Renal Function Test (RFT)

A Renal Function Test is a group of blood and urine tests that assess how well
the kidneys are working.
The kidneys filter waste, balance fluids and electrolytes, and regulate blood
pressure — RFTs help check if these functions are normal.
PARAMETERS IN RFT ARE;
1. Serum Creatinine
2. Serum uric acid
3. Serum albumin
4. Blood urea nitrogen [BUN]
5. BUN/Creatinine ratio
6. Estimated glomerular filtration rate [eGFR]
7. Electrolytes
8. Urinalysis components
[Link] CREATININE:
 Creatinine is a waste product formed from the normal breakdown of
muscle tissue and is filtered out by the kidneys.
 It reflects how efficiently the kidneys are removing waste from the
blood.
Normal Range:
 Men: 0.7 – 1.3 mg/dl Women: 0.6 – 1.1 mg/dL
Significance:
Creatinine is a waste product from muscle metabolism. The kidneys normally
excrete it.
High Creatinine Causes:
Acute or Chronic Kidney Disease, Dehydration, Severe infections, Urinary tract
obstruction, swelling
Low Creatinine Causes:
Reduced muscle mass (elderly, malnutrition)
2. Blood Urea Nitrogen (BUN):
BUN measures the amount of urea nitrogen — a waste product made when
the body breaks down protein — that is present in the blood.
Normal Range: 7 – 20 mg/dL
Significance:
Urea is formed in the liver from ammonia and excreted by kidneys so it
indirectly assess the RFT.
High BUN Causes:
Kidney dysfunction, Dehydration, Gastrointestinal bleeding.
Low BUN Causes:
Severe liver disease, Malnutrition, Overhydration.
3. Serum Albumin
Albumin is a major blood protein that helps maintain fluid balance in the
bloodstream and carries hormones, vitamins, and enzymes.
Low albumin may indicate kidney disease or other systemic illness.
Normal Range: 3.5 – 5.0 g/dL
Significance: Albumin maintains oncotic pressure (keeps fluid in blood vessels).
Low Albumin Causes: Edema (Swelling), Ascites (Fluid in Abdomen), Pleural
Effusion (Fluid around Lungs), Muscle Wasting, Delayed Wound Healing,
Increased Risk of Infections.
High Albumin is rare, which can be mainly caused due to dehydration.
4. BUN/Creatinine Ratio:
The BUN/Creatinine ratio is a comparison of the blood urea nitrogen level to
the serum creatinine level.
It helps differentiate the cause of kidney dysfunction or other medical
conditions affecting the kidneys.
Normal Range: 10:1 to 20:1
Significance:
Helps differentiate between kidney and non-kidney causes of urea or creatinine
abnormalities.
High Ratio (>20:1):
Dehydration, Gastrointestinal bleeding, Heart failure, anaemia, high BP
Low Ratio (<10:1):
Liver disease, Malnutrition, Acute tubular necrosis, Kidney dysfunction
5. Estimated Glomerular Filtration Rate (eGFR):
eGFR is a calculated value that estimates how much blood is filtered by the
glomeruli (small filtering units in the kidneys) per minute.
It provides the best overall index of kidney function.
Normal Range: >90 mL/min/1.73m²
Significance:
Best overall measure of kidney function.
Low eGFR: Chronic Kidney Disease (CKD), Acute Kidney Injury (AKI)
Stages of CKD based on eGFR:
o Stage 1 CKD: eGFR >90 [GFR- 90 along with any damage is stage 1]
o Stage 2 CKD: 60–89
o Stage 3 CKD: 30–59
o Stage 4 CKD: 15–29
o Stage 5 CKD (End-Stage Renal Disease): <15
High GFR [rare]: Chronic kidney disease
6. Serum Uric Acid:
Uric acid is a chemical created when the body breaks down purines, substances
found in certain foods and drinks.
Normal Range:
 Men: 3.5 – 7.2 mg/dL Women: 2.6 – 6.0 mg/dL
Significance:
Uric acid is a product of purine metabolism excreted by kidneys, abnormal
levels suggest issues with excretion or metabolism.
High Uric Acid Causes:
 Kidney dysfunction, Gout, Kidney damage, Cardiovascular disease
Low Uric Acid Causes:
 Liver diseases, SIADH (Syndrome of Inappropriate Antidiuretic Hormone
secretion), Kidney wastings.
7. Electrolytes:
(a) Sodium (Na⁺)
Sodium is a major mineral that helps control fluid balance, nerve function,
and muscle contraction.
The kidneys regulate sodium levels to maintain blood pressure and fluid
balance.

(b) Potassium (K⁺)

Potassium is an essential mineral important for muscle function, especially
heart muscles, and nerve signals.
Kidney health is crucial for proper potassium balance.

(c) Chloride (Cl⁻)

Chloride is an electrolyte that helps maintain proper blood volume, pressure,
and pH (acid–base balance).
Works closely with sodium.

(d) Bicarbonate (HCO₃⁻)

Bicarbonate is a buffer that helps maintain the body’s acid–base (pH) balance.
The kidneys help regulate bicarbonate levels by reabsorbing or excreting it as
needed.
ELECTROLYTES NORMAL INCREASED LEVELS DECREASED LEVELS
RANGE LEADS TO LEADS TO

Sodium (Na⁺) 135–145 mEq/L Hypernatremia: Hyponatremia:

Severe dehydration, Nausea, vomiting,
Confusion, irritability, Confusion, seizures,
Seizures coma.
Coma (in very high
levels)
Potassium (K⁺) 3.5–5.0 mEq/L Hyperkalemia: Hyponatremia:
Muscle weakness, Muscle weakness,
Dangerous heart muscle cramps,
arrhythmias (can fatigue, heart
cause cardiac arrest) arrhythmias.
Chloride (Cl⁻) 98–106 mEq/L Hyperchloremia: Hypochloremia:
Metabolic acidosis Metabolic alkalosis
(blood becomes too (blood too alkaline)
acidic) Muscle twitching
Weakness, deep rapid Confusion
breathing
Bicarbonate 22-28 mEq/dl Metabolic alkalosis, Metabolic acidosis,
(HCO₃⁻) (blood too alkaline) (blood too acidic)
Confusion, Rapid breathing
Muscle twitching. (Kussmaul breathing),
Fatigue,
Shock (if severe).

9. URINALYSIS COMPONENTS:
Urinalysis is a laboratory test that analyzes urine to assess its physical,
chemical, and microscopic properties.
The test examines the urine for color, clarity, odor, pH, and the presence of
substances like blood, protein, glucose, ketones, and bilirubin, as well as
cells, crystals, and casts.
a) Proteinuria (Protein in urine)
Normal: Negative
Significance: Early sign of kidney damage, especially in diabetes and
hypertension.
(b) Hematuria (Blood in urine)
Normal: Negative
Significance: Could indicate infection, kidney stones, glomerulonephritis,
cancer.
(c) Glucosuria (Glucose in urine)
Normal: Negative
Significance: High blood sugar (diabetes) or tubular damage.
(d) Casts, Crystals, Cells
Normal: Negative
Significance: Presence can hint at specific kidney diseases.