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• Dr. ATUL TIWARI (M.D.) INTERNATIONAL UMPIRE - (Table Tennis) Sr. VICE PRESIDENT- MP Table Tennis Asso. NATIONAL AWARDEE- S. Radhakrishnan Award (For- Teaching Excellence) PROFESSOR- Physiology-JMC- Jhalawar (RAJ) PRESIDENT- Medical Teacher Asso (JMCTA) - JMC PRESIDENT-Student Welfare Society (SWS) -JMC CHIEF NODAL OFFICER- Medical Education Unit (MEU) - JMC CONVENER- Anti-Ragging Committee (ARC) - JMCCHIEF NODAL OFFICER- College Website Committee (CWC) - JMC CHIEF ORGANIZER- Cultural, Literary. Fine Arts & Sports- JMC Secretary- Gwalior Dist. TT Association Ex- Secretary- IMA- Gwalior (4 Yrs) Ex- National Office Secretary- NMO (6Yrs) Ex- Radio Singer (BL- Akashwani) Ex- Radio Announcer (Casual- Akashwani) - Poet &, Prose & Script writer - Stage Anchor - Music Composer. Contact- 9602691106. 9414226811. 9826224474 (Gwl) • INULINE CLEARANCE NOTHING OF THIS SHOULD BE OMMITED Plasma Clearances • Renal clearance of a substance is the volume of plasma that is completely cleared of the that substance by the kidneys per unit Time. • However this definition is quite abstract because there is no volume of plasma that is cleared COMPLETELY! • (Basic formula is C=U X V/P (Put “s” with all except “V”) Cs = Us X V/ Ps Cs X Ps = Us X V Cs = Rate at which Plasma that is cleared of a substance each min (ml / Min) Us = Conc. of Substance In Urine (mg / ml) Ps = Plasma Conc. Of substance (mg / ml) V = Urine Flow Rate (ml / Min) BY- DR. ATUL TIWARI 3 Inulin Clearance If a substance is freely filtered (filtered as freely as water or Glucose) but is not reabsorbed or secreted by the renal tubules, Than its clearance rate would be equal to GFRAs per formula (I) Ci = Ui X V = GFR Pi OR Ci X Pi = Ui X V = GFR X Pi (Filtered Load) OR (II) Clearance rate will be equal to GFR & Its rate of excretion in Urine Ci X Pi = GFR X Pi = Ci = GFR = Ui X V OR (III) Clearance value will be equal to filtered Load Ci X Pi = GFR X Pi (Filtered Load) 4 Inulin Clearance & GFR Inulin is the substance that is filtered completely in Glomerulus & it is neither secreted nor reabsorbed in tubules. Other substances that have been used clinically to estimate GFR include radioactive iothalamate and Creatinin. Please remember that Ci is Clearance Rate & is = Ui X V / Pi While Ci X Pi is Clearance Value & is = Ui X V Value & importance of both are same in normal conditions. BY- DR. ATUL TIWARI 5 Calculation for Inulin Since Pi is 1 & V is 1 under normal conditions so GFR = Ui = Ci Please note that-if Inulin was 1mg / ml in Plasma & was Completely filtered than its Conc. in Urine would be 125mg /ml because GFR is125/ ml/Min. It was not re-absorbed at all. At this GFR Urine flow is 1 ml / Minute So Here- Ci = GFR & Since Ci = Ui X V / Pi so GFR would also Be the same I.E. GFR = Ui X V / Pi OR GFR X Pi (FL) = Ci X Pi = Ui X V / Pi (I.E. FL = Clearance value) I.E. -GFR X Pi (125 X 1) = Cinulin X Pi (125 X 1) = Ui X V (125 X 1) Or GFR = Ci = 125ml (Ui) X 1ml / Min (V) / 1mg / ml (Pi) = 125ml / Min BY- DR. ATUL TIWARI 6 Estimation of GFR BY Inulin clearance Please note that same is the formula for Cs so Ci = Ui X V/Pi= GFR OR Cin = 125 X1 / 1 = 125ml / Min = GFR BY- DR. ATUL TIWARI 7