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Para-aminohippurate (PAH) clearance is a method used in renal physiology to measure renal plasma flow, which is a measure of renal function. [citation needed]PAH is completely removed from blood that passes through the kidneys (PAH undergoes both glomerular filtration and tubular secretion), and therefore the rate at which the kidneys can clear PAH from the blood reflects total renal plasma flow.
Effective renal plasma flow (eRPF) is a measure used in renal physiology [1] to calculate renal plasma flow (RPF) and hence estimate renal function.. Because the extraction ratio of PAH is high, it has become commonplace to estimate the RPF by dividing the amount of PAH in the urine by the plasma PAH level, ignoring the level in renal venous blood.
The renal clearance ratio or fractional excretion is a relative measure of the speed at which a constituent of urine passes through the kidneys. [ 1 ] [ 2 ] It is defined by following equation: c l e a r a n c e r a t i o o f X = C x C i n {\displaystyle clearance\ ratio\ of\ X={\frac {C_{x}}{C_{in}}}}
PAH is useful for the measurement of renal plasma flow. [1]The renal extraction ratio of PAH in a normal individual is approximately 0.92. [2] This means that unlike inulin and creatinine, which are filtered in the glomerulus and ignored by the rest of the kidney, aminohippuric acid is both filtered and secreted, being almost entirely removed from the bloodstream in a normal kidney.
renal blood flow: RBF = 1000 mL/min hematocrit: HCT = 40% glomerular filtration rate: GFR = 120 mL/min renal plasma flow: ... C PAH = 420 mL/min ER = 90% ERPF = 540 ...
In this way PAH, at low doses, is almost completely cleared from the blood during a single pass through the kidney. (Accordingly, the plasma concentration of PAH in renal venous blood 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
PAH is not reabsorbed and is secreted, so excretion = filtration + secretion. As with glucose, the transfer is at the proximal tubule, but in the opposite direction: from the peritubular capillaries to the lumen. At low levels, all the PAH is transferred, but at high levels, the transport maximum is reached, and the PAH takes longer to clear.
ortho-Iodohippuric acid (ortho-iodohippurate, OIH) is an analog of p-aminohippuric acid for the determination of effective renal plasma flow. Labelled OIH has a significantly higher clearance than other radiopharmaceutical yet developed and is eminently suitable for renography. It is eliminated mainly by tubular secretion.
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