Urine

Volume: Usually less than 100 mL/24 hr (anuric phase) or 400 mL/24
hr (oliguric phase), which occurs within 2448 hr after renal insult.
Nonoliguric (more than 400 mL/24 hr) renal failure also occurs when
renal damage is associated with nephrotoxic agents (e.g., contrast
media or antibiotics).
Color: Dirty, brown sediment indicates presence of RBCs, hemoglobin,
myoglobin, porphyrins.
Specific gravity: Less than 1.020 reflects kidney disease, e.g.,
glomerulonephritis, pyelonephritis with loss of ability to concentrate;
fixed at 1.010 reflects severe renal damage.
pH: Greater than 7 found in urinary tract infections (UTIs), renal
tubular necrosis, and chronic renal failure (CRF).
Osmolality: Less than 350 mOsm/kg is indicative of tubular damage,
and urine/serum ratio is often 1:1.
Creatinine (Cr) clearance: Renal function may be significantly
decreased before blood urea nitrogen (BUN) and serum Cr show
significant elevation.
Sodium: Usually increased if ATN is cause for ARF, more than 40
mEq/L if kidney is not able to resorb sodium, although it may be
decreased in other causes of prerenal failure.
Fractional sodium (FeNa): Ratio of sodium excreted to
total sodium filtered by the kidneys reveals inability of tubules to
reabsorb sodium. Readings of less than 1% indicate prerenal problems,
higher than 1% reflects intrarenal disorders.
Bicarbonate: Elevated if metabolic acidosis is present.
Red blood cells (RBCs): May be present because of infection, stones,
trauma, tumor, or altered glomerular filtration (GF).
Protein: High-grade proteinuria (34+) strongly indicates glomerular
damage when RBCs and casts are also present. Low-grade proteinuria
(12+) and white blood cells(WBCs) may be indicative of infection or
interstitial nephritis. In ATN, proteinuria is usually minimal.
 Casts: Usually signal renal disease or infection. Cellular casts with
brownish pigments and numerous renal tubular epithelial cells are
diagnostic of ATN. Red casts suggest acute glomerular nephritis.

Blood

BUN/Cr: Elevated and usually rise in proportion with ratio of 10:1 or

higher.
Complete blood count (CBC): Hemoglobin (Hb) decreased in
presence of anemia. RBCs often decreased because of increased
fragility/decreased survival.
Arterial blood gases (ABGs): Metabolic acidosis (pH less than 7.2)
may develop because of decreased renal ability to excrete hydrogen
and end products of metabolism. Bicarbonate decreased.
Sodium: Usually increased, but may vary.
Potassium: Elevated related to retention and cellular shifts (acidosis)
or tissue release (red cell hemolysis).
Chloride, phosphorus, and magnesium: Usually elevated.
Calcium: Decreased.
Serum osmolality: More than 285 mOsm/kg; often equal to urine.
Protein: Decreased serum level may reflect protein loss via urine, fluid
shifts, decreased intake, or decreased synthesis because of lack of
essential amino acids.
Radionuclide imaging: May reveal calicectasis, hydronephrosis,
narrowing, and delayed filling or emptying as a cause of ARF.
Kidney, ureter, bladder (KUB) x-ray: Demonstrates size of
kidneys/ureters/bladder, presence of cysts, tumors, ad kidney
displacement or obstruction (stones).
Retrograde pyelogram: Outlines abnormalities of renal pelvis
and ureters.
Renal arteriogram: Assesses renal circulation and identifies
extravascularities, masses.
 Voiding cystoureterogram: Shows bladder size, reflux into ureters,
retention.
Renal ultrasound: Determines kidney size and presence of masses,
cysts, obstruction in upper urinary tract.
Nonnuclear computed tomography (CT) scan: Cross-sectional
view of kidney and urinary tract detects presence/extent of disease.
Magnetic resonance imaging (MRI): Provides information about
soft tissue damage.
Excretory urography (intravenous urogram or
pyelogram): Radiopaque contrast concentrates in urine and facilitates
visualization of KUB.
Endourology: Direct visualization may be done
of urethra, bladder, ureters, and kidney to diagnose problems, biopsy,
and remove small lesions and/or calculi.
Electrocardiogram (ECG): May be abnormal, reflecting electrolyte
and acid-base imbalances.

Urine tests

Urinalysis: Analysis of the urine affords enormous insight into the

function of the kidneys.
Twentyfourhour urine tests: This test requires you to collect all
of your urine for 24 consecutive hours. The urine may be analyzed for
protein and waste products (urea nitrogen and creatinine). The
presence of protein in the urine indicates kidney damage. The amount
of creatinine and urea excreted in the urine can be used to calculate
the level of kidney function and the glomerular filtration rate (GFR).
Glomerular filtration rate (GFR): The GFR is a standard means of
expressing overall kidney function. As kidney disease progresses, GFR
falls. The normal GFR is about 100140 mL/min in men and 85115
mL/min in women. It decreases in most people with age. The GFR may
be calculated from the amount of waste products in the 24hour urine
 or by using special markers administered intravenously. Patients are
divided into five stages of chronic kidney disease based on their GFR.
Urine Specific Gravity: This is a measure of how concentrated a
urine sample is. A concentrated urine sample would have a specific
gravity over 1.030 or 1.040

Blood tests

Creatinine and urea (BUN) in the blood: Blood urea nitrogen and
serum creatinine are the most commonly used blood tests to screen
for, and monitor renal disease.
o Creatinine is a breakdown product of
normal muscle breakdown.
o Urea is the waste product of breakdown of protein.
o The level of these substances rises in the blood as kidney
function worsens.
Electrolyte levels and acidbase balance: Kidney dysfunction
causes imbalances in electrolytes, especially potassium, phosphorus,
and calcium.
o High potassium (hyperkalemia) is a particular concern.
o The acidbase balance of the blood is usually disrupted as
well.
Decreased production of the active form of vitamin D can cause
low levels of calcium in the blood. Inability to excrete phosphorus by
failing kidneys causes its levels in the blood to rise.
Blood cell counts: Because kidney disease disrupts blood cell
production and shortens the survival of red cells, the red blood cell
count and hemoglobin may be low (anemia). Some patients may also
have iron deficiency due to blood loss in their gastrointestinal system.
Other nutritional deficiencies may also impair the production of red
cells.

Other tests
 Ultrasound: Ultrasound is often used in the diagnosis of kidney
disease. An ultrasound is a noninvasive type of test.
o In general, kidneys are shrunken in size in chronic kidney
disease, although they may be normal or even large in size in
cases caused by adult polycystic kidney disease, diabetic
nephropathy, and amyloidosis.
Biopsy: A sample of the kidney tissue (biopsy) is sometimes required
in cases in which the cause of the kidney disease is unclear. Usually,
a biopsy can be collected with local anesthesia only by introducing a
needle through the skin into the kidney.