Faculty: Faculty of Health and Applied Sciences

Department: Department of Health Sciences

Renal Function
Surname Thomas
Name Jackson
Email address [email protected]
Name of course Work Integrated Learning
Course code WILB821S
Couse coordinator Ms. Eva Uumati
Name of training institution Oshakati NIP
Discipline in which training is Clinical Chemistry
received
Name of training officer Mrs. Rosalia Shaumbwa
Period of training
23/09/24 14/11/24

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Table of Contents
Introduction...................................................................................................................... 3
Methods........................................................................................................................... 4
Results............................................................................................................................. 5
Discussion........................................................................................................................6
Conclusion....................................................................................................................... 8
References.......................................................................................................................9
Appendix........................................................................................................................ 10

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Introduction
The kidneys are important organs that are responsible for a conglomerate of vital tasks.
The functions of the kidneys include removal of metabolic waste products such as urea,
uric acid and creatinine, maintaining the balance of electrolytes, extracellular fluid
volume and the osmolality of serum (Bishop et al., 2009). Kidneys also have a function
in the production of hormones including 1,25 di-hydroxy-vitamin D the active metabolite
of vitamin D, erythropoietin which is responsible for the stimulation of red blood cells
and finally renin which is responsible for regulation of blood volume (Jialal., 2024).
Renal function tests are crucial in diagnosing, managing and monitoring the progression
of conditions such as acute kidney failure (AKD), chronic kidney disease (CKD),
glomerulonephritis, nephrotic syndrome, kidney stones and urinary tract infections
(UTIs) (Jialal., 2024).

Renal function tests include urea, creatinine, electrolytes (chloride, sodium and
potassium), blood gas analysis, urine analysis and inflammatory markers such as CRP.

The concentrations of both urea and creatinine are estimated by enzymatic methods.
Electrolytes are measured by the potentiometric method while blood gas analysis is
facilitated by chemiluminescence method (Abbott Laboratories, 2013). Urine analysis
involves assessing urine characteristics to aid in disease diagnosis,
through microscopic examination, physical observation and chemical (Jialal., 2024).

The integrated chip technology (ICT) is a potentiometric method used by the Architect
analyzer to measure chloride, sodium and potassium. This method uses solid state ion
selective electrodes (chloride, sodium and potassium) that are contained inside a chip
(ICT module). During processing, the following events occur; Firstly, the ICT Reference
Solution is filled into the ICT Reference Solution cup, the ICT Reference Solution is then
aspirated from the bottle through the warming ring and into the ICT reference solution
cup using the syringe located on the right side of the pump. An analysis of the ICT
Reference Solution is then performed in two steps, firstly the ICT probe is positioned
into the ICT reference solution cup which is facilitated by the ICT unit that moves down
and secondly the ICT Reference Solution is aspirated into the ICT module from the cup

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using the syringe on the right side of the ICT aspiration pump. Finally, the
system converts the measurements to millivolt readings that are used as a
reference in determining the concentrations of the sample results once the ICT module
measures the ICT Reference Solution. The low and high concentration waste is then
removed (Abbott Laboratories, 2013).

The most reliable renal function test is the Glomerular Filtration Rate (GFR) which uses
an endogenous marker creatinine to measures the rate in milliliters per minute at which
the metabolism waste product is removed from plasma by filtration through the
glomerulus of the kidney (Jialal., 2024). GFR has a normal reference range of 90 to 120
mL/min. GFR measurement lower than 90 mL/min may be suggestive of chronic kidney
disease, which is graded by Kidney Disease Improving Global Outcomes (KDIGO) as
follows; stage 1 (GFR >90 mL/min/1.73 m²) which is normal, stage 2 through to stage 5
have GFR of less than 90 mL/min/1.73 m² with stage 5 having a GFR less than 15
mL/min/1.73 m² which may be suggestive of end-stage renal disease (Jančič et al.,
2022) & (Jialal., 2024).

Methods
A yellow top tube containing a clot activator and serum separating gel is used for the
patient blood sample. The tube is centrifuged at a centrifugal speed of 1800 XG for ten
minutes. This separates serum from the red cells, white cells and serum since they all
have different densities.

After the tube is centrifugation the sample are taken to the sorting bench to separate
chemistry, immunochemistry and serology samples. After sorting the chemistry samples
are scanned to see whether they are registered onto the laboratory information system
(LIS). The samples are then checked for lipaemia and hemolysis followed by the action
stipulated by the standard operating procedure. After the integrity of the samples is
observed the volumes are then checked and if the volumes are not sufficient the plasma
is poured into sample cups that are place into the test tube. All the caps on the tubes
are then removed followed by placing the test tubes in the Architect machine rack,
which is loaded onto the Architect machine, which then starts to run the tests.

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Results
TEST REFERENCE RESULT FLAG
RANGE
HBA1C
Estimated Average Glucose 17.5 High
HbA1c IFCC 29 – 42 mmol/mol 114.3 High
HbA1c NGSP 4.8 – 5.9 mmol/mol 12.6 High
UREA AND ELECTROLYTES
Potassium 3.6 – 5.1 mmol/mol 5.2 High
Sodium 136 – 144 mmol/l 133 Low
Urea 2.1 – 7.1 mmol/l 8.4 High
Creatinine 35 – 88 mmol/l 127.8 High
Estimated GFR >90 ml per minute 43.5 Low
LIVER FUNCTION TESTS
Total Bilirubin 0-20.5 umol/l 3
Alkaline Phosphatase 32 – 91 U/l 95 High
Gamma Glutamyl Transferase 7 – 50 IU/l 35
Aspartate Amino Transferase 15 – 41 IU/l 12 Low
Alanine Transaminase 7 – 35 IU/l 12
Lactate Dehydrogenase 98 – 192 IU/l 167
Total Protein 61 – 79 g/l 73
FULL BLOOD COUNT
White Blood Count 4.23 - 9.07 x10^9/L 10.20 High
Red Blood Count 4.63 -6.08 x10^12/L 3.41 Low
Hemoglobin 11.1-9.07 g/dL 9.60 Low
Hematocrit 40.1-51.0 % 30.70 Low

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Discussion
Kidney related diseases include a wide range of conditions that have the ability to
significantly impact overall health, this is due to the kidney’s important functions in
filtering and removing metabolic waste products from the blood, regulating electrolyte
balance, and maintaining acid-base homeostasis.

Urea and Electrolytes

The patient identified as ChemP02 has a hyperkalemic result of 5.2 mmol/l and a
sodium result of 133 mmol/l which falls below the normal reference range. The patient
also has elevated creatinine and urea readings of 127.8 mmol/l and 8.7 mmol/l
respectively. These results are all suggestive of kidney failure. The measurement of
urea, creatinine and electrolytes is pivotal in evaluating the status of the kidneys
function. In healthy persons, kidneys efficiently excrete creatinine, which is a by-product
of creatine-phosphate in muscle and urea which is a byproduct of protein metabolism
along with maintaining electrolyte balance (sodium, potassium, chloride) (Jialal., 2024).
In cases of acute or chronic kidney disease, serum creatinine and urea levels often rise
due to decreased glomerular filtration rate (GFR). Electrolyte imbalances are also
exhibited; hyponatremia is a concern since sodium is the main contributor of plasma
osmolality, plasma osmolality is the main contributor of blood volume which ultimately
determines the blood pressure. So hyponatremia may result in low blood pressure
which leads to decreased perfusion of oxygenated blood to the cells (Watanabe, 2020).
Hyperkalemia is particularly concerning as potassium is plays a major role in
neuromuscular excitability, heart rhythm and contractility, so elevation in potassium can
lead to life threatening cardiac arrhythmias (Watanabe, 2020).

Liver Function Tests

The patient has abnormal alkaline phosphatase and aspartate amino transferase results
the alterations in LFTs may occur due to the accumulation of toxins such as urea that
the liver must process. Furthermore, according to studies done previously there is an
association between abnormal liver function enzymes and a decline in GFR (Majoni et
al., 2020). Additionally, when liver deteriorates there is a possibility that it leads to renal

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impairment due to the altered hemodynamics and systemic circulation changes, this is
all illustrated in conditions such as hepato-renal syndrome (Simonetto et al., 2020). This
all proves the interdependence of the liver and the kidney functions.

Inflammatory Markers (CRP)

C-reactive protein (CRP) is generally considered the best inflammatory marker due to it
being more sensitive and accurate then other markers within the body. Conditions such
as glomerulonephritis which is characterized by inflammation of the glomeruli is
frequently correlated with increased CRP levels. Monitoring CRP is therefore
convenient for clinicians to help in assessing disease activity and response to therapy in
patients with kidney-related disorders (Hazin, 2020).

Blood Gas Analysis

These parameters that can significantly be affected by renal function as the kidney play
a key role in maintaining acid-base balance through the reabsorption of bicarbonate and
the excretion of Blood gas analysis gives essential information pertaining a patient’s
acid-base status and oxygenation levels. hydrogen ions. In conditions such as acute
kidney injury or chronic renal disease metabolic acidosis may develop due as a result of
the compounding of acids that cannot be optimally excreted by dysfunctional kidneys.
This imbalance in acid requires careful monitoring through blood gas analysis to guide
appropriate interventions (Dhondup & Qian, 2017) & (Chen et al., 2020).

Hemoglobin

The patient has a haemoglobin result of 9.60 g/dL which falls below the normal range of
11.1-9.07 g/dL suggesting that the patient is anaemic. Anaemia is a common
complication in chronic kidney disease this is primarily because erythropoietin is
produced inadequately by the dysfunctional kidneys. Erythropoietin is the hormone
produced in response to hypoxia and is responsible for stimulating red blood cell
production in bone marrow (Hazin, 2020).

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Conclusion
The correlation between renal diseases and a variety of diagnostic tests is multi-
layered. Urea and Electrolyte studies are essential for the establishment of electrolyte
disturbances and, finally, renal failure. LFTs are useful because they can give indirect
information about the health of the kidneys, such as hepatorenal syndrome or nephrotic
syndrome. Blood gas analysis is important in the evaluation of acid-base disorders in
acute and chronic renal diseases. Complete blood count evaluations, especially
hemoglobin, are useful in the management of anemia related to renal impairment.
Lastly, CRP is useful in the diagnosis and follow-up of inflammatory renal pathologies.
The better these relationships are known, the better will be the diagnostic and
therapeutic approach toward renal pathologies and thus improvement in patient
outcomes.

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References
Abbott Laboratories. (2013). ARCHITECT System Operations Manual 201837-111.
Bishop, M. L., Fody, E. P., & Schoeff, L. E. (2009). Clinical chemistry : techniques,
principles, correlations.
Chen, C.-C., Hsieh, J.-C., Chao, C.-H., Yang, W.-S., Cheng, H.-T., Chan, C.-K., Lu, C.-
J., Meng, H.-F., & Zan, H.-W. (2020). Correlation between breath ammonia and
blood urea nitrogen levels in chronic kidney disease and dialysis patients. Journal
of Breath Research, 14(3), 36002.
Dhondup, T., & Qian, Q. (2017). Electrolyte and acid-base disorders in chronic kidney
disease and end-stage kidney failure. Blood Purification, 43(1–3), 179–188.
Hazin, M. A. A. (2020). Anemia in chronic kidney disease. Revista Da Associação
Médica Brasileira, 66(Suppl 1), s55–s58.
Jančič, S. G., Močnik, M., & Marčun Varda, N. (2022). Glomerular Filtration Rate
Assessment in Children. Children (Basel, Switzerland), 9(12).
https://doi.org/10.3390/children9121995
Jialal., V. G. H. B. I. (2024). Renal Function Tests. StatPearls [Internet].
https://www.ncbi.nlm.nih.gov/books/NBK507821/
Majoni, S. W., Barzi, F., Hoy, W., MacIsaac, R. J., Cass, A., Maple-Brown, L., &
Hughes, J. T. (2020). Baseline liver function tests and full blood count indices and
their association with progression of chronic kidney disease and renal outcomes in
Aboriginal and Torres Strait Islander people: the eGFR follow- up study. BMC
Nephrology, 21(1), 1–10. https://doi.org/10.1186/s12882-020-02185-x
Simonetto, D. A., Gines, P., & Kamath, P. S. (2020). Hepatorenal syndrome:
pathophysiology, diagnosis, and management. Bmj, 370.
Watanabe, R. (2020). Hyperkalemia in chronic kidney disease. Revista Da Associação
Médica Brasileira, 66, s31–s36.

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Appendix

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