Assessment of kidney function
Assessment of kidney function occurs in different ways, using the presence of
Description
The functions of the kidney include maintenance of
The GFR is regarded as the best overall measure of the kidney's ability to carry out these numerous functions. An estimate of the GFR is used clinically to determine the degree of kidney impairment and to track the progression of the disease. The GFR, however, does not reveal the source of the kidney disease. This is accomplished by urinalysis, measurement of urine protein excretion, kidney imaging, and, if necessary, kidney biopsy.[1]
Much of renal physiology is studied at the level of the nephron – the smallest functional unit of the kidney. Each nephron begins with a filtration component that filters the blood entering the kidney. This filtrate then flows along the length of the nephron, which is a tubular structure lined by a single layer of specialized cells and surrounded by capillaries. The major functions of these lining cells are the reabsorption of water and small molecules from the filtrate into the blood, and the secretion of wastes from the blood into the urine.[citation needed]
Proper function of the kidney requires that it receives and adequately filters blood. This is performed at the microscopic level by many hundreds of thousands of filtration units called renal corpuscles, each of which is composed of a glomerulus and a Bowman's capsule. A global assessment of renal function is often ascertained by estimating the rate of filtration, called the glomerular filtration rate (GFR).
Clinical assessment
Clinical assessment can be used to assess the function of the kidneys. This is because a person with abnormally functioning kidneys may have symptoms that develop. For example, a person with chronic kidney disease may develop
Urine tests
Part of the assessment of kidney function includes the measurement of urine and its contents. Abnormal kidney function may cause too much or too little urine to be produced. The ability of the kidneys to filter protein is often measured, as
Blood tests
Blood tests are also used to assess kidney function. These include tests that are intended to directly measure the function of the kidneys, as well as tests that assess the function of the kidneys by looking for evidence of problems associated with abnormal function. One of the measures of kidney function is the glomerular filtration rate (GFR). Other tests that can assess the function of the kidneys include assessment of
Glomerular filtration rate
The glomerular filtration rate (GFR) describes the volume of fluid filtered from the renal (kidney) glomerular capillaries into the Bowman's capsule per unit time.[3] Creatinine clearance is the volume of blood plasma that is cleared of creatinine per unit time and is a useful measure for approximating the GFR. Creatinine clearance exceeds GFR due to creatinine secretion,[4] which can be blocked by cimetidine. Both GFR and CCr may be accurately calculated by comparative measurements of substances in the blood and urine, or estimated by formulas using just a blood test result (eGFR and eCCr) The results of these tests are used to assess the excretory function of the kidneys. Staging of chronic kidney disease is based on categories of GFR as well as albuminuria and cause of kidney disease.[2]
Central to the physiologic maintenance of GFR is the differential basal tone of the afferent and efferent arterioles (see diagram). In other words, the filtration rate is dependent on the difference between the higher blood pressure created by vasoconstriction of the input or afferent arteriole versus the lower blood pressure created by lesser vasoconstriction of the output or efferent arteriole.
GFR is equal to the
]There are several different techniques used to calculate or estimate the glomerular filtration rate (GFR or eGFR). The above formula only applies for GFR calculation when it is equal to the Clearance Rate.
The normal range of GFR, adjusted for body surface area, is 100–130 average 125 (mL/min)/(1.73 m2) in men and 90–120 (mL/min)/(1.73 m2) in women younger than the age of 40. In children, GFR measured by inulin clearance is 110 (mL/min)/(1.73 m2) until 2 years of age in both sexes, and then it progressively decreases. After age 40, GFR decreases progressively with age, by 0.4–1.2 mL/min per year.[citation needed]
Estimated GFR (eGFR) is now recommended by clinical practice guidelines and regulatory agencies for routine evaluation of GFR whereas measured GFR (mGFR) is recommended as a confirmatory test when more accurate assessment is required.[5]
Medical imaging
The kidney function can also be assessed with
Kidney function in disease
A decreased renal function can be caused by many types of
A urinalysis is helpful even when not showing any pathology, as this finding suggests an extrarenal etiology.
The most relevant assessments in a
Chronic kidney disease stages
Risk factors for kidney disease include diabetes, high blood pressure, family history, older age, ethnic group and smoking. For most patients, a GFR over 60 (mL/min)/(1.73 m2) is adequate. But significant decline of the GFR from a previous test result can be an early indicator of kidney disease requiring medical intervention. The sooner kidney dysfunction is diagnosed and treated the greater odds of preserving remaining nephrons, and preventing the need for dialysis.
CKD stage | GFR level ((mL/min)/(1.73 m2)) |
---|---|
Stage 1 | ≥ 90 |
Stage 2 | 60–89 |
Stage 3 | 30–59 |
Stage 4 | 15–29 |
Stage 5 | < 15 |
The severity of chronic kidney disease (CKD) is described by six stages; the most severe three are defined by the MDRD-eGFR value, and first three also depend on whether there is other evidence of kidney disease (e.g., proteinuria):
- 0) Normal kidney function – GFR above 90 (mL/min)/(1.73 m2) and no proteinuria
- 1) CKD1 – GFR above 90 (mL/min)/(1.73 m2) with evidence of kidney damage
- 2) CKD2 (mild) – GFR of 60 to 89 (mL/min)/(1.73 m2) with evidence of kidney damage
- 3) CKD3 (moderate) – GFR of 30 to 59 (mL/min)/(1.73 m2)
- 4) CKD4 (severe) – GFR of 15 to 29 (mL/min)/(1.73 m2)
- 5) CKD5 kidney failure – GFR less than 15 (mL/min)/(1.73 m2) Some people add CKD5D for those stage 5 patients requiring dialysis; many patients in CKD5 are not yet on dialysis.
Note: others add a "T" to patients who have had a transplant regardless of stage.
Not all clinicians agree with the above classification, suggesting that it may mislabel patients with mildly reduced kidney function, especially the elderly, as having a disease.[6][7] A conference was held in 2009 regarding these controversies by Kidney Disease: Improving Global Outcomes (KDIGO) on CKD: Definition, Classification and Prognosis, gathering data on CKD prognosis to refine the definition and staging of CKD.[8]
See also
References
- ^ "UpToDate". www.uptodate.com.
- ^ PMID 23732715.
- ^ Nosek, Thomas M. "Section 7/7ch04/7ch04p11". Essentials of Human Physiology. Archived from the original on 2016-03-24. – "Glomerular Filtration Rate"
- ISBN 978-0-07-184897-8.
- S2CID 202573933.
- PMID 18385419.
- PMID 19406541. Archived from the original(PDF) on 2011-07-25.
- ^ "KDIGO Controversies Conference: Definition, Classification and Prognosis in CKD, London, October 2009". Kidney Disease: Improving Global Outcomes (KDIGO). 2009. Archived from the original on 2010-11-24.
External links
Online calculators
- Online GFR Calculator
- Schwartz formula for estimating pediatric renal function
- Creatinine clearance calculator (Cockcroft-Gault Equation)- by MDCalc
- MDRD GFR Equation
- GFR calculator using Cystatin C
Reference links
- National Kidney Disease Education Program website. Includes professional references and GFR calculators
- eGFR at Lab Tests Online