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Block 3.3Faculty of MedicineUniversity of Gadjah Mada
RENAL FUNCTION TESTS:samples,urinalysis, other
dr. Harjo Mulyono SpPK-KClinical Pathology Dept
Ref:Ravel: Clinical Laboratory Medicine;Clinical Application of Laboratory
DataWalmsley: Cases in Clinical Pathology
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Laboratory examination of kidneya.purpose
laboratory examination
(of kindneys function)
screening diagnostic/prognostic monitoring
urinelysis urinelysis urinelysis
RFT RFTTDM
methodes of laboratory examinationanalytically, diagnostically
sensitivity,specificity
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Laboratory examinationb.sampling
Urinelysistyp e of samp le indic ate
1.randomized quality measured2.fasting urine DM (screening for DM)
3.2 hrs after meal DM (screening for DM)4.morning urine qualitative: hormonal
(pregnant:urine hCG)5.24 hrs urine quantity measured
(volume, electrolytes,urea, protein, creatinin,sugar, clearence, GFR)
6.midstream; catether,spp microbiology test
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Laboratory examinationc.urinelysis
Urinelysis
physical test chemist test microscopic test
dry chemistry wet chemistry
stick conventional test flowcytometry test
result (color) 1.centrifugation of10 ml urine volume 20L 2.centrifugation:fixed angel cells: rbc, wbc -
photometer 3.centrifugation epithels polimorphyc 4.kinds of Xtals bacterie
quantity 5.kinds of cells casts6.kinds of casts Xtal 7.quality,semiquantity quantity (L)
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Laboratory examinationurinelysis
dry chemistry-stick technique
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urinelysisdry chemistry test
stick technique
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Urinelysischemist exam, dry chemistry test
automatic technique
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urinelysistests and sample types:Laboratory exam:sample types:morning urine,urine randoma.Urinelysis: formation, excretion urine
diseases of: urinary tractnon urinary tract
test: physical:appearance: clear
color : pale yellowgravity : 1,010-1,020odor : specificvolume : 1 1,5 L/24 hrs
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urinelysischemist:reaction :acid (pH6-6,5)
protein (albumin) :nonglucose :non
ketones :nonbile :nonurobilinogen :normalurobilin :normal
nitrite :nonleucocyte esterase:normal (25uL)blood (Hb) :non
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Laboratory examinationd.renal function test
d1. glomerular functions test
Test for the glomerular function (GFR)1.clearence
conditional?kinds:PAH (para amino hipuric) Inulin
Diodrast ureacreatinin
parameters: urine: volume/minute,creatininblood: creatininbody surface: body weight, height
Formula: Cl c r=(CrU:CrB)X Urine vo l/m nt Xfactor (m L/mnt)
clearence standard (urin e vo l2m l/mn t)
alternative test:Cockroft-Gault:{(140-age) X BW} : (BCr X 72)
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Laboratory examinationrenal function test
d1. glomerular functions test
2.Cys tatin C : measured cystatin C in plasma*produce in all nucleus cell*protein MW
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Laboratory examinationd.renal function tes
d1.glomerular functions test
4.Microalbuminuria*protein does not free filtration, small proteindoes filtered in glomerular, reabsorption in prox
tub*normobumin:albumin in urine less (200 g/dl
*clinical identification: glomerular thicknesscardiac hypertentionnephropatia diabetica
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Laboratory examinationd.renal functions test
d2.others functions test d2.1.Test for tubular function
reabsorbsi&excretion: Fractional excretion of NaFe(Na)={U[Na]XP[creat]}:{P[Na]XU[creat]}X100%
d2.2.Dilution test:
ps give 1000ml water,fast in 30 minutes07 AM ps give 1000ml/30minutespt collected urine at 08.30;09.30;10.30;11.30 AMpositive result:total urine 1000 ml, one of sample SG 1,030
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case report:Wati, a woman 52 years old, has low back pain,dysurie
Urinelysis:physic: color:redish; SG:1,028; pH:6,4chemist:protein:pos; bile:neg urobilinogen:normal
glucose:neg; ketone:neg; nitrit:pos
blood:pos; leucocyte: posmicroscopic: leucocyte:10-12/VF; RBC:10-12/VFcrystal: Ca ox; bacterie:positive
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Ahmad, a man 45 years old, hypertension,Lab exam: fasting glucose: 160g/dl
2 hrs glucose:220 g/dldyslipidemia
What the next lab exam?
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matur nuwunkawigatosanipun