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Renal Function TestsRenal Function Tests
Functions of the Kidneys.Functions of the Kidneys.
1. Formation of urine.1. Formation of urine.
a. Excretion of water soluble waste products ofa. Excretion of water soluble waste products ofmetabolism, mainly the nitrogenous waste products.metabolism, mainly the nitrogenous waste products.
b. Excretion of toxic substances.b. Excretion of toxic substances.
c. Control of blood volume and extrac. Control of blood volume and extra--cellular fluid volumecellular fluid volumeby regulating the reby regulating the re--absorption of water and electrolytes.absorption of water and electrolytes.
d. Red. Re--absorption of essential metabolites filtered in theabsorption of essential metabolites filtered in theglomerular filtrate.glomerular filtrate.
2.2. Endocrine functions.Endocrine functions.
a. Secretion of erythropoietin and control of red blood cella. Secretion of erythropoietin and control of red blood cellproduction.production.
b. Secretion of renin and maintenance of blood pressure.b. Secretion of renin and maintenance of blood pressure.
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Renal Function TestsRenal Function Tests
1. Urine routine examination: appearance, volume, spgravity, pH, glucose, protein and sediment.
2. Blood urea conc.
Blood urea nitrogen (BUN).
3. Serum creatinine conc..
4. Clearance tests to measure the GFR.
a. Inulin clearance test.b. Creatinine clearance test.
c. Urea clearance test.
5. Serum electrolytes (Na, K, Cl, HCO).
6. Urinary total protein, Microalbumin.7. Other Investigations.
USG of kidneys.
X-ray KUB, IVU, CT Scan.
Renal biopsy (FNAC).QMC BAHAWALPURQMC BAHAWALPUR 22SAJJAD AHMADSAJJAD AHMAD
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Blood UreaBlood Urea
Urea in blood is mostly derived from catabolism of
protein. It is freely filtered through glomeruli.
It is passively reabsorbed from the filtrate.
Its blood conc. may rise due to increased production,
decreased filtration or increased reabsorption. Normal blood conc. is 15 50 mg/dl of blood.
BUN is the nitrogen derived from protein breakdown
only. It is calculated as:
Urea X 28/60 = BUNBUN X 60/28 = Urea
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Serum CreatinineSerum Creatinine
Creatinine is derived from creatine.
Its blood conc. depends on total muscle mass.
It is filtered freely through glomeruli.
It is not reabsorbed from the filtrate.
Small amount of it is secreted by the tubules.
Its blood conc. rises due to decreased filtration andincreased production.
Normal blood conc 0.6-1.2 mg/dl of blood.
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Clearance testsClearance tests
Clearance test measures the volume of plasma
completely cleared of a substance per minute. Itis a measure of GFR.
Inulin clearance test is the most ideal but a littledifficult to perform. Most convenient and usefulis the creatinine clearance test.
Clearance of a substance (GFR) is calculatedusing the following formula:
Clearance (GFR) = Conc. in urine X 24 hrs urinevolume/ Conc. in blood X Collecting time in min.
Normal creatinine clearance is:Adults < 55 yrs: 95 145 ml/min.
Clearance decreases progressively with age.
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C S F
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Examination of CSFExamination of CSF
Introduction: Cerebrospinal fluid is formedfrom plasma by the filtering & secretory activitiesof the choroid plexus in the lateral ventricles. Itpasses through the third & fourth ventricles into
the subarachnoid space between the pia mater& arachnoid mater, & completely surrounds thebrain & spinal cord. CSF is reabsorbed into theblood stream by the arachnoid villi which projectinto the subarachnoid space.
In the adult the total volume of CSF is about 140ml.
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CSF STYDYCSF STYDY
Functions of CSF:
The CSF supports the brain &
protects it against injury. It also has asimilar function to lymph & remove waste
products of metabolism.
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Laboratory Examination Of CSFLaboratory Examination Of CSF
It includes the following examination:
*A. Physical Examination
*B. Chemical Exam.
*C. M/E
*D. Bacteriological Examination.
*E. Other tests.
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Physical ExaminationPhysical Examination
* Appearance: Normal CSF is clear.
* Colour: Colourless.
* Clot: Normal CSF does not clot.
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Cell CountCell Count
Normal: 0-5 lymphocytes/cmm.
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Chemical ExaminationChemical Examination
1. Protein: Normal: 15- 45mg/dl.
2. Glucose: Normal: 50-70mg/dl.
3. Chloride: Normal: 710-750mg/dl.
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Bacteriological ExaminationBacteriological Examination
Normal CSF is sterile.
1. Smear of centrifused deposit.
2. Culture.
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Other testsOther tests
1. VDRL
2.Antigen detection
3.Immunologial tests &
Electrophoresis.
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MeningitisMeningitis
Bacterial
1. 1st 06 wks
Enteric gram neg
Group B strept
Meningococci
Staph
Pneumococci L.monocytogens
Group A strept
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MeningitisMeningitis
2. Six wks to six yrs
H. influnzae
Meningococci Pneumococci
3. Over six yrs
Pneumococci
Meningococci
4. All ages: Tuberculosis
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MeningitisMeningitis
Viral causes
1. Neurotropic viruses
Polio viruses
LCM
Arbo.encephalitis
2. Non-neurotropic viruses
Enteroviruses,Mumps,Herpes simplex,Infectiosmononucleosis,Varicela-zoster,measles
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CSFCSF
3.Fungal causes
Cryptococcosis
AspergillosisHistoplasmosis
Mucormycosis
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CSF in normal health & common disordersCSF in normal health & common disorders
Normal Pyogeni
c
Meningit
is
Tubercul
ous
Meningit
is
Viral
Meningit
is
Subarac
hnoid
Haemorr
hage
Tumour
1.Press
ure(mm
H20)
60-100 Normal/i
ncrease
d
Normal/i
ncrease
d
Normal Increase
d
Increase
d
2.Color Crystal
Clear
Cloudy,p
urulent
Clear/Cl
oudy
Clear Blood-
mixed/x
anthocro
mic
Clear
3.Cell
count/m
m3
Lympho
cytes 0-
5
Neutrop
hils
often
more
than
1000-
5000
Mostly
Lympho
cytes
upto 500
Lympho
cytes
upto 200
RBCs
mostly
Normal
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CSF in normal health & common disordersCSF in normal health & common disorders4.Protein(
mg/dl)
15-45 Increased
500-2000
Increased
500-3000
Increased
500-2000
Normal Increased
500-2000
5.Glucos
e(mg/dl)
50-70 May
disappear
Decrease
d 20-30
Normal Normal Normal
6.Chlorid
e(mg/dl)
710-750 Normal
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CSFCSF
Indication of CSF study
Meningitis
Subarachnoid haemorrhageMalignancy
Demyelinating disease
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