Clinical Evaluation of the Urinary Tract

Chapter 2 Clinical Evaluation of the Urinary Tract



Introduction and Terminology












Clinical Approach





History









Physical Examination














Laboratory Evaluation of Renal Function



Glomerular Function (values for glomerular function tests in the dog and cat are presented in Table 2-2)





1. Glomerular filtration rate (GFR) is directly related to functional renal mass. GFR is the gold standard for the assessment of renal function and detection of renal disease progression. Determination of renal blood flow (RBF) also can be useful in detecting progression of renal disease, but is less commonly evaluated than GFR. Unfortunately, GFR is not routinely measured in the evaluation of renal function. Instead, surrogates for GFR such as blood urea nitrogen (BUN) and serum creatinine concentrations are used because they are more easily determined than is GFR. An ideal substance for estimation of GFR should be produced at a constant rate in the body, have little binding to plasma proteins, be freely filtered, and not undergo tubular reabsorption or secretion.

b. Serum creatinine concentration. Normal serum creatinine concentrations are 0.3 to 1.3 mg/dL in the dog and 0.8 to 1.8 mg/dL in the cat. An individual patient’s serum creatinine concentration will increase over time with progression of renal disease, and increasing serum creatinine concentrations should not be ignored even if the results still are within the reference range.






c. BUN and serum creatinine concentrations often both increase during disease processes. Neither one is more sensitive than the other.




d. The relationship of BUN and serum creatinine concentrations to GFR is a rectangular hyperbola.





Renal Clearance













Radioisotopes









Serum Phosphorus Concentration












Urine Protein









5. Urine protein/urine creatinine ratio (UPr/UCr).







Jul 10, 2016 | Posted by in INTERNAL MEDICINE | Comments Off on Clinical Evaluation of the Urinary Tract

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