Escolar Documentos
Profissional Documentos
Cultura Documentos
By:
Mohd Fahmi Mastuki
Mohd Nazri Abu
Department of Medical Laboratory Technology
Faculty of Health Sciences, UiTM
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Learning Outcomes
At the end of the session, you should be able to describe:
1. List the origin and principle clinical significance of BUN, Creatinine, Uric
Acid and Ammonia
2. List the reference ranges for the 4 principle ( Non - Protein Nitrogen )
NPNs
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Functions of the kidneys
3 major functions:
1- Production of urine:
Excretion of waste
Elimination of metabolic end products (urea & creatinine)
Elimination of foreign material (drugs).
2-maintance of extracellular fluid (ECF) volume & composition:
Water and electrolyte balance
Acid/ base status →hydrogen ion homoeostasis
3-Hormone synthesis:
i. 1,25-dihydroxycholecalciferol → calcium homoeostasis
ii. erythropoietin → erythropoiesis
iii. Renin → control blood pressure
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Why Test Renal Function?
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RENAL FUNCTION
TEST (RFT)
a.k.a. NON - PROTEIN NITROGEN
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Introduction
NPN ( Non - Protein Nitrogen ) is a term that can be
used for a bunch of different substances that have
the element nitrogen in them, but are not proteins.
Optional - Glucose
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BUN (Blood Urea Nitrogen)
Renal function
Specimen : Plasma or serum
Dietary protein
Protein catabolism
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BUN (Blood Urea Nitrogen)
Glomerular nephritis
Renal failure form Diabetes Mellitus
Kidney stones
Bladder or prostate tumors
UTIs
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BUN (Blood Urea Nitrogen)
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Uric Acid
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Uric Acid
Gout
Increased plasma uric acid
Painful uric acid crystals in joints
Usually in older males ( > 30 years-old )
Associated with alcohol consumption
Uric acid may also form kidney stones
Uricase
Uric acid + O2 + H2O Allantoin + CO2 + H2O2
Uric acid absorbs light @ 293 nm.
The rate of decreased absorption is proportional to the uric acid concentration.
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Ammonia
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Ammonia
Reference range : 20 – 60 µg / dl
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Creatinine Clearance
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24 Hour Urine collection
Container.
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Creatinine Clearance specimens
UV 1.73
24 Hour Creatinine Clearance
Formula
P A
CREATININE CLEARANCE =
25
Example of a 24 Hour Creatinine Clearance calculation
UV 1.73 20.0 1000
1440 1.73
Creat Cl
P A 5.0 2.05
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Reference range
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Procedure for 24 Hour Urine Collection
UV 1.73
Creatinine Clearance
Don’t forget to divide V by 1440 ! P A
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Reference Ranges
BUN 10 - 20 mg / dl
Ammonia 20 - 60 ug / dl
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ASSIGNMENT 1
DIFFERENTIATE BETWEEN
ACUTE RENAL FAILURE
AND
CHRONIC RENAL FAILURE
(in a table)