常用腎臟功能實驗室檢測

1、診斷學(xué),腎功能檢查Assessment of Renal Function,山東大學(xué)劉運芳,提要,Urine Tests: Cheap and convenient; For screening and followingRenal FunctionsImmunological TestImaging ExaminationRenal Biopsy,3,When or for What,Kidney diseases o

2、r injuriesOther diseases induced kidney function injuries Diabetes mellitusHypertensionShock or extensive burnAuto-immunological diseasesDrug toxicity,4,Structure of Kidney,5,,,,,腎單位,集合管,腎小體,腎小管,腎小球,腎小囊,近曲小管,遠(yuǎn)曲小管,髓

3、袢,腎小球功能檢查,Glomerular function assessment,6,Structure and Function,,,,GFR: the volume of fluid filtered from the glomerular capillaries into the Bowman's capsule per unit time120-160ml/min,Contents,Serum Creatinine

4、(sCr) & Serum urea (SU)Creatinine Clearance Rate, CcrCystatin CMicroalbumin (MA) 、 Transferrinuria (TRU)、uric acid、urine Ig……,Serum Creatinine (sCr),,Endogenous a waste product produced by muscle metabolism,,,,9,

5、Serum Creatinine (sCr),A small molecule, filtrated by glomerular completely, and not reabsorbed by tubulesCr: rise if the filtering of the kidney is deficient, Normal Value: Serum Cr: male: 44-132μmol/L

6、female: 70-106μmol/L,10,Stage of renal failure (male),11,Scr,Clinical Significance of sCr increase,12,rise only with marked damage to nephrons filtration,Serum urea (SU),also named as BUN,Influence factorsProtein intake

7、Protein degradationLiver functionGlomerular filtrationNormal value:Adults: 1.8-7.1mmol/LChildren or infants: 1.8-6.5mmol/L,13,Urea or ornithine cycle in liver,Clinical Significance of SU,Renal dama

8、ge:Chronic renal failureCompensatory stage: SU9mmol/LFailure stage: SU>20mmol/LUremia: SU>28.6mmol/LAcute renal disease,14,Clinical Significance,Physical: ↑：high protein diet ↓：pregnancyPre-renal:High fev

9、er, Shock, Upper gastrointestinal hemorrhage, extensive burn，severe trauma……Post-renal:Obstruction in urinary tract,15,SU/Cr ratio:,Creatinine Clearance Rate, Ccr,Definition：Ccr is the volume of blood plasma with creat

10、inine that is cleared by kidneys per unit time. 即：單位時間內(nèi),腎臟可全部清除多少毫升血漿中的肌酐,Normal value： 80-120 ml/min·1.73m2,Clinical Significance of Ccr,Physiological ： related with sports, diets, age……Pathological d

11、ecreaseSensitive for kidney injuryGFR<50%時Ccr≈50ml/min,Stage of renal failure,19,CCr,For treatment,20,,combine treatment, planning for end-stage failure,Stage of kidney impairement,Expressed in all nucleated cells,

12、 encoded by house keeping geneLow molecular weight, Filtrated freely through glomerulusConcentration in serum or plasma is determined by GFR,Cystatin C,Cystatin C better than creatinine in predicting,Cystatin C better

13、than creatinine in predicting,優(yōu)點,High sensitivity：better than CcrHigh specificity：not influenced by acute phase reaction, activities, gender and age, et al.Used widely: for renal transplantation statusfor monitoring

14、GFR in nephrotoxic drug therapyfor acute and chronic kidney diseases including a diabetic nephropathyOperated easily,腎小管功能檢查,Tests of tubular function,26,Function of renal tubular,重吸收：水、電介質(zhì)、小分子蛋白 葡萄糖、氨基

15、酸,,,,,腎單位,集合管,腎小體,腎小管,腎小球,腎小囊,近端小管,遠(yuǎn)端小管,髓袢,尿液稀釋、濃縮,,,遠(yuǎn)端腎單位,,近端腎小管功能檢查,Tests of proximal tubular function,28,Tests of Proximal tubular Function,β2-microglobulinα1-microglobulinRetinol-binding protein, RBPN-acetyl-β-D-g

16、lucosaminidase, N-NAGFraction of urine natrium excretion, FeNa,β2-microglobulin, β2-MG,Present on all nucleated cells, especially on lymphocytes, and stable in bloodSmall protein, freely filtrated by glomeruliAlmost

17、reabsorbed by tubules completelyThreshold of reabsorption:5mg/L,Normal value: Urine：<0.3mg/L,Clinical Significance of β2-MG,Serum β2-MG ↑：GFR↓ :when Ccr<80ml/min，more sensitive than Scr惡性腫瘤、炎性疾?。ǜ窝?、

18、類風(fēng)濕關(guān)節(jié)炎等）Reabsorption function of proximal tubules： urine β2-MG increase (blood β2-MG<5mg/L) Acute and chronic pyelonephritisDrug or toxin induced tubular necrosis,Clinical Significance,Evaluation for transplan

19、t kidney functionUrine β2-MG↑↑，implied graft rejectionserum β2-MG: help for sub-clinical rejection of grafts腎移植雖有少尿，但血β2-MG下降者提示預(yù)后良好。,α1-microglobulin, α1-MG,Small glycoproteins, synthesized in liverFreely filtrated

20、through glomeruliAlmost reabsorbed by proximal tubules completely,Normal value: Urine：<15mg/24h,Clinical Significance of α1-MG,Decrease: severe hepatitis and hepatic necrosisSerum α1-MG ↑：GFR↓ : when Ccr<

21、;100ml/min，more sensitive than Scr and β2-MGUrine α1-MG↑: Reabsorption function of proximal tubules injuryAcute and chronic Diabetic nephropathyα1-MG ↑ ：serum and urineDamage in both glomeruli and tubules,Retinal-b

22、inding protein, RBP,視黃醇結(jié)合蛋白Can be detected widely, in all body fluidFreely filtrated by glomeruli, almost reabsorbed by tubules completely, and degenerated into amino acidsOnly a little was excreted with urineNormal

23、: 0.11±0.07mg/L,Clinical Significance,Blood RBP: Increase: glomerular function Higher specificity and sensitivity than ScrDecrease: liver function, malnutritionUrine RBP: tubular functionmore specific:

24、similar sensitive with β2-MGand sensitive than Scrbetter stability,N-acetyl-β-D-glucosaminidase (NAG),N-乙酰-β-D-氨基葡萄糖苷酶widely distributed lysosomal hydrolasenot filtered at the glomerulusLocated predominantly in the r

25、enal proximal tubulesExcreted in low amounts in urine,Clinical Significance,Urine NAG increase: exocytosis process of tubular cellsToxic acute tubular injuries: lead, aminoglycoside antibiotics, nephrotoxic drugs,

26、 anti-cancer drugs (cisplatin……)Acute rejection: Various glomerular diseases: diabetic nephropathy, hypertensive nephropathyUrinary infection: upper >lower，location,Fraction of urine natrium excretion,Natrium: free

27、ly filtrated through glomeruli and 99% was reabsorbed by proximal tubulesNormal values:FeNa: <1%,Clinical Significance,Pre-renal：鈉攝入過多或血容量下降 尿鈉↑同時伴有血鈉↑Reabsorption damage: 急性腎小管壞死

28、 尿鈉↑ ，但血鈉不高Differential diagnosis of azotemiaPrerenal : FeNa 1%,Summary,β2-microglobulinα1-microglobulinRetinol-binding protein, RBP ——reabsorption functi

29、onN-acetyl-β-D-glucosaminidase, N-NAG —— kidney toxicity damageFraction of urine natrium excretion, FeNa —— differential diagnosis of pre-renal and intra-renal azotemia,遠(yuǎn)端腎小管功能檢查,Tests of distal tubular funct

30、ion,42,Renal concentration function,Mosenthal’s testAlso as : Circadian urine specific gravity (SG) testNormal intake (water<500-600ml), no extra waterEmpty bladder at 8 am in the morningDetect the volume an

31、d SG of the urine every 2 hours from 10am to 8pm, and morning urine of next day,Normal Values,volume：24h total volume: 1000～2000ml；12h overnight urine: 3～4∶1SG specific gravity：1.015-1.025highest >1.018the gap

32、of the highest and the lowest >0.009,Clinical Significance,Impairment in distal tubules：Early stage： overnight urine>750ml, Day/overnight ↓, SG is normalSevere impairment: polyuria，overnight urine↑ SG↓Failure