KIDNEY FUNCTION TESTS

Anatomy of kidney
 FUNCTIONS OF KIDNEY
Retention of water and electrolytes in a negative body balance

Elimination of water and electrolytes in a positive body balance

Excretion or retention of hydrogen ions to maintain blood pH within

permissible limits.

Retention of certain substances such as amino acids, hormones,

vitamins, plasma proteins and glucose.

Removal of certain end products such as urea, creatinine and

allantoin

Elimination of foreign toxic substances

Production of renin and prostaglandin's.
Help in activation of Vitamin D
COMMONLY USED TESTS TO EVALUATE KIDNEY FUNCTIONS

1. Blood Urea Nitrogen

2. Creatinine

3. Endogenous and exogenous creatinine clearance

4. Urine protein/creatinine ratio

5. Water deprivation test (abrupt and gradual)

6. Antidiuretic hormone test

7. Fractional electrolyte clearance

8. Sulfanilate clearance

9. Urinalysis
BLOOD UREA NITROGEN (BUN)
*Test is used to evaluate the ability of the kidneys to remove
nitrogenous waste from the blood.
* 75% of the kidneys should be nonfunctional for BUN elevation.
INTERPRITATRION
a) Increased values of BUN is seen in
Pre-renal causes (shock, congestive heart failure, dehydration,
drenocortical insufficiency)
renal causes (diseases causing damage to 75% nephrons)

post-renal causes (obstruction in the urinary passage).

b) BUN is decreased in

Hepatic insufficiency, dietary protein restriction, late pregnancy

and overhydration.
Normal BUN values are 10 -30 mg/dl
CREATININE
*Creatinine is formed from creatine which stores energy in muscles
in the form of phosphocreatine.
* Creatinine can also be found in sweat, feces etc. Creatinine can be
decomposed by bacteria.
* Serum/plasma creatinine levels help in evaluating renal functions
especially the glomeruli
* Renal tubules do not play any role in excretion or absorption.
Thus, it can be used as rough index for glomerular filtration rate

* it is elevated when 75% of nephrons are damaged.

* creatinine levels are not affected by high protein diet.
* Causes of increased creatinine levels are almost similar to BUN

* Normal values range from 0.5 to 2 mg/dl

ENDOGENOUS CREATININE CLEARANCE
Test does not require administration of creatinine

CALCULATION:

UCr V
CCr = _________
SCr x T x bw

CCr = creatinine clearane (ml/min/kg)

UCr and Sqr = mg/dl of creatinine in urine and serum respectively
V = urine volume (ml)
T = time in minutes
BW = body weight (kg)
Normal values : Dog - 2.4 to 5.0ml / min/kg
Cat - 2.0 to 5.0ml / min/kg
EXOGENOUS CREATININE CLEARANCE
Test requires administration of single subcutaneous injection
of creatinine.
Normal values :
Dog - 3.5 to 5.0ml/min/kg
Cat - 2.5 to 4.0ml/min/kg
Decreased creatinine clearance in:
* Renal disease
* Pre-renal factors such as dehydration, cardiac insufficiency
or any other factor that reduce renal blood flow can influence
glomerular filtration
* Drug therapy (e.g. trimethoprim, thiazide diuretics, cimetidine).

Increased creatinine clearance:

* It is not significant but may be seen during exercise and drug
therapy (furosemide, methyl prednisolone).
URINE PROTEIN/URINE CREATININE RATIO

Divide urine protein concentration (mg/dl) by urine creatinine

Concentration (mg/dl) to calculate ratio.

*Ratio less than 0.5 is normal

* Ratio between 0.5 to 1.0 is doubtful

* Ratio greater than 1.0 is abnormal

DOGS:
Glomerulonephritis - values 1 to 40 or higher

Renal amylodosis - higher than 10.0.

WATER DEPRIVATION TEST (ABRUPT)

The test is useful to evaluate renal functions

Dehydrated animals, if the urine is not concentrated the animal

has failed the test and further water deprivation could be highly
dangerous

Healthy Dogs :
*Urine specific gravity reaches 1.050 to 1.076 after water
deprivation.It indicated dehydretion

* Urine osmolality is 1787 to 2791 mOsm/kg

* Osmolality ratios (urine/plasma ) is 5.7 to 8.9

WATER DEPRIVATION TEST (GRADUAL )

Dog is advised to reduce water consumption by 20 per

cent for 3 to 5 days but not less than 60 ml/kg/day

Provide dry food ad-Iibitum during this period.

Same proceed for abrupt water deprivation test

ANTIDIURETIC HORMONE TEST
Test is performed when patients cannot concentrate urine after water
deprivation or in patients in which water deprivation is risky.
Inject intramuscularly 3 to 5 U of vasopressin tannate in oil

Provide water ad-Iibitum and empty bladder every 3 to 6

hours after injection

Measure specific gravity of urine at 0, 6, 12, 18 and 24 hours

Healthy Dogs:
*Maximum Urine specific gravity of 1.024 to 1.060 at 8 hours

* Maximal urine osmolality should be 1033 to 2001 mOsm/kg

* Maximal urine/plasma osmolality ratio should be 3.8 to 7.4.

FRACTIONAL ELECTROLYTE CLEARANCE
Test is used to evaluate tubular function
Concentration of electrolytes in the urine reflects glomerular
filtration, tubular reabsorption and tubular secretion

CALCULATION:

Ux SCr
FCx =
UCr Sx
FCx = Fractional clearance of electrolyte x (per cent)
Ux = Urine concentration of electrolyte x (mEq/L)
UCr = Urine concentration of creatinine (mg/dl)
SCr = Serum concentration of creatinine (mg/dl)
Sx = Serum concentration of electrolyte (mEq/L)
Normal values in dogs for fractional clearance
Sodium- 1%
Chloride-1%
Potassium-20%
Phosphate-40%

FCNa values
* Less then 1% suggest non-renal fluid loses.
e.g. GIT
*More then 1%suggest renal fluid losses.
e.g. renal disease hypoadrenocorticism.

FCNa helps to differentiate pre-renal from primary renal azotemia.

 Sulfanilate Clearance

*Clearance is used for evaluating glomerular filtration

* Test is especially useful in animals that are suspected of having

kidney disease but with little increase in BUN values.

* Test is simple, does not need urine collection, less time

consuming and accurate.
Method
*Administer a 10 % solution of sodium sulfanilate
@ of 20 mg/kg BW by I/V
* Collect blood samples at 30, 60 and 90 minutes.
* Measure sulfanilate concentration in whole blood
Result
* Sulfanilate T V2 for normal dogs can vary from 32 to 84 minutes.
* Dogs with significantly increased BUN can have sulfanilate
T V2 values of 200 minutes.
* Dogs with near normal BUN values have sulfanilate TV2 from
104 to 174 minutes

* Renal diseases result in decreased sulfanilate clearance and

T V2 time increases in renal diseases.
Typical Blood Chemistry Reference Ranges
Test Canine

BUN, mg/dl 10-30

Calcium, mg/dl 8.0-12.0

Creatinine, mg/dl 1.0-2.0

Glucose, mg/dl 65-130

Phosphorus, mg/dl 3.0-7.0

Potassium, mE/L 4.0-5.7

Protein (total), g/dl 5.4-7.6

Sodium, mEq/L 140-158

Normal Findings – Fresh Canine Urine
Component Adult Dog
Color Yellow

Turbidity Clear

Specific Gravity

Minimum 1.001

Maximum 1.065+

Typical Range 1.015-1.045

pH 4.5-8.5

Glucose Negative

Ketones Negative

Bilirubin Trace to 1+*

Occult Blood Negative

Protein Trace*

Protein-Creatine Ratio 0-.3**

RBC (per high-power field) 0-5 (?)

WBC (per high-power field) 0-5 (?)

Bacteria (per high-power field) Negative

Crystals (per high-power field) Variable

Notice the pale, yellow color of the kidney.
The area with a red center is a cut portion of the kidney
to show that it is the outer most layer (cortex)
that is affected the most.
Notice how the outer layer of the kidney(cortex) looks thin and
pale compared to the inner layer (medulla).
This is the outer surface of the kidney above.
Here you can see that it looks scarred and small.
This indicates a chronic disease of the kidney.
Both photos above are examples of a
"White Spotted Kidney"
You will see white spots all over the kidney surface.
Be sure to cut into the kidney
to see if the discoloration extends into the inner tissue.
The pale areas in this kidney are called infarcts.
The red areas within the pale areas are due to hemorrhage.
You will see them extend into the kidney on the cut surface.