Renal function is an indication of the kidney's condition and its role in renal physiology. Glomerular filtration rate (GFR) describes the flow rate of filtered fluid through the kidney. Creatinine clearance rate (CCr or CrCl) 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, 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.
Most physicians use plasma concentrations of waste substances such as creatinine and urea (U), as well as various electrolytes (E), to determine renal function. These measures are normally adequate to determine if a patient is suffering from kidney disease. However, blood urea nitrogen (BUN) and creatinine in the plasma will not exceed normal ranges until 60% of total kidney function is lost. Hence, a more accurate glomerular filtration rate or its approximation using creatinine clearance is measured whenever renal disease is suspected or careful dosing of nephrotoxic drugs is required.
Elevated protein levels in urine mark some kidney diseases. The most sensitive marker of proteinuria is elevated urine albumin. Persistent presence of more than 30 mg albumin per gram creatinine in the urine is diagnostic of chronic kidney disease (micro albuminuria is a level of 30 mg/L to 299 mg/L urine or 30–299 mg/24 h; a concentration of albumin in the urine that is not detected by usual urine dipstick methods).
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Clinical Nephrology and Research