Renal Function Test (RFT)

Muhammad Asif Shaheen

Lecturer Pathology
KEMU, LAHORE
RFT test includes
• Most common test
• Urea or Blood Urea Nitrogen (BUN)
• Creatinine
• Les commonly included test in RFTs
• Uric Acid
• Micro albumin
• Creatinine clearance
•Your liver produces ammonia — which contains nitrogen — after it
BUN
breaks down proteins used by your body's cells.
•The nitrogen combines with other elements, such as carbon,
hydrogen and oxygen, to form urea, which is a chemical waste
product.
•The urea travels from your liver to your kidneys through your
bloodstream.
•Healthy kidneys filter urea and remove other waste products from
your blood.
•The filtered waste products leave your body through urine.
A BUN test can reveal whether your urea nitrogen levels are higher
than normal, suggesting that your kidneys or liver may not be working
properly.
• Normal urea is 20-50mg/dl
• A normal BUN level is between 7 and 20 mg/dL. It is calculated by
dividing urea level with 2.14.
Creatinine Test
• Creatinine is a waste product produced by muscles from the breakdown of a
compound called creatine. Creatinine is removed from the body by the
kidneys, which filter almost all of it from the blood and release it into the
urine. This test measures the amount of creatinine in the blood and/or urine.
• Creatine is part of the cycle that produces energy needed to contract muscles.
Both creatine and creatinine are produced by the body at a relatively constant
rate. Since almost all creatinine is filtered from the blood by the kidneys and
released into the urine, blood levels are usually a good indicator of how well
the kidneys are working. The amount of creatinine you produce depends on
your body size and your muscle mass. For this reason, creatinine levels are
usually slightly higher in men than in women and children.
eGFR
• Results from creatinine tests may be used to estimate the amount of blood
filtered per minute by the kidneys. This is known as the 
estimated glomerular filtration rate (eGFR). GFR is difficult to measure
directly. Estimated GFR is used to screen for and detect early kidney
damage, to help diagnose chronic kidney disease (CKD), and to monitor
kidney status.
• Another, less common way to obtain GFR is to calculate creatinine clearance.
There are several versions of the creatinine clearance calculation. All of
them include the measurement of the amount of creatinine in a blood
sample collected just before or after the urine collection, the amount of
creatinine in a 24-hour urine sample, and the 24-hour urine volume.
• For eGFR normal results range from 90 to 120 mL/min/1.73 m2
• Normal Creatinine
Male 0.9 - 1.3 mg/dL
Female 0.6 - 1.1 mg/dL
Uric Acid
• Uric acid is produced by the breakdown of purines. Purines are nitrogen-containing compounds
found in the cells of the body, including our DNA. This test measures the level of uric acid in the
blood or urine.
• As cells get old and die, they break down, releasing purines into the blood. To a lesser extent,
purines may come from the digestion of certain foods, such as liver, anchovies, mackerel, dried
beans and peas and certain alcoholic drinks, primarily beer. Most uric acid is removed from the
body by the kidneys and is eliminated from the body in the urine, with the remainder
eliminated in the stool.
• If too much uric acid is produced or not enough is removed, it can accumulate in the body,
causing increased levels in the blood (hyperuricemia). The presence of excess uric acid can
cause gout, a condition characterized by inflammation of the joints due to the formation of uric
acid crystals in the joint (synovial) fluid. Excess uric acid can also be deposited in tissues such as
the kidney, leading to kidney stones or kidney failure.
• Normal Uric acid levels are 2.4-6.0 mg/dL (female) and 3.4-7.0 mg/dL (male). 
Microalbumin test
• A urine microalbumin test is a test to detect very small levels of a
blood protein (albumin) in your urine. A microalbumin test is used to
detect early signs of kidney damage in people who are at risk of
developing kidney disease.
What is Kidney Failure?

• Kidney failure refers to temporary or permanent damage to the

kidneys that results in loss of normal kidney function. End-stage renal
disease (ESRD) is when the kidneys permanently fail to work.
• Conditions that may lead to kidney failure depend on the type of
kidney failure: acute or chronic.
• Acute kidney failure has starts abruptly and is potentially reversible.
• Chronic kidney failure progresses slowly over at least three months. It
can lead to permanent kidney failure
 Causes of Acute Kidney Failure
• Acute kidney failure causes may include, but are not limited to, the following:
• Myocardial infarction - a heart attack may lead to temporary kidney failure.
• Rhabdomyolysis - kidney damage that can occur from muscle breakdown. This condition can
occur from severe dehydration, infection, or other causes.
• Decreased blood flow to the kidneys for a period of time. This may occur from blood loss or
shock.
• An obstruction or blockage along the urinary tract.
• Hemolytic uremic syndrome - usually caused by an E. coli infection, kidney failure develops as
a result of obstruction to the small functional structures and vessels inside the kidney.
• Ingestion of certain medications that may cause toxicity to the kidneys.
• Glomerulonephritis - a type of kidney disease that involves glomeruli. During
glomerulonephritis, the glomeruli become inflamed and impair the kidney's ability to filter
urine. Glomerulonephritis may lead to chronic kidney failure in some individuals.
• Any condition that may impair the flow of oxygen and blood to the kidneys such as cardiac
arrest.
 Causes of Chronic Kidney Failure
• Chronic kidney failure causes may include, but are not limited to, the following:
• Diabetic nephropathy - diabetes can cause permanent changes, leading to kidney damage.
• Hypertension - chronic high blood pressure (hypertension) can lead to permanent kidney damage.
• Lupus (SLE) - a chronic inflammatory/autoimmune disease that can injure the skin, joints, kidneys,
and nervous system.
• A prolonged urinary tract obstruction or blockage.
• Alport syndrome - an inherited disorder that causes deafness, progressive kidney damage, and eye
defects.
• Nephrotic syndrome - a condition that has several different causes. Nephrotic syndrome is
characterized by protein in the urine, low protein in the blood, high cholesterol levels, and tissue
swelling.
• Polycystic kidney disease - a genetic disorder characterized by the growth of numerous cysts filled
with fluid in the kidneys.
• Cystinosis - an inherited disorder whereby the kidneys have excessive excretion or certain amino
acids. This leads to severe kidney stones.
• Interstitial nephritis or pyelonephritis - an inflammation to the small internal structures in the
kidney.