KIDNEY FUNCTION TESTS

INTRODUCTION

The main responsibility of the kidneys is the

regulation of the internal environment of the body.
 The kidneys accomplish this by:

1. Elimination of excess body water

2. Elimination of inorganic element

3. Elimination of nonvolatile end products of

metabolic activity
• Retention within the body of substances required
for the maintenance of normal functions (amino
acids, hormones, vitamins, plasma proteins,
glucose, etc.)
• Elimination of certain foreign toxic substances

• Formation and excretion of substances such as

hydrogen ions and ammonia.
… The most important functions of kidney are
Excretion of urine-1
Excretes the waste products of protein metabolism -2
Regulates fluid, electrolyte, and acid-base balance -3
The kidney also has a biosynthetic role, and is involved -4
in the production of renin, erythropoietin,
.prostaglandins, and vitamin D
kidney is able to perform gluconeogenesis under -5
conditions of starvation
 Cont’d

 Therefore, the kidneys play an important role in the regulation of

water balance, electrolyte balance, acid/base balance,
maintenance of osmotic pressures of body fluids and in the
removal of metabolic waste products and other toxic substances.

 The effectiveness of this regulation is directly related to renal

blood flow rate, glomerular filtration and renal tubular excretion
and reabsorption; therefore, renal function tests are directed
toward the measurement of these factors in order to determine
the nature of an impairment of renal function.
 Cont’d

Renal function tests in common use for clinical purposes

fall into the following categories:

1. Urine specific gravity and the ability of the

kidney to concentrate or dilute urine.
2. Estimations of nonprotein nitrogen levels in the
blood.
3. Dye excretion tests.
4. Renal clearance tests.
5. Miscellaneous blood chemistry tests.
 SPECIFIC RENAL FUNCTION TESTS:

Urine Concentration Tests

Water Deprivation

 The urine specific gravity primarily reflects the ability of

the renal tubules to respond to the activity of antidiuretic
hormone (ADH) to produce concentrated urine.

 If the tubules are nonfunctional, water will not be

reabsorbed and the specific gravity will remain low.
 Cont’d

The water deprivation test is indicated when

repeated random samples of urine have a
specific gravity of glomerular filtrate ranges
from 1.008 to 1.012.
Urine specific gravity within this range is
classified as isosthenuria.
Urine specific gravity less than this range is
referred to as hyposthenuria.
 Urine specific gravity greater than that of the
glomerular filtrate is classified as hyperosthenuria.

 A urine specific gravity of at least 1.025 to 1.030 in

horses and bovines, 1.030 to 1.035 in dogs, and
1.035 to 1.045 in cats suggests that the kidneys
likely have adequate capacity to concentrate the
urine
 Cont’d

Tests for Nonprotein Nitrogen Blood Levels

Determination of the nonprotein group of nitrogenous
substances, especially urea and creatinine, is important
because significantly increased values are usually the
result of accumulation of these substances in the blood
because of defective kidney elimination.
1. Blood Urea Nitrogen
 Urea is used as a serum biochemical marker of
nitrogenous waste retention by the kidneys.
 Urea represents the endpoint of protein catabolism.
During the process of protein catabolism, ammonium
is generated.
 Cont’d
 The major source of blood urea comes from
endogenous synthesis, primarily by the liver.
 A small portion of the urea that is filtered through the
glomerulus is reabsorbed by the kidney and may
reenter the general circulation
 Additionally, a small amount of urea is found in the gut
due to pancreatic secretions and movement of urea-
containing water into the gut.
 However, little of this urea is directly absorbed as urea.
 urea is produced as the end product of protein
metabolism, the blood urea nitrogen(BUN)
concentration is directly proportional to the rate of
protein catabolism. Therefore, diseases or physiologic
states that alter the rate of protein catabolism can
affect BUN.
 What is the fate of urea once it is presented to the glomerulus?

 Because of the filtration pressure at the

glomerulus, urea is passively moved across the
glomerular basement membrane during the
formation of the glomerular filtrate.

 The concentration of urea within the initial

glomerular filtrate passively equilibrates with
the concentration of urea in the blood.
• Therefore the blood urea concentration is equal
to that contained within the initial glomerular
filtrate.

• Diminished glomerular filtration causes high

BUN concentration.

• Urea may passively diffuse with water from the

tubular lumen back into the blood.
 Is BUN concentration affected by the rate
of renal tubular fluid flow?
• The rate of renal tubular fluid flow does affect
BUN.

• The movement of urea into and out of the filtrate

occurs by passive diffusion, which depends on the
fluid flow rate through the renal tubules.

• A more rapid flow rate through the tubules allows

less time for passive reabsorption of urea and
therefore more excretion of urea in the urine.
• Dehydrated patients have decreased renal tubular
fluid flow rates, which allow greater reabsorption of
urea and therefore less excretion of urea in the urine.

• At the highest flow rate, this reabsorption is

approximately 40%.

• If urine flow is decreased, more is reabsorbed (up to

60%) adding to the blood urea concentration.
• It is excreted almost entirely by the kidney.
 What is the fate of urea that is reabsorbed by the kidney?

 Reabsorbed urea enters the renal interstitium,

where it may remain as a component of the
medullary solute concentration gradient.

 A portion of the reabsorbed urea may also

reenter the general circulation and contribute to
the BUN concentration.
URINALYSIS
Urine formation overview

 The blood enters the glomerulus of each nephrons by

passing through the afferent arteriole into the
glomerular capillaries.
 The capillary walls in the glomerulus are highly
permeable to water and the low molecular-weight
components of the plasma.
 They filter through the capillary walls and the closely
adhering membrane of Bowman's Capsule into
Bowman's Space from where the plasma ultra filtrate
passes into the tubule where reabsorption of some
substances, secretion of others, and the concentration
of urine occur.
 Many components of the plasma filtrate such as
glucose, water, and amino acids, are partially or
completely reabsorbed by the capillaries surrounding
the proximal tubules.

 In the distal tubules, more water is reabsorbed and

potassium and hydrogen ions are secreted.
 Cont’d

 The Loop of Henle and the system of collecting tubules

are the principal sites where the urine is concentrated as
a mechanism for conserving body water.

 Urine formed by the three physiological processes that

are by glomerular filtration, tubular reabsorption, and
tubular secretion, is collected by the collecting duct and
passes into bladder through ureters and then comes out
through urethra.
Urinalysis is performed for:
• Acquiring a large amount of information about several
body systems (as a screening method).
• Evaluation of the kidneys, through detection of
abnormal components in the urine that maybe of renal
origin such as cast and protein.
 The Composition of Urine

Normal Urine Constituents

 Water (about 95% of urine)

 Urea
 Creatinine
 Uric acid
 Electrolytes
Abnormal Urine Constituents
 Glucose
 Protein
 Blood cells
 Bile pigments
 Cast parasites and Bacterial microbes
 Cont’d

The Factors Affecting the composition of Urine

ƒ
 Diet and nutritional status
 ƒ Condition of body metabolism ƒ
 Ability of kidney function ƒ
 Level of contamination with pathogenic
microorganisms ( bacteria) or even non-pathogenic
microflora
Collection and Preservation Of Urine Specimen
 Cont’d

Long standing of urine at room temperature can cause : ƒ

 Growth of bacteria ƒ

 Break down of urea to ammonia by bacteria leading

to an increase in the pH of the urine and this may
cause the precipitation of calcium and phosphates. ƒ
 Oxidation of urobilingen to urobilin.

 Destruction of glucose by bacteria. ƒ

 Lysis of RBCs, WBCs and casts.

Type of Examination in
Routine Urinalysis Microscopic Examination
of Urine ƒ
Physical Examination of Urine
RBCs ƒ
ƒ
WBCs
Volume ƒ ƒ Epithelial cells ƒ
Color ƒ Casts ƒ
Odor Bacteria ƒ
ƒ Appearance ƒ Yeasts ƒ
pH ƒ Parasites ƒ
Crystals ƒ
Specific gravity
Artifacts
II. Chemical Examination:
Acid-alkaline reaction (pH):
Normal values of the pH reaction of urine from any species of
animal must be carefully considered as the diet and state of
metabolism. In general bovine, ovine and caprine have
alkaline urine, while canine and feline have acid urine.
• The hydrogen ion concentration can be determined

by the use of litmus paper or hydrogen Ph paper strips.

• Increased acidity of the urine may result from
starvation, fever and acidosis.
• Alkaline urine occur in cystitis, ingestion of salts
such as sodium lactate, sodium bicarbonate,sodium
citrate and nitrate
Protein:
Protein in urine can be estimated through
Roberts' test as follows: Pour 2ml of 20%sulphosalicylic acid
solution into a test tube. Carefully pour 6 drops of urine
down the side of the tube from a dropping pipette to for
alayer of urine above the acid. Development of white ring
at the junction indicate the presence of protein
Protein urea indicated …
• Tissue destruction and necrosis
• Fever & sever inflammatory processes
• Renal diseases
• Diabetes mellitus
Glucose:
A number of methods are available for both
qualitative and quantitative estimation of glucose
• in the urine. The simplest method is the use of
Benedict reagent. Glucose is increase in the case of
diabetes mellitus.
Ketone bodies:
The Ross test has been widely utilized for the detection
of ketone bodies in the urine
Indications…
• Primary ketosis
• Secondary ketosis
Blood:
Blood may be present in the urine (hematuria)
or the pigment hemoglobin (hemoglobinuria).
Benizidine test.
Bile salt: Hay's test:
Urobilinogen: Ehrlicks' benzaldehyde test:
 PHYSICAL EXAMINATION
Quantity of Urine
1. Normal - varies with food and water intake, climate and
exercise
2. Abnormal
a. Increased amount (polyuria)
1) Chronic interstitial nephritis - the kidney cannot
concentrate urine
2) Diabetes mellitus - strong osmotic activity of glucose in
the distal tubules of kidney does not allow water to be
removed normally and diuresis occurs
3) Diabetes insipidus- deficiency of antidiuretic
hormone (ADH) from posterior pituitary
4) Absorption of large serous effusions and exudates
5) Pyometra - produces polydipsia and polyuria
6) Diuretics - cause rapid formation of urine
7) Excessive fluid intake
a) parenteral injection
b) orally - known as psychogenic water consumption
b. Decreased amount (oliguria)
1) Acute interstitial nephritis
2) Reduced fluid intake
3) Dehydration from any cause
4) Gastrointestinal disorders with vomiting and diarrhea
5) Cardiac decompensation - interferes with renal
circulation
Color
1. Color of urine is dependent upon the presence of urochromes
from endogenous metabolic processes and hemoglobin
metabolism. The urochromes may be diluted or concentrated
depending upon the volume of urine.
2. Interpretation
a. Pale yellow to yellow brown - normal color due to urochromes
b. Colorless to pale yellow (usually low specific gravity and
polyruia except in diabetes mellitus)
1) Chronic interstitial nephritis
2) Diabetes mellitus (polyuria with a normal to high specific
gravity)
3) Diabetes insipidus
 Cont’d

4) Excessive intake of water or fluids

5) Pyometra - in some cases
6) Hyperadrenocorticism
7) Amyloidosis
8) Generalized nephritis and pyelonephritis
c. Dark yellow to yellow brown (concentrated urine with a high
specific gravity and oliguria)
1) Acute nephritis
2) Decreased fluid intake
3) Dehydration
4) Fever
5) Prolonged vomiting or diarrhea
d. Yellow brown to greenish yellow (bile pigments and
urobilinogen usually produce a greenish foam when
shaken)
e. Red, wine or brown
1) Cloudy - hematuria
2) Translucent - hemoglobinuria
f. Brown to brownish black
1) Normal horse urine is yellow when voided, but turns a deep
brown color upon standing due to oxidation
2) Azoturia - myoglobinuria
3) Methemoglobinuria
4) Melanin in standing urine
Transparency
1. Recorded as:
a. Clear
b. Cloudy
c. Flocculent
2. Interpretation
Most of the time urine is clear on being voided,
except in the horse when it is normally thick and
cloudy due to calcium carbonate crystals and
mucus.
Material which impart turbidity to the urine are:
a. Bacteria
b. Epithelial cells
c. Erythrocytes (urine pink or red)
d. Leukocytes
e. Mucus
f. Fat
g. Crystals
Foam
1. When normal urine is shaken after collection, a small
amount of white foam is produced.
2. If foam is abundant and slow to disappear, there is a
high concentration of protein (proteinuria).
3. Bile salts produce a green or yellow foam.
4. Hemoglobin foam is red to brown.
Odor
1. Urine from males of the feline, porcine and caprine
species normally has a strong odor.
2. A strong ammonia odor may indicate the presence of
bacteria, as bacteria convert urea to ammonia.
3. A sweet fruity odor is produced by ketone bodies
from conditions such as:
a. Diabetes mellitus
b. Pregnancy ketosis
Specific Gravity

 The specific gravity of urine is a measurement of the

relative amount of solids in solution and is an indication of
the degree of tubular reabsorption or concentration by the
kidney.

 Under conditions of normal renal function and normal

metabolism, the specific gravity varies inversely with the
volume of urine excreted.
 If large volumes of urine are excreted, the specific
gravity is usually low, whereas if small quantities are
being eliminated, the specific gravity is generally
high.

1. Methods of Determination

a. Urinometer - requires large volume of urine (at least

10 ml)

b. Refractometer - only one drop of urine is needed

 If large volumes of urine are excreted, the specific
gravity is usually low, whereas if small quantities are
being eliminated, the specific gravity is generally
high.
1. Methods of Determination
a. Urinometer - requires large volume of urine (at least
10 ml)

b. Refractometer - only one drop of urine is needed

Normal Values

Interpretation
a. Decreased specific gravity
1) Chronic interstitial nephritis - usually from 1.003 to 1.015 due to inability of kidney to
concentrate the urine.
a) A "fixed" specific gravity may result (isosthenuria)
and refers to the phase when the specific gravity is
fixed between 1.008 and 1.012, which is the same
molecular concentration as that of plasma
dialysate.

It is due to the inability of the kidney to dilute or

concentrate the urine beyond these points.
b) A water deprivation or concentration test can be used
to differentiate chronic interstitial nephritis from low
specific gravity due to increased water intake or
diabetes insipidus. The results would be as follows:
Normal kidney - S.G. >1.020

Impaired Kidney - the closer the S.G. is to 1.010, the

less the amount of functioning kidney
Diabetes insipidus - S.G. may increase, but not to
normal range

CAUTION! This test is contraindicated if BUN and

creatinine concentrations are increased (uremia) or
the patient is already dehydrated.
2) Uremia - if advanced

3) Diabetes insipidus - S.G. usually from 1.001 to

1.006 due to a deficiency of antidiuretic hormone
(ADH) from the posterior pituitary
a) Administration of 0.5 to 1.0 ml of posterior pituitary
extract will produce immediate, but temporary, cessation
of thirst and polyuria.
b) Restricting fluids for 12 hours will elevate the
specific gravity, but not to normal limits and less
urine will be produced.
c) With infusion of Ringer's solution, isotonicity will be
preserved in both plasma and urine of healthy
animals, while hypertonic plasma and hypotonic
urine will occur if the animal has diabetes insipidus.
4) Diabetes mellitus - sometimes, although increased S.G. is
more common
5) Pyometra
6) Hyperadrenocorticism
7) Renal amyloidosis
8) Generalized nephritis and pyelonephritis
9) Mobilization of effusions or edema fluids
10) Fluid therapy
11) Administration of ACTH or corticosteroids
12) Treatment with diuretics
b. Increased specific gravity
1) Acute interstitial nephritis - usually from 1.030 to 1.060
due to inability to excrete water
2) Cystitis - products of inflammatory reaction are added
to the urine
3) Diabetes mellitus - usually from 1.012 to 1.040, as the
glucose in the urine is responsible for the increased
specific gravity, despite the polyruia
4) Reduced fluid intake
5) Dehydration
6) Vomiting and diarrhea - if prolonged
7) Hypovolemic Shock
8) Edema associated with circulatory failure
9) Burns
10) Fever
11) High environmental temperature
12) Excessive panting or sweating

NOTE: For each 0.4 gram of protein or 0.27 gram of glucose in

the urine, the specific gravity increases by 0.001.
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