CLEARANCE UNITS

The units of clearance are often confusing to the first-time reader, so let us be sure of the meaning. First, the units are volume per time (not amount per time). The easiest way to think of this is to ask what volume of plasma contains the amount excreted in a given time. Suppose 5 mg of a substance is excreted per hour and 200 mL of plasma contains 5 mg. Then the clearance of the substance is 200 mL/h, ie, 200 mL of volume has been completely cleared of the substance. Again, note the units: volume per time (ie, the volume of plasma from which a substance is completely removed [cleared]).
The general meaning and specific renal meaning of clearance can be illustrated by comparing how the body handles 2 substances with similar-sounding names but very different properties: insulin and inulin. Insulin is the familiar pancreatic hormone involved in regulating blood sugar (glucose). It is a protein with a molecular weight of 5.8 kDa and is small enough to be freely filtered by the glomerulus. Once in Bowman’s space, it moves along with every other filtered substance into the proximal convoluted tubule, where it is largely taken up by endocytosis and degraded into its constituent amino acids. Very little insulin escapes this uptake, and very little of the filtered insulin survives to be excreted in the urine. Thus, the kidney takes part in clearing insulin from the blood; however, because so little appears in the urine, the specific renal clearance is very low (<1 mL/min). However, the body has additional mechanisms for clearing insulin, and its metabolic clearance rate is quite high (half-life less than 10 min). Let us contrast this with inulin. Inulin is a polysaccharide starch of about 5 kDa molecular weight. Like insulin, it is freely filtered by the glomerulus, but it is not reabsorbed or secreted by the nephron. All the inulin that is filtered flows through the nephron and appears in the urine. Thus, inulin’s renal clearance is relatively large. Inulin in the blood is not taken up by other tissues, and the kidneys are the only excretion route. As we will see, this makes inulin a very special substance with respect to assessing renal function.