystatin c in baby is obviously higher than that of adult, due to the unmatured glomerular filtration function
After 5 months, a sharp decrease could be seen showing a constant serum level, same as that of adult.Ccr and Cystatin C*prepared by xuejingwangCcr and Cystatin CReference interval
Clinical significancenull*prepared by xuejingwangTubule function examination*prepared by xuejingwangTubule function examinationnull*prepared by xuejingwangProximal convoluted tubule function examination
Distal convoluted tubule function examination
Diagnostic test for renal tubule acidosisProximal convoluted tubule function test*prepared by xuejingwangProximal convoluted tubule function testReabsorption tests
Excretion testsReabsorption test*prepared by xuejingwangReabsorption testtubule maximal glucose reabsorptive capacity test (TmG)
肾小管葡萄糖最大重吸收量试验
Method: burden test
Reference interval: 330-440mg/min
Clinical significance:
Excretion test*prepared by xuejingwangExcretion testphenol sulfonphothalein(PSP) excretion test
酚红排泄试验
paraaminohippuric acid excretory capacity test(TmPAH)
对氨基马尿酸最大排泌量试验Distal convoluted tubule test
concentration and dilution tests
osmolality
electrolytes analysis*prepared by xuejingwangDistal convoluted tubule test
concentration and dilution tests
osmolality
electrolytes analysisConcentration and dilution test
Mosenthal test
*prepared by xuejingwangConcentration and dilution test
Mosenthal test
Method
Reference interval
24 hours urine volume: 1L to 2L
daytime/nighttime: >=2:1
maximal gravity difference:>0.009
Clinical significance:concentration dysfunction
urine volume above 2L
nighttime urine increase
fixative urine gravity
Urinary osmolality test*prepared by xuejingwangUrinary osmolality testconcept of osmolality: how many particles existing in a solution, have nothing with its size, charge and kind.
Osmolality:mass /kg, Osmolarity:volume /L
质量渗摩尔 体积渗摩尔
Freezing point depression method(冰点下降法)
Reference interval
urine osmolality: 50~1200mOsm/kg H2O, average 800 mOsm/kg H2O
plasma osmolality: 275~305 mOsm/kg H2O
Uosm/Posm: 3~4.5 : 1
Clinical signifance: distal nephron dysfunction
null*prepared by xuejingwangOsmotic clearance test: how much solute in plasma can be eliminated in a given time.
Cosm=Uosm/Posm*V
Solute-free water clearance test: how much water un-wanted in plasma can be eliminated in a given time.
CH20=V-CosmDiagnostic tests for renal tubule acidosis
(self-study)*prepared by xuejingwangDiagnostic tests for renal tubule acidosis
(self-study)Typing of tubule acidosis
Urinary acidification function test
Ammonium chloride loading test(acid loading test)
Bicarbonate absorption and secretion test(base loading test)Assessment and monitoring for early renal injury*prepared by xuejingwangAssessment and monitoring for early renal injuryUrinary marker for early injuries*prepared by xuejingwangUrinary marker for early injuriesGlomerular markers*prepared by xuejingwangGlomerular markersFunctional markers(commonly used)
Structural markers(in research)Microalbumin
微量白蛋白*prepared by xuejingwangMicroalbumin
微量白蛋白MW67000 dalton, negtive charge
Cannot be filterred too much normally
Elevated in early glomerular damage
Reference interval:<30mg/24h etc.
Clinical significance
early glomarular damage caused by various diseases, such as DM, hypertension,pregnancyTransferrin
转铁蛋白*prepared by xuejingwangTransferrin
转铁蛋白MW76500 dalton
Negtive charge
Cannot be filterred by glomerular normally
Referance interval:<2 mg/L
Clinical significance: same as that of albuminStructural markers*prepared by xuejingwangStructural markersType 4 collagen
Phosphate heparin
Sialytic acidTubular markers*prepared by xuejingwangTubular markersFunctional markers
Structural markersa1-microglobulin
a1微球蛋白*prepared by xuejingwanga1-microglobulin
a1微球蛋白MW30000 dalton
Freely pass through glomerulus
Completely reabsorbed by proximal tubule
Reference interval: <12.5 mg/L
Clinical significance:
NAG
N-乙酰-B-D-氨基葡萄糖苷酶*prepared by xuejingwangNAG
N-乙酰-B-D-氨基葡萄糖苷酶MW140000 dalton
Abundant in proximal tubule cell
Lysosomal enzyme 溶酶体酶
Easily attacked and released by various factors( biological and chemical toxic, immunol factors, etc)
Reference interval:
Clinical significance:
Other markers*prepared by xuejingwangOther markersFunctional markers
Retinol binding protein 视黄醇结合蛋白
Protein 1
Structural markers
AAP: 丙氨酸氨基肽酶 MW280000 dalton, brush border enzyme 刷状缘酶
r-GT: r谷氨酰转肽酶 brush border enzyme刷状缘酶
B-Glu: B-葡萄糖苷酸酶 lysosomal enzymeOther laboratory investigation*prepared by xuejingwangOther laboratory investigationImmunological examination: ANCA, GBM
Gene diagnosis: ADPKDSelection of renal functional tests*prepared by xuejingwangSelection of renal functional testsRoutine urinalysis( protein, glucose, RBC,WBC,pH etc.)
Glomerular function tests: Ccr, Cr, Urea,UA,cystatin-C
Tubular function tests: osmolality, urine protein analysis(quantitation and qualification)
Tubular acidosis: blood-gas and acid-base analysis
Early renal injury: combined analysis( albumin and transferrin + NAG and a1-microglobulin)
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