Renal Function Tests

Measurement of Serum Urea and Urea Clearance

The kidneys, the bodys natural filtration system, perform many vital
functions, including removing metabolic waste products from the bloodstream,
regulating the bodys water balance, and maintaining the pH (acidity/ alkalinity)
of the bodys fluids. Kidney function tests help to determine if the kidneys are
performing their takes adequately. Kidney function tests is a number of clinical
laboratory tests that measure the levels of substances normally regulated by
the kidneys can help determine the case and extent of kidney dysfunction.
These tests are done urine samples, as well as on blood samples.
There are several blood tests that can aid in evaluating kidney
function. These include: urea and creatinine. and Other blood tests
measurement of the blood levels of other elements regulated in the
part by the kidneys can also be useful in evaluating kidney function.
These include sodium, potassium, chloride, bicarbonate, calcium,
magnesium, phosphorous, protein, uric acid, and glucose.
Blood urea nitrogen test (BUN):
Urea is a byproduct of protein metabolism. Formed in the liver, this waste product
is then filtered from the blood and exerted in the urine by the kidneys. The BUN
test measures the amount of nitrogen contained in the urea. High BUN levels can
indicate kidney dysfunction, but because BUN is also affected by protein intake and
liver function, the test is usually done together with a blood creatinine a more
specific indicator of kidney function.
High BUN value can mean:
1.Kidney disease.
2.Blockage of the urinary tract (by a kidney stone or tumor).
3.Low blood flow to the kidneys caused by dehydration or heart failure.
4.Many drugs may cause a high BUN.
5.A high BUN value be caused by a high protein diet, tissue damage (such as from
severe burns), or from bleeding in the gastrointestinal tract.
Low BUN value can mean:
1.A diet very low in protein, malnutrition, or severe liver damage.

2.Women and children may have lower BUN levels than men because of how their
bodies break down protein.
Urea and Urea Clearance Test:
Urea: Is the waste product of the degradation of amino acids into CO 2 and
ammonium. Urea is synthesized in the liver and transported through blood to the
kidney, where it is filtered through glomerulus. Almost half of urea is reabsorbed
back into the blood by passive transport in the nephron tubule.
Azotemia may indicate renal disease or a non- renal that causes a secondary
increase of blood urea as a consequence of disease.
Principle:
Enzymatic determination of urea according to the following reaction:
Urease

Urea + H2O

2NH4 + CO2

Nitroprusside

NH3 + Salicylate

Hypochlorite

2,2-Dicarboxy Indophenol

Urea Clearance:
Refer to the relationship between the renal excretory mechanisms and the
circulating blood levels of the materials to be excreted. For the purpose of
clearance test, substances that pass through the glomerulus and are not altered by
the renal tubules are analyzed. The assumption is that all of the substance is
cleared from the plasma via the glomerulus and is excreted unchanged into the
urine. Substances that may measure in clearance test include inulin, urea, Para
amino hippuric acid(PAH), and creatinine. Blood urea levels are affected by a
variety of factors, and therefore, it is out the ideal substance for renal clearance
tests. Blood urea levels may be elevated if shock, trauma, sepsis, or tumors cause
increased protein metabolism.
Calculation:
The average urea clearance over a 24 hrs period can be measured by
collected a 24 hrs and taking a blood sample during this time.
The urea clearance is obtained from the plasma (P) and urine (U) urea
concentration after calculating (V) from the 24 hrs urine volume (ml) divided
by 1440, the number of minutes in a day.
Urea clearance= UV/P

Where:
U = Amount of urea in urine
V = Volume of urine excreted per 24 hours
P = Plasma urea level
Normal value:
Serum: 10 - 55 mg/dl
Urine: 20 35 mg/24 hrs
BUN: 7- 20 mg/dl
Clinical Significance:
Hyperuremia: (high level urea)
1.
2.
3.
4.

Dehydration.
Vomiting.
Diarrhea.
Kind of renal disorder like glomerular nephritis, chronic nephritis and
nephritis syndrome.

Hypouremia: (low level urea)

1. Liver failure.
2. Pregnancy.

Measurement of Serum Creatinine and Creatinine Clearance

Creatinine:
This test measures blood levels of creatinine. Is produced as a waste
product of creatine and phosphocreatine. Is filtered from the blood by the
kidneys and excreted into the urine. Production of creatinine depends on an
individuals muscle mass, which usually fluctuates very little. With normal
kidney function, then, the amount of creatinine in the blood remains
relatively constant and normal. For this reason, and because creatinine is
3

affected very little by liver function, an elevated blood creatinine is a more

sensitive indication of impaired kidney function than the blood urea.

Principle of Creatinine:
In the Jaffa reaction, creatinine reacts with picric acid in an alkaline
environment to generate an orange-red product from creatinine picrate. The
methodology is dependent upon picric acid concentration, alkaline pH, reaction
temperature, reaction time, and wave length at which the product is measured.
Normal value of creatinine:
Male : 0.7-1.4 (mg/dl).
Female : 0.6-1.2 (mg/dl).
Urine : 0.8-1.8 (g/24 hrs).

Creatinine Clearance:
In general, creatinine clearance is removal of creatinine from the body. More
accurately creatinine clearance is volume of blood plasma, that is cleared of
creatinine per unit time. Clinically, creatinine clearance is a useful measure for
estimating the Glomerular Filtration Rate (GFR) of the kidney. The result of this test
is an important parameter used in assessing excretory function of the kidneys.
Measuring serum creatinine is a simple test and it is the most commonly
used indicator of renal function. A rise in blood creatinine levels is observed
only with marked damage to functioning nephrons. Therefore this test is not
suitable for detecting early stage kidney disease.
A better estimation of kidney function is given by creatinine clearance test.
creatinine clearance can be accurately calculated using serum creatinine
concentration and some or all of the following variables: sex, age, and
weight without a 24 hour urine collection.
A commonly used marker for actual creatinine clearance is the CockroftGault formula, which employs creatinine measurements and a patients
weight to predict the clearance. The formula, as originally published, is:
(140- age) *Weight (kg) * 0.85(if female)
X=

72 * serum creatinine (mg/dl)

(140- age) *Weight (kg)

X=
72 *serum creatinine (mg/dl)

(140- age) *Weight (kg) * Constant

X=
creatinine (mol/l)
The Constant is 1.23 for men and 1.04 for women.

Normal value of creatinine clearance:

90-140 ml/min

(male)

80-130 ml/min

(female)

Clinical signification:
Increase creatinine clearance in:
1. Pregnancy.
2. Exercise.
Decrease creatinine clearance in:
1.
2.
3.
4.
5.

Renal insufficiency.
Advanced age.
Inadequate urine specimens.
Medication.
Antibiotic.

Calculation creatinine clearance:

creatinine clearance = UV/P

where:
U= urinary creatinine excreted in 24 hours (mg/dl).
V= urine volume (mg/ml).
P= plasma concentration of creatinine (mg/dl).