Kidney function tests glomerular filtration rate

Inulin is used in an important test for renal failure called the inulin clearance method (Gretz et al., 1993 Chiu, 1994). As inulin is neither secreted nor reabsorbed in the kidney, it can be administered by injection to measure glomerular filtration rate. The relative amounts of inulin in the plasma and urine give an indication of renal function. 

After the equilibration period, clearance periods of 20 min are used. Urine samples are collected and perfusate is obtained at midpoint of the clearance period for the evaluation of overall kidney function. For determination of glomerular filtration rate (GFR) and fluid transport, 3H-labelled polyethylene glycol is added to a modified Krebs-Henseleit bicarbonate buffer. Electrolytes are determined in urine by standard flame photometry. Fractional excretions of water, electrolytes and test compounds are calculated. 

As renal function improves, the excretion of urea increases and the concentration of urea in blood declines. So a reduction in blood urea nitrogen (BUN) is also a useful sign of returning kidney function. More complex tests, such as creatinine clearance, would be needed to check whether the glomerular filtration rate (GFR) has returned to normal. 

Renal function is an indication of the physiological state of the kidney glomerular filtration rate (GFR) describes the flow rate of Altered fluid through the kidney, while creatinine clearance rate (Ccr) is the volume of blood plasma that is cleared of creatinine per unit time, and is a useful measure for approximating the GFR. Most clinical tests use the plasma concentrations of the waste substances of creatinine and urea, as well as electrolytes, to determine renal function. The nephron is the functional unit of the kidney (Figure 10.1) it consists of two parts ... 

Creatinine has no useful function and is eliminated by renal glomerular filtration and to a small extent by renal tubular secretion. Creatinine clearance approximately parallels the glomerular filtration rate (GFR) and is used as a kidney function test. It is calculated as follows ... 

Early kidney disease is difficult to detect. The urinalysis is normal in early lead nephropathy and the blood urea nitrogen and serum creatinine increase only when two-thirds of kidney function is lost. Measurement of creatinine clearance can often detect earlier disease as can other methods of measurement of glomerular filtration rate. An abnormal Ca-EDTA mobilization test has been used to differentiate between lead-induced and other nephropathies, but this procedure is not widely accepted. A form of Fanconi syndrome with aminoaciduria, glycosuria, and hyperphosphaturia indicating severe injury to the proximal renal tubules is occasionally seen in children. 

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