Renal Functions In Children
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The document discusses various tests used to evaluate renal function, including tests of glomerular filtration rate (GFR) and clearance tests. It describes how the kidney regulates water, electrolytes, and acid-base balance and produces hormones. Laboratory tests discussed include measures of creatinine, urea, urine output, protein, and osmolality. Causes of impaired kidney function are categorized as pre-renal, renal, or post-renal.
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Renal Functions In Children
- 1. Renal function- basic data for students and residents Department of Paediatrics Section for Pediatric Nephrology University Hospital Motol, Prague
- 16. Creatinine and Urea Plasma Concentration- hyperbolic correlation GFR 50% pCr, pUrea 140 mL/min (100%) 0 mL/min (0%) Tendency in individual patients is more important than the one value, ever test if the hydration is OK. In patients with CRI always note also the BSA! Lower limit today not 80 ml/Min. /1.73 m 2 but 90 ml/Min./1.73 m 2 Normal range->
- 18. Urea cycle CO2 NH3 aspartate Urea 3 ATP Urea Cycle
- 19. Enzymatic conductivity rate method for measuring urea Urease solution Urea + 3H2O HCO3¯ + 2NH4 + OH¯ urease
- 22. Plasma creatinine vs. GFR not linear, hyperbolic correlation! GFR [pCreat] 140 mL/min (100%) 0 mL/min (0%) Change within an individual patient is usually more important than the absolute value
- 23. Jaffe´ reaction for measuring creatinine, simple, but better is enzymatic method Creatinine + alkaline picrate solution Bright orange/red colored complex absorbs light at 485nm (many interfering substances in blood Can be minimized using rate method )
Notas del editor
- The kidneys excrete the end products of metabolism, urea from amino acid breakdown, uric acid from purine (nucleic acids) metabolism and creatinine from the catabolism of creatine an amino acid found in muscle. Homeostatic functions include the maintenance of water balance by regulating urine volume, acid base balance by altering hydrogen ion excretion, sodium balance by altering the rate of sodium reabsorption. Endocrine functions include the secretion of renin from the JGA which influences aldosterone. Erythropoietin effects the rate of red cell production and 1,25-dihydroxycholecalciferol is the active form of vitamin D, effecting calcium homeostasis. Patients with chronic renal disease and impaired renal functions will show defects in endocrine and excretory functions before the loss of homeostatic control. When the homeostatic functions cease then the patient is in renal failure and would die if there were no interventions.
- From a clinical perspective it is important to have test which would have these characteristics. No such test exists. An early test to detect renal damage, for instance a simple strip test for haematuria is important in screening for heavy metal poisoning. There is a clinical need to monitor a patient with renal disease and this is achieved by serial plasma measurements. We need to know when to start dialysis in renal failure and laboratory tests assist the clinical decision making. There are about a million nephrons in each kidney and this represents a considerable functional reserve. In renal disease about half the nephrons have to lose their functioning before the abnormality can be detected by conventional laboratory tests.
- I shall review the tests in the left column today. The measurement of urine protein is important in certain conditions, e.g.diabetes. The detection of substances such as red cells or glucose could be an early indicator of renal damage.
- Oliguria is a significant finding in a patient. An example is provided by Case 3 in the Chem Path tutorials. The traditional classification of causes is into prerenal, renal and postrenal. Usually the cause of the oliguria is obvious and can be appropriately managed.
- I shall review the tests in the left column today. The measurement of urine protein is important in certain conditions, e.g.diabetes. The detection of substances such as red cells or glucose could be an early indicator of renal damage.
- Urine volume depends on how much you drink and sweat. In health it is closely matched to water balance by the hormone ADH or vasopressin, AVP. We define abnormally low urine volume as a 24 hour volume less than 400 mL. This is known as oliguria. A patient is considered anuric when there is no or little urine, less than 100 mL/24 h. There is no absolute definition for polyuria as some people can drink an awful lot and match it with a high urine output. If a patient has a urine volume greater than 3 litres per day and is not drinking then this is polyuria.
- I shall review the tests in the left column today. The measurement of urine protein is important in certain conditions, e.g.diabetes. The detection of substances such as red cells or glucose could be an early indicator of renal damage.
- Urea is easily measured. It has a wide reference range and the value increases after a meal. Its concentration is increased in many different conditions which makes it sensitive to the presence of disease but a non-specific test.
- Urea is easily measured. It has a wide reference range and the value increases after a meal. Its concentration is increased in many different conditions which makes it sensitive to the presence of disease but a non-specific test.
- In health only about 60% of filtered urea is excreted the rest is reabsorbed passively by the renal tubules. The rate of urea reabsorption is variable and depends on the rate of tubular flow. More urea is reabsorbed if the flow rate is slow as there is more time for urea to diffuse into the peritubular capillaries. Flow rate is slow when there is a decrease in RBF, following myocardial infarction for example. More urea is reabsorbed and plasma urea increases. Many conditions result in renal hypoperfusion including fluid loss, circulatory insufficiency, renal artery stenosis
- From a clinical perspective it is important to have test which would have these characteristics. No such test exists. An early test to detect renal damage, for instance a simple strip test for haematuria is important in screening for heavy metal poisoning. There is a clinical need to monitor a patient with renal disease and this is achieved by serial plasma measurements. We need to know when to start dialysis in renal failure and laboratory tests assist the clinical decision making. There are about a million nephrons in each kidney and this represents a considerable functional reserve. In renal disease about half the nephrons have to lose their functioning before the abnormality can be detected by conventional laboratory tests.
- In most circumstances the measurement of plasma creatinine can provide a specific test of glomerular function. The reference range is wide. A body builder may have a plasma creatinine at the top end and an old lady a value at the low end and this reflects muscle mass. Plasma creatinine should not be measured until 8 hours after a meal as there is some evidence that the concentration increases after meat ingestion. Plasma creatinine concentration increases when GFR falls. The problem is that GFR has to fall quite a bit before plasma creatinine concentration reliably increases. There are some important analytical interferences which you should check with the laboratory. A patient with ketoacidosis, jaundice or infection might have agents in the plasma which could invalidate the measurement of creatinine. Overhead 1 follows
- GFR is not often measured in clinical practice. It requires a patient to come to hospital. Currently people who are considering donating a kidney whilst they are alive have their GFR measured. Before administering a drug with potentially toxic effects some patients will require a GFR measurement before the chemotherapy. This enables the oncologist to calculate the exact dose of drug after estimating its elimination rate. GFR used to be measured by calculating the clearance of inulin. Nowadays radioactive substances are used, either technetium labelled diethylenediaminetetra acetic acid DTPA or 51-chromium labelled EDTA ethylenediaminetetra acetic acid.