Renal blood flow

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Overview

In the physiology of the kidney, renal blood flow (RBF) is the volume of blood delivered to the kidneys per unit time. In humans, the kidneys together receive roughly 20% of cardiac output, amounting to 1 L/min in a 70-kg adult male. RBF is closely related to renal plasma flow (RPF), which is the volume of blood plasma delivered to the kidneys per unit time.

While the terms generally apply to arterial blood delivered to the kidneys, both RBF and RPF can be used to quantify the volume of venous blood exiting the kidneys per unit time. In this context, the terms are commonly given subscripts to refer to arterial or venous blood or plasma flow, as in RBF_a, RBF_v, RPF_a, and RPF_v. Physiologically, however, the differences in these values are negligible so that arterial flow and venous flow are often assumed equal.

Calculation

Renal blood flow calculations are based on renal plasma flow and hematocrit (HCT). This follows from the fact that hematocrit estimates the fractional volume of blood consumed (occupied) by red blood cells. Hence, the fraction of blood that is in the form of plasma is given by 1-HCT.

RPF = RBF(1 − HCT)

Alternatively:

Renal plasma flow

Renal plasma flow is given by the Fick principle:

This is essentially a conservation of mass equation which balances the renal inputs (the renal artery) and the renal outputs (the renal vein and ureter). Put simply, a non-metabolizable solute entering the kidney via the renal artery has two points of exit, the renal vein and the ureter. The mass entering through the artery per unit time must equal the mass exiting through the vein and ureter per unit time:

where P_a is the arterial plasma concentration of the substance, P_v is its venous plasma concentration, U_x is its urine concentration, and V is the urine flow rate. The product of flow and concentration gives mass per unit time.

As mentioned previously, the difference between arterial and venous blood flow is negligible, so RPF_a is assumed to be equal to RPF_v, thus

Rearranging yields the previous equation for RPF:

Measuring

Main article: PAH clearance

Values of P_v are difficult to obtain in patients. In practice, PAH clearance is used instead to calculate the effective renal plasma flow (eRPF). PAH (para-aminohippurate) is freely filtered, and it is not reabsorbed by the kidney so that its venous plasma concentration is approximately zero. Setting P_v to zero in the equation for RPF yields

which is the equation for renal clearance. For PAH, this is commonly represented as

Since the venous plasma concentration of PAH is not exactly zero (in fact, it is usually 10% of the PAH arterial plasma concentration), eRPF usually underestimates RPF by approximately 10%. This margin of error is generally acceptable considering the ease with which eRPF is measured.

References

• Boron, Walter F., Boulpaep, Emile L. (2005). Medical Physiology: A Cellular and Molecular Approach. Philadelphia, PA: Elsevier/Saunders. ISBN 1-4160-2328-3. 
• Eaton, Douglas C., Pooler, John P. (2004). Vander's Renal Physiology, 8th edition, Lange Medical Books/McGraw-Hill. ISBN 0-07-135728-9. 

v • d • e Urinary system, physiology: renal physiology and acid base physiology
Filtration	Renal blood flow - Ultrafiltration - Countercurrent exchange
Hormones affecting filtration	Antidiuretic hormone (ADH) - Aldosterone - Atrial natriuretic peptide
Secretion/clearance	Pharmacokinetics - Clearance of medications
Reabsorption	Solvent drag -Na+ - Cl- -urea -glucose -oligopeptides -protein
Endocrine	Renin - Erythropoietin (EPO) - Calcitriol (Active vitamin D) - Prostaglandins
Assessing Renal function / Measures of dialysis	Glomerular filtration rate - Creatinine clearance - Renal clearance ratio - Urea reduction ratio - Kt/V - Standardized Kt/V - Hemodialysis product - PAH clearance (Effective renal plasma flow - Extraction ratio)
Acid base physiology	Fluid balance - Darrow Yannet diagram - Body water - Interstitial fluid - Extracellular fluid - Intracellular fluid/Cytosol - Plasma - Transcellular fluid - Base excess - Davenport diagram - Anion gap - Arterial blood gas
Buffering/compensation	Bicarbonate buffering system - Respiratory compensation - Renal compensation

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Acknowledgement and Attribution Regarding Sources of Content

Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .