Renal Function Tests

Kidney Function Tests
(Renal Function Tests)
Renal Function Tests:

Renal function tests include: Blood urea, Serum
creatinine and Creatinine clearance.
The non-protein nitrogenous compounds include

urea, creatinine, creatine and uric acid.
Urea, creatinine and uric acid are the end products

of metabolism.
They are waste products that should be eliminated
from the body.
The kidney is the main route of elimination of most
of these waste products.
Many diseases affect renal function. With
progressive renal insufficiency, there is retention
of urea, creatinine and uric acid in the blood.
General chemical tests such as blood levels of

urea, creatinine and uric acid are mainly of value
in detecting presence of these diseases.
Functions of kidney:
1. Excretion of waste products (such as urea, creatinine,
and uric acid), drugs & toxins.
2. Maintaining water balance in the body.
3. Excretion of sodium (effect on BP).
4. Excretion of potassium (effect on heart).
5. Excretion of hydrogen ions (maintenance of blood pH).
6. Activation of vitamin D (effect on bone).

7. Production of a hormone called erythropoietin which
stimulates erythropoiesis (effect on RBCs).
8. Filtration: 180 liters/day of water with sodium,
chloride, sugar and amino acids.
9. Reabsorption: 178.5 liters are reabsorbed; nearly all
glucose and amino acids are reabsorbed; most of sodium
and chloride is reabsorbed.
ESTIMATION OF BLOOD UREA

Urea is the main waste product of protein
breakdown. It is formed in liver by the reactions of
Krebs urea cycle. Amino acids are deaminated
(nitrogenous amine group is removed), releasing
ammonia. The ammonia, which is toxic to the body,
is detoxified by combining with carbon dioxide to
form urea which passes into the circulation and is
excreted by the kidneys.
Not all the urea that is filtered by the glomeruli is

excreted in the urine. Depending on a person’s state
of hydration, 40–70% of the urea is passively
reabsorbed with water and returned to the blood.
The rate of reabsorption is inversely related to the

rate of urine flow. When the rate of urine flow is
low, more urea is absorbed.
As a kidney function test, the measurement of

urea is less useful than creatinine. because:
A number of extra renal factors influence the
circulating urea concentration, like
• state of hydration and
• dietary intake,
• increased protein catabolism (Cushing syndrome,
diabetes mellitus, starvation, thyrotoxicosis ),
• reabsorption of blood proteins after gastrointestinal
hemorrhage.
Blood Urea:
Clinical Significance:
Urea is the end product of protein metabolism.
Hepatic enzymes convert ammonia from amino acids
to urea. More than 90 % of urea is excreted through
the kidneys in the urine.
Decrease urea level:

Low-protein diet, malnutrition or starvation.
Chronic liver disease.
Overhydration, or drinking a lot of water.
Pregnancy (due to increased plasma volume).
Elevated urea
Blood urea may increase (uremia) in:
• Diet with excess of proteins.

• Renal disease (e.g. acute or chronic renal failure).
• Heart failure
• Gastrointestinal hemorrhage
• Dehydration
• Renal obstruction
blood urea nitrogen (BUN)
• The blood urea nitrogen (BUN) test is a measure
of the amount of nitrogen in the blood in the form
of urea.
BUN ≈ 50% urea
Note: Blood urea ≈ BUN x 2.14
Laboratory measurement of urea

Specimen Collection:
- Serum or plasma
-non fasting specimen is acceptable.
Principle of the test:
Enzymatic colorimetric method based on the specific
action of urease which hydrolyzes urea in the
sample into ammonium ions and carbon dioxide.
Then ammonium ions react with salicylate and
Sodium hypochlorite (NaClO), in the presence of the
catalyst nitroprussiate, to form a green complex
“indophenol”:
Urease
Urea + H₂O (NH₄)² +CO₂
Nitroprussiate
NH₄ +Salicylate +NaClO Indophenol
The intensity of color of the final product is directly
proportional to the urea concentration in the
specimen. Is measured at 600 nm
Reagents:
 R1:
• Salicylate
• Nitroprussiate
 R2:
• Urease
 R3:
• Na-hydrochlorate
• NaOH
 R4:
• Standard urea (40mg/dl)
Manual procedure:
Pipette into test
Blank Standard Test
tubes
Working reagent
1ml 1ml 1ml
(R1+R2)
Demineralised
10µl
water
Standard 10 µl
Specimen 10 µl
Mix well then wait for 4 minutes at room temperature or 2
minutes at 37˚c, then add:
Base diluted (R3)
1 ml 1 ml 1 ml
¼
Mix. Let stand for 8 minutes at room temperature.
Read absorbance at 600 nm against reagent blank.
Calculation:
A Test - A Blank
Urea concentration = × Urea Standard concentration
A Standard - A Blank
(specimen)
A = Absorbance, measured by spectrophotometer.

Urea standard concentration = 40 mg/dl.
Expected values:
in normal adult persons (male & female):

- Blood urea: 13 – 43 mg/dl.
- Blood urea nitrogen (BUN) = 6 - 24 mg/dl
Note: Blood urea ≈ BUN x 2.14

Renal Function Tests

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Kidney Function Tests

(Renal Function Tests)

Renal Function Tests:

The non-protein nitrogenous compounds include

Urea, creatinine and uric acid are the end products

General chemical tests such as blood levels of

2. Maintaining water balance in the body.

3. Excretion of sodium (effect on BP).

4. Excretion of potassium (effect on heart).

5. Excretion of hydrogen ions (maintenance of blood pH).

6. Activation of vitamin D (effect on bone).

ESTIMATION OF BLOOD UREA

Not all the urea that is filtered by the glomeruli is

The rate of reabsorption is inversely related to the

As a kidney function test, the measurement of

Decrease urea level:

Blood urea may increase (uremia) in:

• Diet with excess of proteins.

BUN ≈ 50% urea

Note: Blood urea ≈ BUN x 2.14

Laboratory measurement of urea

A = Absorbance, measured by spectrophotometer.

in normal adult persons (male & female):

Note: Blood urea ≈ BUN x 2.14

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