Renal Function Test (RFT)
Introduction
Renal function tests (RFT) are a group of tests that may be performed
together to evaluate kidney (renal) function. The tests measure levels of
various substances, including several minerals, electrolytes, proteins, and
glucose (sugar), in the blood to determine the current health of the
kidneys.
If the kidneys are not functioning properly, waste products can accumulate
in the blood and fluid levels can increase to dangerous volumes, causing
damage to the body or a potentially life-threatening situation. Numerous
conditions and diseases can result in damage to the kidneys. The most
common causes of and main risk factors for kidney disease
are diabetes and hypertension.
Learning Objective
The learning objective of a renal function test is to assess the overall health
and function of the kidneys by measuring levels of various substances in
the blood and urine, allowing for early detection and monitoring of kidney
diseases, including the ability to identify potential issues with waste
removal, fluid balance, and electrolyte regulation within the
body; essentially, to determine how well the kidneys are filtering waste
products from the blood.
Brief Literature Review
• Cockcroft & Gault (1976): Developed a formula to estimate creatinine
clearance, improving early detection of renal impairment.
• Levey et al. (1999): Introduced the MDRD equation for estimating
GFR, later refined into the CKD-EPI equation (2009) for better
accuracy.
• National Kidney Foundation (2002): Standardized chronic kidney
disease (CKD) staging using eGFR, influencing global nephrology
practices.
• Waikar & Bonventre (2008): Highlighted biomarkers like cystatin C
and NGAL as potential early indicators of kidney injury.
• Recent Advances: Studies explore novel biomarkers (e.g., KIM-1, L-
FABP) for early AKI detection and AI-based models for predicting
renal dysfunction.
Observations
Key observations from a renal function test:
• Elevated creatinine levels: Indicates reduced kidney function as
creatinine is a waste product normally filtered by the kidneys.
• High blood urea nitrogen (BUN): Also suggests impaired kidney
function, as urea is another waste product the kidneys filter.
• Low eGFR: A decreased estimated glomerular filtration rate
signifies poor kidney function.
• Abnormal urine protein levels: Presence of excessive protein in
the urine (proteinuria) can indicate kidney damage.
• Abnormal urine specific gravity: Can indicate issues with the
kidneys' ability to concentrate urine.
• Presence of blood or red blood cells in urine: May suggest
kidney stones, infection, or other problems.
Important considerations when interpreting renal function test results:
• Patient history: Factors like age, muscle mass, and medication use
can influence test results.
• Clinical context: The interpretation of test results should be
considered alongside the patient's symptoms and other medical
conditions.
• Repeat testing: Serial testing may be necessary to monitor kidney
function over time.
Indication
Indications for the assessment of renal function are varied and range from
acute emergency to chronic settings.
1. Primarily, renal function tests are performed to identify the renal
disease to determine appropriate patient management and prevent
further deterioration of renal function.
2. Further indications in patients in whom the renal disease has been
identified are to stage level or type of renal disease and to monitor the
progression of renal disease to ensure that optimal management
occurs and to monitor response to interventions[4].
Components of RFT
Clinically, the most practical tests to assess renal function is to get an
estimate of the glomerular filtration rate (GFR) and to check for
proteinuria (albuminuria).[4]
Glomerular Function- Clearance test
Within the kidneys are about a million tiny blood filtering units called
nephrons. In each nephron, blood is continually filtered through a cluster
of looping blood vessels, called a glomerulus, which allows the passage of
water and small molecules but retains blood cells, proteins such as
albumin, and larger molecules.
The best test to assess glomerular function is Glomerular filtration rate
(GFR), which is the rate in milliliters per minute at which substances in
plasma are filtered through the glomerulus; in other words, the clearance
of a substance from the blood. The normal GFR for an adult male is 90 to
120 mL per minute.
Testing for GFR can be a complicated and lengthy procedure, which is why
doctors use a formula to estimate GFR or eGFR. The standard way to
estimate GFR is with a simple blood test that measures creatinine levels.
Creatinine is a waste product from the digestion of dietary protein and the
normal breakdown of muscle tissue. Aside from chronic kidney disease,
creatinine levels can be affected by other factors, including diet, muscle
mass, malnutrition, and other chronic illnesses.
According to the Kidney Disease Improving Global Outcomes (KDIGO),
The stages of chronic kidney disease (CKD):
Stage 1 GFR greater than 90 ml/min/1.73 m²
Stage 2 GFR-between 60 to 89 ml/min/1.73 m²
Stage 3a GFR 45 to 59 ml/min/1.73 m²
Stage 3b GFR 30 to 44 ml/min/1.73 m²
Stage 4 GFR of 15 to 29 ml/min/1.73 m²
Stage 5-GFR less than 15 ml/min/1.73 m² (end-stage renal disease)
Albuminuria
Albuminuria refers to the abnormal presence of albumin in the urine
Albuminuria is used as a marker for the detection of incipient
nephropathy in diabetics.
It is an independent marker for the cardiovascular disease since it
connotes increased endothelial permeability, and it is also a marker
for chronic renal impairment.
Urine albumin may be measured in 24-hour urine collections or early
morning/random specimens as an albumin/creatinine ratio. The presence
of albuminuria on two occasions with the exclusion of a urinary tract
infection indicates glomerular dysfunction. The presence of albuminuria
for three or more months is indicative of chronic kidney disease.
Typical Tests
The individual tests included in a kidney function panel can vary by
laboratory, but the tests typically performed include:
1. Electrolytes – electrically charged chemicals that are vital to normal
body processes, such as nerve and muscle function; among other
things, they help regulate the amount of fluid in the body and
maintain the acid-base balance. Electrolytes include:
Sodium
Potassium
Chloride
Bicarbonate (Total CO2)
2. Minerals
Phosphorus – a mineral that is vital for energy production, muscle and
nerve function, and bone growth; it also plays an important role as a
buffer, helping to maintain the body's acid-base balance.
Calcium – one of the most important minerals in the body; it essential
for the proper functioning of muscles, nerves, and the heart and is
required in blood clotting and in the formation of bones.
3. Protein
Albumin – a protein that makes up about 60% of protein in the blood
and has many roles such as keeping fluid from leaking out of blood
vessels and transporting hormones, vitamins, drugs, and ions like
calcium throughout the body.
4. Waste products
Urea – urea is a nitrogen-containing waste product that forms from
the metabolism of protein; it is released by the liver into the blood and
is carried to the kidneys, where it is filtered out of the blood and
eliminated in the urine.
Creatinine – another waste product that is produced by the body's
muscles; almost all creatinine is eliminated by the kidneys.
5. Energy Source
Glucose – supplies energy for the body; a steady amount must be
available for use, and a relatively constant level of glucose must be
maintained in the blood.
Clinical Significance
Creatinine: Serum creatinine is elevated when there is a significant
reduction in the glomerular filtration rate or when urine elimination is
obstructed. About 50% of kidney function must be lost before a rise
in serum creatinine can be detected. Thus serum creatinine is a late
marker of acute kidney injury.
BUN : Serum urea/BUN level increases in acute and chronic renal
disease.
eGFR equations are used to determine the presence of renal disease,
stage of CKD, and to monitor response to treatment.
Conclusion
What the test does
• Measures or estimates the glomerular filtration rate (GFR)
• Determines if kidney disease is acute or chronic
• Checks urine albumin levels to detect nephropathy
• Checks urine amino acids, glucose, phosphate, and pH to detect tubular
function disorders
What the results mean
• A GFR of less than 60 could indicate kidney disease
• A urine albumin-to-creatinine ratio (UACR) of more than 30 milligrams
per gram could be a warning sign of kidney disease
• Increased sodium levels could indicate kidney disease
• Increased blood urea nitrogen (BUN) levels could indicate renal
impairment or failure
References
• Lamb EJ, Jones GRD. Kidney function tests
• Oh MS, Briefel G, Pincus MR. Evaluation of renal function, water,
electrolytes, and acid-base balance
• Pincus MR, Abraham NZ, Bluth M. Interpreting laboratory results
