KLUBSY: RENAL FUNCTION Flashcards
These are bean-shaped and are located on the posterior abdominal wall in the area known as the RETROPERITONEUM
Kidneys
The kidneys are bean shaped and are located where?
located on the posterior abdominal wall
the kidneys are bean-shaped and are located on the posterior abdominal wall in the area known as the what?
retroperitoneum
An adult human kidney has a mass of what?
approx. 150 g
an adult juman kidney measures roughly what in length, width, and depth?
length - 12.5 cm
width - 6 cm
depth - 2.5 cm
each kidney contains approximately how many functional units?
1 to 1.5 million
what are these functional units of the kidneys called?
nephrons
this makes up approx 85% of the total nephron
cortical nephron
this is found mainnly in the cortex of the kidney
cortical nephron
this is responsible primarily for removal of waste products and reabsorption of nutrients
corical nephron
what is the primary responsibility of the cortical nephron?
-removal of waste products
-reabsorption of nutrients
the cortical nephron makes up approx. what percent of the total nephron?
85%
this has loops of Henle that extend deep into the medulla of the kidney
Juxtamedullary nephrons
their primary function is the concentration of urine
Juxtamedullary nephrons
What is the primary function of the juxtamedullary nephrons?
primary function is the concentration of urine
nephrons consist of what?
1-glomerulus
2-tubules (PCT and DCT)
3-loop of henle
4-collecting ducts
the most metabolically active part of the nephron is the?
PCT (proximal convulated tubules)
What are the general functions of the kidney?
-excretory function
-regulation of water balance in the body
-regulation of acid-base balance
-regulation of electrolytes
- regulation of blood pressure through secretion of renin
-stimulates erythropoiesis through secretion of EPO
-Regulation of body temperature
One of the most important functions of the kidneys?
excretory function through urine formation
Urine comes from what?
waste products from the blood
under excretory functions, what are the processes under it?
- glomerular filtration
- tubular reabsorption
-tubular secretion
this supplies blood to the kidney
renal artery
what is the role of renal artery to the kidney
it supplies blood to the kidney
the human kidney receives approx. how uch of the blood pump?
25%
what is both a hormone and an enzyme?
renin
total renal blood flow:
1200 mL/min
renal plasma flow?
600 - 700 mL/min
this is a pressure that is created by varying sizes of the arterioles, which is important for glomerular filtration
hydrostatic pressure
this pressure maintains consistency of glomerular capillay pressure and renal blood flow within the glomerulus
hydrostatic pressure
what is the measurement for the hydrostatic blood pressure?
averages 55 mm Hg
it is the driving force behind glomerular filtration?
hydrostatic pressure
the plasma ultrafiltrate already in Bowman’s space exerts a hydrostatic pressure of how much that opposes filtration?
15 mm Hg
this pressure is caused by higher protein concentration in the plasma opposes glomerular filtration as well
oncotic pressure of 30 mm Hg
the outcome of the three pressure differences is a net filtration of how much?
net filtration of 10 mm Hg
this part at the vascular pole supplies blood INDIVIDUALLY to the glomerulus of each nephron
an afferent arteriole
What is the order of blood flow in the nephron?
Renal artery > afferent arteriole > Glomerulus > Efferent arteriole > peritubular capillaries > Vasa recta > renal vein
*RAGE PVR
What is the order of urine formation from the nephron (urinary filtrate flow)?
glomerulus > Bowman’s space > PCT > DLH > ALH > DCT > Collecting ducts > renal calyces > ureter > bladder > urethra
This consists of a coil of approximately EIGHT CAPILLARY LOBES
Glomerulus
the glomerulus consists of what?
a coil of approx. EIGHT CAPILLARY LOBES
The EIGHT CAPILLARY LOBES are referred collectively as the what?
referred collectively as the CAPILLARY TUFT
This resembles as a “sieve”
Glomerulus
Glomerulus resembles as a what?
as “sieve”
Where is the glomerulus located?
located WITHIIN the Bowman’s capsule
What are the processes involved in URINE FORMATION?
-Glomerular filtration
-Tubular reabsorption
-Tubular secretion
T/F: Yung dumi sa ating dugo ay nagiging ihi
T.
Which has the LARGER opening the afferent arteriole or the efferent arteriole?
AFFERENT
What is the pressure due to the difference in the size of the opening of the afferent and efferent arterioles?
HYDROSTATIC PRESSURE
What are the 2 types of pressure that will regulate the flow of blood going to the glomerulus for filtration?
1-hydrostatic pressure
2-oncotic pressure
The major contributor for oncotic pressure is?
Albumin (protein)
What is the FIRST STAGE in urine formation?
Glomerular FILTRATION
The endothelial cells of the capillary wall of the glomerulus differ from those in other capillaries by containing PORES and are referred to as what?
FENESTRATED endothelium
The glomerulus has capillaries that contain pores called?
fenestrated endothelium
a non-selective filter for plasma substances with molecular weights of less than what?
70,000 daltons
*>70k daltons HINDI na makakalusot sa mga butas ng capillary lobes
How would you describe the 8 capillary lobes of the glomerulus?
fenestrated structure
T/F: Anything <70,000 daltons cannot pass through the fenestrated capillary lobes
F.
Anything > 70,000 dalton cannot pass
What type of filtration does the glomerulus have?
NON-SELECTIVE CHEMICAL filtration
Normally, the fluid leaving the glomerulus has a specific gravity of what?
1.010 - constant!
Anything filtered by the glomerulus has a specific gravity of what?
1.010
Approx. how much of the renal plasma is filtered through the glomeruli forming what is known as the ultrafiltrate?
Approx. 120 mL/min or one-fifth of the renal plasma
Approx. 120 mL/min or 1/5 of the renal plasma is filtered through the glomeruli forming what is known as the what?
ultrafiltrate
What is the average GFR?
120 mL/min or 1/5
this has the same composition as the blood plasma but is normally free of protein except for about 10 mg/dL of low molecular-weight protein
ULTRAFILTRATE
The ultrafiltrate has the same composition as the blood plasma but is normally free of protein except for about how much?
for about 10 mg/dL of low molecular-weight protein
Tha plasma filtraye must pass through these 3 cellular layers:
1-capillary wall membrane
2-basement membrane
3-visceral epithelium of Bowman’s capsule
what are the cellular structure of the glomerulus?
1-capillary wall membrane
2- basement membrane
3-visceral epithelium of Bowman’s capsule
These are the intertwining foot processes that is a barrier that prohibits the filtration of large molecules
PODOCYTES
This repels molecules with a negative charge even molecules are small enough to pass (e.g albumin)
Shield of negativity
*Albumin is with a negative charge under normal body pH
*Principle: same charges repel. albumin is negatively charged as well as the shield of negativity.
*Since importante si Albumin sa katawan, pag lumusot si Albumin sa fenestrated capillary, tatamaan siya ni shield of negativity para lumundag pabalik
What charge does albumin have?
NEGATIVE CHARGE
this maintains the glomerular blood pressure
Juxtaglomerular apparatus
this is found in the afferent arteriole
this secretes the Renin enzyme
Juxtaglomerular cells
found in the DCT, sensor of change in blood pressure
Macula densa
Where is the juxtaglomerular cell located?
found in the AFFERENT arteriole
where is the macula densa located?
found in the DCT
What are the sequence of events in cases of DECREASED BLOOD PRESSURE?
Dilation of afferent arteriole > constriction of efferent arteriole
what are the sequence of events due to increased blood pressure?
constriction of afferent arteriole > dilation of efferent arteriole
Increase or decreased BP: Dilation of afferent arteriole
Decreased
increased or decreased BP: Constriction of efferent arteriole
decreased
increased or decreased BP: constriction of afferent arteriole
increased
increased or decreased BP: dilation of efferent arteriole
increased
This is the system that regulates the flow of blood to and within the glomerulus.
Renin-Angiotensin-Aldosterone system (RAAS)
What does RAAS stand for?
Renin-Angiotensin-Aldosterone System
this system responds to changes in blood pressure and plasma sodium content that are monitored by the juxtaglomerular apparatus.
RAAS
What electrolyte is directly proportional to BLOOD PRESSURE?
Sodium
*decreased Na = decreased BP
RAAS responds to changes in blood pressure and plasma sodium content that are monitored by what?
monitored by the juxtaglomerular apparatus, which consists of the juxtaglomerular cells in the afferent arteriole and the macula densa of the DCT
This consists of the juxtaglomerular cells in the afferent arteriole and the macula densa of the DCT
juxtaglomerular apparatus
this controls the regulation of the flow of blood to and within the glomerulus
RAAS
What is the primary electrolyte affected when activated in the RAAS?
Sodium
This is responsible for the dilation of the afferent arteriole and constriction of the efferent arteriole
RAAS
This is responsible for the Stimulation of sodium reabsorption in the proximal convoluted tubule
RAAS
This Triggers the adrenal cortex to release the sodium-retaining hormone, aldosterone, to cause reabsorption of sodium and
excretion of potassium in the distal convoluted tubule and collecting duct
RAAS
This has the function to Trigger release of antidiuretic hormone by the hypothalamus to stimulate water reabsorption in the collecting duct
RAAS
This is the bloodborne substrate for renin enzyme
Angiotensinogen
A product formed from enzymatic reaction of renin with angiotensinogen
Angiotensin I
Inert form angiotensin
Angiotensin I
A product formed from enzymatic reaction of ACE with angiotensin I
Angiotensin II
Active form angiotensin and a powerful vasoconstrictor that increases BP
Angiotensin II
This corrects renal blood flow
Angiotensin II
this Raises blood pressure (BP) by a number of actions, the most important ones being
vasoconstriction, sympathetic nervous stimulation, increased aldosterone biosynthesis and
renal actions
Angiotensin II
What are the other actions of Angiotensin II?
- induction of growth
- cell migration
- mitosis of vascular smooth muscle cells
- increased synthesis of collagen type I and III in fibroblasts
- thickening of the vascular wall and myocardium
- fibrosis
This acts as both a hormone and an enzyme
Renin
Renin + Angiotensinogen =
Angiotensin I
What produces the ACE (Angiotensin converting enzyme)
Lungs
In the case wherein the stimulus is DECREASED BP, what is the potent product that can increase BP?
Angiotensin II
What product can increase BP directly?
Angiotensin II
What are the 4 processes that take place when the body detects the production of Angiotensin II?
1- DA/CE
2- Sodium reabsorption at PCT
3- Aldosterone for sodium retention
4-ADH for water reabsorption
This process is responsible for the dilation of afferent and constriction of efferent
DA/CE
This is the sodium retention hormone / salt retention hormone
ALDOSTERONE
This is the WATER retention hormone
ADH
What is the purpose of RAAS?
increase BP in order to maintain normal GFR
Which of the ff system is responsible for sal reabsorption?
a-aldosterone
b-adh
c-renin
d- RAAS
RAAS
*take note of the word “SYSTEM”
This is a compensatory system in decreased BP
RAAS
Which of the ff hormones is responsible for salt reabsorption?
a-aldos
b-adh
c-renin
d-raas
aldosterone
Best indicator of overall glomerular function
clearance test
what are the 2 ways to assess filtration process?
1-clearance test
2-eGFR methods
this is the traditional test for glomerular function
clearance test
this test for glomerular function requires 24 hr urine collection
clearance test
What specimen is required for a clearance test?
24 hr urine collection
this glomerular function test does not require collection of 24 hr timed urine specimens
eGFR methods
What are examples of eGFR methods?
-MDRD
-Cockroft and gault
-CKD-EPI
kinds of clearance tests:
- inulin clearance test
-creatinine clearance test
-others (cystatin C, Beta-2-microglobulin, radioisotopes, urea clearance test)
this is the earliest clearance test
urea clearance test
Approx. how much of the filtered urea is reabsorbed back by the kidney
40%
This is a polymer of fructose
Inulin
It is an extremely stable substances that is not reabsorbed or secreted by the tubules
Inulin
It is not a normal body constituent, however, and must be infused by IV at a constant rate throughout the testing period
Inulin
Inulin is a polymer of what?
A polymer of fructose
This is the most commonly used clearance test
Creatinine clearance test
This is a waste product of muscle metabolism that is produced enzymatically by creatine phosphokinase from creatine, which links with ATP to produce ADP and energy
Creatinine
Creatinine is a waste product of muscle metabolism that is produced enzymatically by what?
creatine phosphokinase
this links with ATP to produce ADP and energy
creatinine
this is the 1st clearance test
urea clearance test
Is urea clearance test still used now?
No, because it reabsorbs UREA back.
this the gold standard/reference method for glomerular function
inlun clearance test
What is the molecular weight of cystatin C?
13,359
This is a small protein produced at a constant rate by ALL NUCLEATED CELLS.
Cystatin C
it is readily filtered by the glomerulus and reabsorbed and BROKEN DOWN by the renal tubular cells.
Cystatin C
*reabsorbed si urea PERO sinisira naman.
it has potential as a marker for long-term monitoring of renal function
cystatin C
What is the relationship of Cystatin C with GFR?
INVERSELY
*Increased plasma cystatin C = decreased GFR
T/F: The plasma concentration of cystatin C is inversely related to GFR
TRUE
T/F: The rate of production of Cystatin C is not affected by muscle mass, sex, or race
TRUE
It dissociates from human leukocyte antigens (MHC class I) at a constant rate and is rapidly removed from the plasma by
glomerular filtration.
BETA-2-MICROGLOBULIN
Beta-2-microglobulin dissociates from human leukocyte antigens. What MHC class?
MHC Class I
It is a better marker of reduced renal tubular function than of glomerular function
Beta-2-microglobulin
This can be used to differentiate disorders of the kidney as either glomerular or tubular
beta-2-microglobulin
This is also used to identify end-stage renal disease
B2M
This is also used to identify early rejection of a kidney transplant
B2M
This is not a reliable in patients who have a history of immunologic disorders or malignancy
B2M
Signs of tubular damage (tubular reabsorption defect)
-normal B2M in blood or serum
-increased B2M in urine
signs of glomerular disorder
-increased B2M in serum or blood
-No to decrease B2M in urine
What is the formula for the computation of GFR using the creatinine clearance test?
C = (Urine creatinine / plasma creatinine) X volume of urine/24 hours X 1.73 / A
By far the greatest source of error in any clearance procedure utilizing urine is what?
the use of improperly
timed urine specimens
How and when to collect plasma sample for creatinine?
ideally collected at the MIDPOINT of the 24-hour urine collection
When do we need to collect a plasma sample for a clearance creatinine test?
midpoint of the 24-hour urine collection
Is this true about creatinine clearance: Some creatinine is secreted by the tubules
Yes
Is this true about creatinine clearance? A diet heavy in meat consumed during collection of a 24-hour urine specimen will influence the results if the plasma
specimen
YES. Falsely elevated
What are the 4 parameters included in MDRD?
- serum creatinine
- Ethnicity
- age
-sex
*SEAS
What are the 6 parameters included in MDRD?
-bun
-age
-serum creatinine
-ethnicity
-serum albumin
- Sex
*BASESS
What are the parameters included in Cockroft and gault formula?
- Body weight
- Age
- Sex
- Serum creatinine
*BASS
This is the most frequent used formula for creatinine
Modification of Diet in Renal Disease (MDRD)
The body must not lose how much of water-containing essential substances every minute
120 mL
This is often the first function affected in renal disease
The loss of tubular function capability
What is the urine composed of?
-95% water
-5% solutes
How many grams of total solute is produced in 24 hours in a normal healthy individual?
60 grams (35 grams organic substances, 25 grams inorganic substances)
what are the 2 mechanisms of tubular reabsorption?
-Active transport
-passive transport
the substance to be reabsorbed must
combine with a carrier protein contained in the membranes
of the renal tubular cells.
active transport
This transport requires energy
Active transport
What type of energy is required in active transport?
ELECTROCHEMICAL ENERGY
the movement of molecules across a
membrane as a result of differences in their concentration or
electrical potential on opposite sides of the membrane.
PASSIVE TRANSPORT
It is
Characterized by movement of a substance from an
area of higher concentration to one of lower
concentration
PASSIVE TRANSPORT
Passive transport is characterized by movement of a substance from what concentration?
from an
area of higher concentration to one of lower
concentration
what type of transport? glucose, amino acids, salts
active transport
what type of transport? chloride.
active transport
what type of transport: sodium
active transport
what type of transport: water
passive transport
what type of transport: urea
passive transport
what are the substances reabsorbed by the PCT?
-Sodium AND salt
-Water
-Amino acids
-Glucose
- Urea
*SWAG - U
What are the active transport substances?
- Glucose, amino acids, and salts
- chloride
- sodium
*S(sodium)orry, P(PCT)weD(DCT)e C(chloride)AH(Ascending looop of Henle) P(PCT)a GAS (Glucose, amino acids, Salt)?
What are the passive transport substances?
-water
-urea (40% are reabsorbed)
- Sodium
for passive transport, water is reabsorbed where?
PCT, DLH, CD
For passive transport, where is urea reabsorbed?
PCT, ALH
In passive transport, sodium is reabsorbed where?
ALH
in active transport, glucose is reabsorbed where?
PCT
in active transport, amino acids are reaborbed where?
PCT
In active transport, salt is reabsorbed where?
PCT
In active transport, chloride is reabsorbed where?
ALH
in active transport, sodium is reabsorbed where?
PCT and DCT
Passive reabsorption of water takes place in all parts of the nephron except the what?
except the ALH
reabsorption has limitations. What is this limitation called?
renal threshold
Why do patients with DM have glucosuria?
because a person with DM has too much sugar. and it exceeds the renal threshold
What is the glucose renal threshold?
160-180 mg/dL
sodium is actively transport in all part of the nephron except in the ???
except in the Ascending loop of Henle
This is actively transport in all part of the nephron except in the Ascending loop of Henle
Sodium
What does “Tm” mean?
Maximal tubular reabsorptive capacity
the maximal rate of reabsorption of a solute by the tubular epithellum per minute (milligrams per
minute).
maximal tubular reabsorptive capacity
Reabsorptive capacity varies with each solute and depends on the what?
depends on the GFR
the plasma concentration at which active transport stops is termed the ???
the renal threshold
the glucose renal threshold is 160-180 mg/dL or equivalent to what?
equivalent to 350mg/min
what is the sodium renal threshold?
110 to 130 mmol/L
Renal concentration begind where?
begins in the DLH and ALH
The final concentration of urine continues to where?
to the COLLECTING DUCT
Water is removed by osmosis in the WHERE?
DLH
This is removed by osmosis in the DLH
WATER
Sodium and chloride are reabsorbed wherE?
in the ALH
The movement of water across a semipermeable membrane in an
attempt to achieve an osmotic equiibrium between two compartments or
solutions of differing osmolality (i.e., an osmotic gradient).
Osmolality
What mechanism is OSMOLALITY?
Passive
T/F: Passive transport required NO energy
true
this serves to maintain the osmotic gradient of the medulla
contercurrent mechanism
ADH is responsible for the reabsorption of ???? in the DCT and CD of the kidney
What is the effect of ADH (Vasopressin) on renal concentration when there is INCREASED BODY HYDRATION?
Increased body hydration = decreased ADH = Increased Urine volume = DILUTED or low S.G
What is the effect of ADH (Vasopressin) on renal concentration when there is DECREASED body hydration?
Increased ADH = Decreased volume = concentrated or high S.G
What is the S.G measurement when body hydration is INCREASED?
Diluted or low S.G
What is the S.G measurement when body hydration is DECREASED?
Concentrated or High S.G
When the body is dehydrated what will happen to water?
Water will be reabsorbed.
*Hindi yan ilalabas as urine dahil dehydrated nga. Irreasborb niya
When the body is dehydrated, water will be reasborbed. What hormone will aid in the reabsorption of water or retention of water?
ADH or vasopresson
What happens to urine volume when ADH is decreased?
Increased urine volume
What happens to urine volume when ADH is increased?
decreased volume
What are the new methods for tubular reabsorption?
-S.G
-Osmolality
What are the old methods for tubular reabsorption?
-Fishberg
-Mosenthal
*these methods are inconvenient and obsolete. WHY? Dahil 24 hours kang bawal uminom ng tubig. No fluid intake for 24hrs
This measures the number of particles/solute in our urine.
Osmolality test
This measures only the number of particles (solute) on solution
osmolality test
What is the normal urine to serum ratio should be?
1:1 to 3:1
*3:1 is the BEST answer
This was the first principle incorporated into clinical osmometers, and many
instruments
measurement of FREEZING POINT DEPRESSION
The other instrument used in clinical osmometry is called ?
Vapor pressure osmometer
The actual measurement
performed in clinical osmometry, however, is that of the what?
dew point
This is the temperature at which water vapor condenses to a liquid.
dew point
What are the 2 types of Diabetes Insipidus?
- Renal DI
- Central DI
Renal DI is a.k.a?
Nephrogenic DI
Central DI is a.k.a?
Neurogenic DI
DI is a disorder related to what hormone?
ADH
What are the 3 Ps of DI?
- Polyuria
- Polydypsia
- Polyphagia
What is the results of urine osmolality for Neurogenic DI?
Urine osmolality > 800mOm
what is the serum ratio in the urine for neurogenic DI?
serum ratio is 3:1
what is the urine osmolality result for nephrogenic DI?
Urine osmolalality < 400mOsm
what is the serum ratio of urine in nephrogenic DI?
1:1
This type of DI has urine osmolality of > 800mOsm
Neurogenic DI
This type of DI has a urine osmolality of <400mOsm
Nephrogenic DI
This type of DI has a serum ratio of 1:1
Nephrogenic DI
This type of DI has a serum ratio of 3:1
Neurogenic DI
What is the ADH level for neurogenic DI?
DECREASED ADH
What is the ADH level for nephrogenic DI?
Normal to increased ADH
This type of DI has a problem with the production of ADH
Neurogenic DI
What organ produces or makes ADH?
Hypothalamus
This type of DI has ADH, however, does not RESPOND to ADH
Nephrogenic ADH
This measures the NUMBER and SIZE of particles (solute) on solution
S.G
*Dalawang letters si S.G kaya dalawa ang immeasure niya (number and size). Meanwhole si osmolality test, measures only the NUMBER of solutes
what type of test are Fishberg and Mosenthal?
Water deprivation tests
In this test, patients are deprived of fluids for 24 hours before measuring S.G
Fishberg
This test is compares the volume and S.G of day and night urine samples
Mosenthal
This is determined by first calculating the osmolar clearance using the standard clearance
formula
Free water clearance test
This is used to determine the ability of the kidney to respond to the state of body hydration
Free water clearance test
This indicates how much water must be cleared each minute to produce a urine with the same osmolality as the plasma
Calculating osmolar clearance
This is required to compute free water clearance
Osmolar clearance
What is the formula for osmolar clearance?
(Urine osmolality X urine volume) / (Plasma osmolality)
What is the formula for free water clearance?
Osmolar clearance - urine volume
This is the major organ that regulates water level
kidneys
This involves the passage of substances from the blood in the peritubular capillaries to the tubular filtrate
Renal secretion
involves the passage of substances from the blood in the peritubular capillaries to the tubular fitrate
renal secretion
In this process, it comes FROM the blood vessel to the tubules
Renal secretion
In renal secretion, this involves the passage of substances from where?
from the blood in the peritubular capillaries to the tubular fitrate
What are the 2 major functions of tubular secretion?
1-ELIMINATION of waste products NOT filtered by the glomerulus
2-REGULATION of acid-base balance in the body through the secretion of HYDROGEN IONS
What are the 2 major regulators of the acid-base content in the body?
-lungs
-kidneys
How does the kidney regulate acid-base balance?
(1) Through secretion of hydrogen in the form of
-ammonium ions
-hydrogen phosphate
-weak organic acids
(2) by the reabsorption of bicarbonate from the filtrate in the convoluted tubules
What form of hydrogen is secreted by the kidneys and seen in the urine?
-ammonium ions
-hydrogen phosphate
-weak organic acids
This can result in metabolic acidosis or renal tubular acidosis
Disruption of secretory function of the renal
Disruption of secretory function of the renal can result in what?
can result in metabolic acidosis or renal tubular acidosis
This is a state wherein the kidney is unable to produce an acid urine
Renal tubular acidosis
What is the urine pH for renal tublar acidosis?
Alkaline/Basic
What is the blood pH for renal tubular acidosis?
Acidic
Tubules to BV: What process?
Tubular reabsorption
BV to tubules: What process?
Tubular secretion
What are the tests for renal secretion and blood flow?
-PSP dye excretion test
-PAH
- titratable acidity
- Urinary ammonia
What does the test PAH stand for?
phenolsulfonphthalein
What does the PAH test stand for?
Para amino hippuric acid
This test for renal secretion and blood flow is considered obsolete?
PSP dye excretion test
Which test for renal secretion and blood fow is MOST COMMONLY USED
PAH test
This test has the disadvantage of being exogenous
PAH
This chemical meets the criteria needed to measure renal blood flow
PAH
This nontoxic substance is loosely bound to plasma proteins, which permits its complete removal as the blood passes through the peritubular capillaries
PAH
This aspect of PAH permits its complete removal as the blood passes through the peritubular capillaries
Plasma proteins
These can be used to determine the defective function
- measurement of urine pH
- Titratable acidity
urinary ammonia
measurement of urine pH, titratable acidity, and urinary ammonia can be run simultaneously on what?
on either fresh or toluene-preserved urine specimens
