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Comprehensive one-day renal function testing in man
Insights
A comprehensive nine-hour renal function test offers thorough diagnosis in one outpatient visit. This efficient system aids in early detection and management of kidney diseases like analgesic nephropathy.
Area of Science:
- Nephrology
- Clinical Chemistry
Background:
- Comprehensive renal function testing is crucial for diagnosing and managing kidney diseases.
- Current diagnostic methods may involve multiple visits and prolonged testing periods.
Purpose of the Study:
- To describe a detailed, one-day, nine-hour comprehensive renal function testing system.
- To highlight the clinical utility and efficiency of this integrated diagnostic approach.
Main Methods:
- A single, nine-hour outpatient visit incorporating numerous laboratory tests.
- Sequential determination of urinary parameters (pH, bicarbonate, titratable acid, ammonium, total acid) using an automatic titrator.
Main Results:
- Demonstrated successful application in a patient with analgesic nephropathy, identifying severe renal failure and distal renal tubular acidosis.
- Provided normal value ranges for the laboratory's comprehensive renal function tests.
Conclusions:
- The nine-hour renal function testing system provides thorough, cost-effective diagnosis with minimal patient disruption.
- This system is highly effective for investigating analgesic nephropathy, renal tubular acidosis, and post-renal transplant patients.
Abstract:
A comprehensive one-day renal function test consisting of a single outpatient visit lasting nine hours, with a minimum of time off work or away from home, is described in detail. Although a large number of laboratory tests are performed in one day, patients usually appreciate thoroughness, and the cost is more than offset by the saving in occupancy of hospital beds and by the early and precise diagnosis of reversible aspects of renal disease. Some aspects of improved methodology, such as the sequential determination of minimum urinary pH, bicarbonate, titratable acid, ammonium, and total acid on a single sample using an automatic titrator, are given in detail. Clinical application of the comprehensive nine-hour renal function testing system is illustrated by the result sheet of a patient with analgesic nephropathy, who was shown in one day to have secondary severe renal failure (glomerular filtration rate 20% of normal for age and surface area), renal tubular acidosis of the distal gradient type (minimum urinary pH 6.20), increased urinary white cell excretion rate, hyaline casts, and absence of red cell casts, consistent with a diagnosis of analgesic nephropathy and urinary tract inflammation. Normal values with 95% range for this laboratory are also given. This testing system has been found to be very useful in investigating patients with analgesic nephropathy, renal tubular acidosis, and after renal transplantation.