ClinLab Block 2 Flashcards
Kidney’s selectively clear what waste?
Kidney’s maintain homeostatic regulation by ?
Urea
Water/electrolyte balance
Acid/base balance
What are the four functions of the nephron?
Concentrate urine
Filter blood
Excrete waste products
Reabsorb nutrients
What are four factors that affect renal function?
Renal blood flow
Glomerular filtration
Tubular reabsorption
Tubular secretion
Substances with a molecular weight less than ______ pass into filtrate
70K daltons
Glomerular filtration rate is maintained through what three methods?
Renal autoregulation using myogenic control
Extrinsic neural responses to stress
RAAS mechanism to increase SBP by inc Na reabsorption
Tubular reabsorption begins when _______ and involves near total reabsorption of ___ and is hormonally regulated____ and ___
Filtrate enters PCT
Organic nutrients
Water and Ions
When the plasma level of a substance exceeds the renal threshold, what happens?
What happens if the plasma level of a substance stays above the renal threshold?
Substance appears in urine
Active transport can’t reabsorb substance from filtrate
Define Tubular Secretion
What are the two functions of Tubular Secretion?
Active transport of substances from peri-tubular capillaries into tubular filtrate
Eliminate substances no found in blood
Regulate acid-base balance by secreting H+ and NH4+
Where does final concentration of urine begin?
How is this process regulated?
Average adult daily volume of urine output per day?
Late DCT, continues through collecting duct
ADH
1200-1500mL w/ pH slightly acidic
If we were so over hydrated we would have no ADH which would cause a decrease in what factors?
Osmality ADH release Number of aquaporins Water reabsorption in CD Large volume of diluted urine (Exact opposite if max ADH is present)
Define Polyuria
Define Oliguria
Define Anuria
Inc urine output >2.5L/day
Dec urine output <400ml/day
Severe low output <100ml/day
Diabetes insipidus results from decreased production of ? causing urine to take on a ? appearance
ADH
Truly diluted and low SpecGrav
Whats the difference in DM and DI urine samples?
DM= Looks dilute, high osmality DI= Truly diluted and low SpecGrav
When is oliguria usually seen?
Anuria can be a result of what two factors?
Dehydration
Serious kidney damage
Decreased blood flow to kidneys
Purpose of Random Samples
Purpose of First Morning samples
Routing Screening
Routine screening, Pregnancy, Orthostatic protein
Fasting specimens are collected for?
Why are 2H postprandial collected?
Diabetic screening/monitoring
Diabetic monitoring
When are glucose tolerance tests performed?
Why are 24hr urine collections performed?
Accompanied with blood samples in glucose tolerance tests
Quantitative chemical tests
Why are catheter urine samples performed?
When are mid-stream collections taken?
Bacterial culture
Routine, Bacterial culture
Why are suprapubic aspiration urine samples taken?
Why are three-glass collections taken?
Urine specimens need to be delivered to the lab within _hrs or need to be ___
Bladder urine for bacterial infections, Cytology
Prostate infections
2hrs or refrigerated at 2-6*C
What are some reasons specimens will be unaccepted by the lab?
Not labeled Labels don't match Contaminated Insufficient quantity Improper transportation
What factors will INCREASE in a urine sample?
Odor- bacteria breaking urea down to ammonia
pH- urea breakdown produces loss of CO2
Nitrite- multiplication of nitrate reducing bacteria
Bacteria- multiply
Urine samples under go what three tests?
Physical exam, Chemical analysis, Microscopic
What give urine it’s normal yellow color?
Normal urine color ranges are ?
Variations are due to ?
Urochrome- product of endogenous metabolism which is naturally produced at a constant rate
Pale yellow to straw/very dark yellow to amber
Hydration levels
What causes urine samples to be dark amber or orange?
Conjugated bilirubin
Photo-oxidation of urobilinogen to urobilin produces color change too
Pink/red or brown urine samples are indicative of ?
RBCs in acidic urine due to oxidation of hemoglobin to methmeglobin
RBCs in urine give samples a ___ appearance
If HgB or myoglobin is present in urine the specimen will appear as ?
Cloudy
Red and clear
What causes urine to be brown/black?
Methemoglobin- HgB iron in acidic urine oxidized to methemoglobin
Melanin if PT has metastatic malignant melanoma
Homogentisic Acid is AKA and causes what change to urine color?
Inborn-error of metabolism
Increased excretion in alkaptonuria
Alkaline urine turns brown
Why does melanin appear in urine?
What turns urine orange in color?
PT w/ metastatic malignant melanoma
Pyridium- UT analgesic for bladder infections or Rifampicin
What causes urine to be blue/green?
Bacterial infection of Pseudomonas
Intestinal tract infection from increased urinary indican
Normal non-pathologic urine haziness can be due to what five factors?
Amorphous crystals Squamous cells Seminal fluid Fecal contamination Mucus
Pathologic urine haziness can be caused by what five factors?
WBCs RBCs Bacteria Renal cells Lipids
What conditions cause urine to take on abnormal odors?
Bacterial- noxious
Ketones- sweet
Maple Syrup
Food- asparagus
Clinitests are often performed on pediatric PTs up to what age? This is performed to test for?
2 y/o
Reducing sugars- Galactose, Fructose, Pentose, Lactose
Bilirubin is the result of broken down ____
Conjugated bilirubin can be excreted because?
Heme ring
Water soluble
Why is urobilinogen found in urine?
Water soluble, excreted through kidneys
Most is converted to stool pigmentation
Why would leukocyte esterase be found in urine sample?
Renal threshold for glucose is exceeded when serum glucose exceeds what level?
UTI
170mg, causes glucosuria
Glucosuria w/out hyperglycemia (renal glucosuria) is caused by tubular reabsorption impairment from what two issues?
Pregnancy or heavy metal poisoning
Significance of positive urine glucose results that are renal associated?
Fanconi Syndrome
Advanced renal disease
Osteomalacia
Pregnancy
How are urine samples tested for ketones?
Chemstrip, detects acetoacetic acid only
Not Acetone or hydroxybutyric acid
Positive ketones in urine sample can significant because?
Starvation/acute diet DM High fat/protein, low carb diet Severe exercise Malabsorption Frequent vomiting
Study and review Slides
Slide 52 - 65
Define Specific Gravity
Density of substance to reagent grade water
Proportions of solids to toal volume of specimen and degree of concentration of samples and reported to the third decimal place
Deydration with oliguria will cause what shift in specific gravity and what type of issue?
Diabetes Insipidus will have what type of specfic gravity and urination urge?
High, Solute diuresis, positive glucose and polyuria
Polyuria and low concentration
Define Isosthenuria
What are the three most common causes of isosthenuria chronic renal failure?
Consistent SG of 1.010 isosthenuria= renal tubular damage and loss of tubular function
Diabetic neuropathy, HTN renal Dz, Chronic Glomerulonephritis
What is a more exact measurement of urine concentration, osmolality or SH?
Osmolality- Number of particles in a fluid sample
What are the major clinical uses of osmolality?
Evaluating renal concentration ability Renal Dz tracking Fluid/electrolyte therapy Differential diagnosis of Hyper/Hyponatremia Renal response to ADH
What are the normal ratios of urine to serum osmolality?
At least 1 : 1
After controlled fluid intake 3 : 1
The ratio of urine to serum osmolality can be used to differentiated whethere diabetes insipidus is caused by what two factors?
Dec ADH production= Neurogenic
Inability of renal tubules to respond= nephrogenic
What is indicated if there is a failure to achieve an osmolality ratio of 3:1 aafter ADH?
Collecting duct does not have functional ADH receptors
If concentration takes place after ADH injection= inability to produce adequate ADH
Positive blood results are further tested and can be reactive to what three things?
Intact RBCs, Free HgB, Myoglobin
Hematuria can be caused by what four conditions?
Glomerulonephritis
Lower UTI
Strenuous exercise/menses
Renal calculi
Hemoglobinuria from intravascular hemolysis can be caused by what two conditions?
Hemolytic anemia
Transfusion reaction
hemoglobinuria can be caused by what four conditions?
Intravascular hemolysis
Strenuous exercise
RBC lysis in UT in dilute, alkaline urine
Why is free HgB dangerous to the kidney?
What can cause myoglobinuria?
Damages nephrons
Trauma, rhabdo
How does myoglobinuria appear?
Normal serum
Elevated Ck and LDH
Slide
82 focus on?
Why is urine pH useful?
Acid-base disorder
Acidosis- acidic urine
Alkalosis- alkaline urine
What type of urine pH discourages renal calculi formations?
What is the major serum protein found in normal urine?
Alkaline pH
Albumin- presence tested by Chemstrip
Define Uromodulin
Tamm-Horsfall protein, a mucoprotein synthesized in DCT and involved in cast formation
What is the follow on test for a positive urine protein test?
24hr urine protein determination
>150mg/day triggers electrophoresis test to ID proportion testing
When is protein in the urine considered pathologic?
What level is considered massive proteinuria?
Exceeds 150mg/day or 30mg/dl
3.5g/day
What are the 3 major groups of proteinuria?
Prerenal- non renal diseases
Renal- kidney diseases
Postrenal- protein from below UT/kidney parenchyma
What type of proteinuria result is indicative of pre-eclampsia
Significant proteinuria w/ HTN and edema
What are the low molecular weight plasma proteins?
HgB
MgB
Acute phase reactants to infection/inflammation
Proteinuria can be caused by what five conditions?
Multiple myeloma Renal artery stenosis HTN Fever Muscle injury
What are the two types of renal proteinuria?
Primary- glomerulonephritis
Induced- drug/toxin, systemic diseases
Define Tubular Proteinuria
Defective tubular reabsorption characterized by increased levels of low-molecular weight proteins
(Drug/toxin, severe viral/bacterial infection, Fanconi Syndrome)
Define Polynephritis
What can cause postrenal proteinuria?
Ascending UTI that reaches pyelum or pelvis of kidney
Inflammation of bladder, urethra or prostate
What urinary tract pathogens can cause a color change on a chemstrip nitrite test?
What type of urine sample is preferred for testing for nitrites?
E Coli, Proteus
First morning
What can cause a false negative urine nitrite result?
What can cause a false positive urine nitrite test?
UTI pathogens don’t reduce nitrates
Urine wasn’t in bladder long enough for nitrate reduction to occur
Improper preservation
How are positive bacteriuria results confirmed?
Microscopic examination of urine sediment and culture
Urine sample that tests positive for leukocyte esterase indicates?
Pyuria from infection/inflammation of GU system
Bacterial UTIs that generate positive leukocyte esterase results often generate what other positive result?
Positive nitrite
What type of infections can cause a positive leukocyte esterase result without a positive nitrite result?
Vaginal/urethral Trichomonas infections Yeast Chlamydia Mycoplasma Virus
A positive LE sample but negative for nitrates will be confirmed with what methods?
Microscopic sediment exam
Yeast, bacteria or Trichomonas are observable
What is the purpose of microscopic examinations of urine sediments?
Detect/ID insoluble materials in urine R/WBC Epithelial cells Casts/Crystals Bacteria, yeast, parasites Junk- mucus, sperm, artifacts
Microscopic exams of urine are conducted under two situations
Requested
Abnormal Chemstrip result
RBCs seen on a microscopic exam is associated with ?
Hematuria associated with UTIs ill be associated ?
Glomerular damage
Pyuria
Bleeding into the UT from renal pelvis to urethra is usually seen without ?
Significant proteinuria UT stones Neoplasms Trauma Prostatis
Nephronal hematuira is seen with ?
Proteinuria and RBC casts
Glomerular or tubular disease
A combination of what 3 findings in a urine sample are indicative of a kidney infection?
Mod/heavy proteinuria
WBC casts
Hematuria
How does cystitis present in lab findings?
Hematuria
Small amount of protein
No casts
What is the most frequently seen yet least clinically significant cells found in urine?
Squamous epithelial cells
From entire female urethra
Only lower male urethra
Where do transitional epithelial cells originate from?
What type of procedure can increase the number of transitional eipithelial cells in a urine sample?
Renal pelvis, ureters, bladder and upper male urethra
Catheter
Renal tubular cells in a urine sample can be indicative of ?
Heavy metals
Drug induced toicity
HgB/MgB toxicity
Pyelonephriits
Lipids that pass across the glomerular membrane are absorbed by ?
Renal Tubular Cells that contain lipids are described as oval fat bodies and are commonly seen in ?
Renal tubular cells
Nephrotic syndrome
Casts are unique to what kidney structure and are made where?
Casts are usually found in urine with what chemical properties?
Nephrons, Formed in DCT and CD
Acidic and high concentration, favor precipitation of proteins
Define Stasis
What is the major constituent of casts?
Diminished flow of urine through nephrons allowing time for protein to precipitate in tubules, such as in oliguria
Tamm-Horsfall protein- mucoprotein excreted by renal tubular cells
Where do casts form depending on the substance they’re made out of?
RBCs- highest DCT WBCs- high DCT Epithelial- mid DCT Broad- CD Hyaline- Lower DCT
Hyaline casts can be formed as a result of what four non-pathological things? Pathloglogical?
Non- Strenuous exercise, Dehydration, Fever, Emotional stress
Path- acute glomerulonephritis, polynephritis, chronic renal disease
Presence of cellular casts are indicative of ?
WBC casts are indicative of ?
Serious renal disease
Nephron infection/inflammation
RBC casts are primarily associated with damage to ?
WBC casts are most frequently associated with ?
Glomerulus
Polynephritis
Renal tubular epithelial cell casts are indicative of ?
Fatty casts are associated with?
Intrinsic renal tubular disease and often seen in conjunction with R/WBCs
Renal disease, Nephrotic syndrome, Toxic tubular necrosis, DM
Non-pathologic granules are a by-product of?
Pathologic?
Protein metabolism excreted by tubular cells
Path- degenerated white/epithelial cells and can be seen in any disorder causing cellular cast formation
Waxy casts mark the end stage of ?
Disintegration of cellular casts
Presence indicates severe urine stasis in renal tubules and found in chronic renal failure
Where are broad casts formed and what do they indicate?
In dilated tubules of enlarged nephrons/CDs during severe stasis
Renal failure/end stage renal failure casts
Amorphous urates form in ? urine
Amorphous phosphates form in ? urine?
What type of crystals are seen in ethylene glycol poisoning?
Acidic
Alkaline
Oxalate crystals
What yeast organism is most commonly found in urine?
What parasite?
Candid albicans
Trichomonas, if others are seen indicates fecal contamination
What type of findings can indicate a urine sample was not a clean-catch sample?
Several starch granules
Squamous epithelial cells
Bacteria
Unpreserved urine experiences numerous changes but only three factors increase
pH
Nitrite
Bacteria
Prerenal proteinuria is associated with ? diseases such as?
Non-renal CHF Renal hypoxia from stenosis HTN Fever
Renal proteinuria is acused by ? and contain what two types?
Kidney diseases
Primary or induced- protein leaks through glomerulus due to change in hydrostatic pressure
Primary and induced proteinuria include what diseases?
Primary- glomerulonephritis, nephrotic syndrom
Induced- drug/toxin, systemic diseases
Define postrenal proteinuria
Protein from UT below level of kidney, inflammation of the UT
Cystitis, urethritis, prostatitis
Hyperglycemia is a problem of ?
Hypoglycemia is a problem of ?
Osmotic water loss
Cerebral problems
What is the panel for DM management?
BMP
Glycosylated HgB
Anion gap
Lipid profile
Ketone bodies are acute and typically only occur in ? type of diabetes?
What is an early indicator of diabetes?
Type 1
Microalbumin
Fructosamine and glycated albumin tests are used primarily as monitoring tools for ?
How is serum fructosamine formed?
Help people with diabetes control glucose, not as diabetes diagnosis
Nonenzymatic glycosylation of serum proteins, mostly albumin
A1C can show longer picture if PT is managing their diabetes but what test can be helpful if PT has hemolytic disease or pregnant?
Fructosamine or Glycated Albumin
What are the two testing methods for detecting ketone bodies?
Acetest or KetoDiastix
Most sensitive for acetoacetate only
What are four non-diabetic reasons for hyperglycemia
CF related diabetes
Meds (corticosteroids, BBs)
Organ failure
Shock
For every 100mg/dL increase in blood sugar, plasma sodium decreases by ?
1/7 mmol/L, results in dilutional hyponatremia
What are non-insluin causes of hypoglycemia?
ETOH
Addisons Dz
Hyperinsulinemia
What studies are included in a BMP?
Ca CO2/HCO3- buffer Cl- ECAnion to maintain acid-base balance and facilitates O/CO2 exchange by RBCs SrCr- break down from muscle Glucose K- cardiac muscle contraction Na- nerve conduction BUN
Electrolytes have key roles i nwhat four processes?
Homeostasis
pH regulation
Heart/nerve function
RedOx reactions
What is the major extracellular cation?
What is the major intracellular cation?
What is the major extracellular anion?
Na
K
Cl
Functions of Na as an electrolyte
How are Na levels regulated in the body?
Maintains osmotic pressure, Acid-base balance, Musclular depolarization, Electrical neutrality
Aldosterone, ANP
S/Sx of hyponatremia
Nausea
Weakness
Confusion
Mental impairment
Define Hypo-osmotic Hyponatremia
Depletional:
Loss of ECF water
Low urine Na- extrarenal loss
High urine Na- renal loss
Dilutional- hypervolemia
High urine Na- renal failure
Low urine Na- blood volume decreased
Define Hypo-osmotic Hyponatremia Normovolemic
Isolated NaCl deficit Normal TBF SAIDH Diuretics Hypothyroid Hypoaldernalism
Define Hyperosmotic Hypernatremia
Inc solutes in ECF from extracellular shift of water or intracellular shift of Na to maintain balance between ECF and ICF
Define Isosmotic Hyponatremia
Dec plasma Na
Plasma osmolality, glucose and urea are normal= pseudohyponatremia from electrolyte exclusion
Define Hypernatreima
Always hyperosmolar
Presents w/ tremors, irritability, ataxia, confusion/coma
Hypernatremia can develop from what three situations
Hypovolemia
Hypercolemia
Normovolemia
Define Hypovolemic Hypernatremia
Dec ECF from extra/renal loss of hypo-osmotic fluid leading to dehydration
Extrarenal- concentrated urine, low Na
Renal loss- less concentrated and high Na
Define Normovolemic Hypernatremia
Prelude to hypovolemic hypernatremia
Extrarenal- concentrated urine
Low urine osmo- water diuresis from diabetes insipidus
Define Hypervolemic Hypernatremia
Commonly in hospitalized PTs on hypertonic saline/soidum bicarb
Hyperaldosteronism
Cushings
How are K levels regulated?
Insulin
Catecholamines cause K movement into cells
Acidosis- K into plasma
Alkalosis- K into cells
Define Pseudohyperkalemia
Redistribution of K from ICF to EFT
What is Cl’s physiologic role?
Maintain osmotic pressure and electrical neutrality
Moves passivley with Na and inversely varied to HCO3
Inc nerve resting potential
Where is Cl found?
Serum Plasma CSF Tissue fluid Urine
What will Cl levels be in metabolic alkalosis/respiratory acidosis
Hypochloremia
Hyponatremia
Vomitting
Inc HCO3
What will Cl levels be in metabolic acidosis/respiratory alkalosis
Hypernatremia
Diabetes inspidus
Dehydration
How is BiCarb levels measured?
As the principle component of total CO2
What is the measurement of the metabolic component of the acid-base balance?
Phosphate levels are inverse to what electrolyte?
BiCarb
Ca
What electrolyte is the cofactor for enzymatic reactions?
Define Anion Gap
Mag
Difference between anions (Cl and HCO3) and cations (Na and K)
WHat is the mnemonic for the elevated anion gap acidosis?
MULEPAKS
What does an increase serum anion gap mean?
What does a decreased anion gap measure?
Presence of unmeasured anion which results in increase in the corresponding measured cation
Increase in unmeasured cations resulting in an increase in corresponding anions
An increase in a cationic protein will increase?
Multiply myeloma increases cationic protein which will increase it’s anion chloride
Normal anion gap metabolic acidosis mean?
Non-Gap Acidosis
Gastrointestinal BiCarb loss from diarrhea
Renal BiCarb loss from CAIs, renal tubular acidosis, aldosterone inhibitors or hypoaldosteronism
ABGs measure ? things
pH PO2 PCO2 O2 sats BiCarb Base excess/deficit
Causes of metabolic acidosis
Diabetic ketoacidosis Lactic acidosis Methanol poisoning Ethylene glycol poisoning Renal failure Diarrhea
What are the causes of metabolic alkalosis
Prolonged vomiting
Diuretic therapy
Hyperadrenocortical disease
Exogenous base excess
Causes of respiratory acidosis
Emphysema
Pneumonia
Pulmonary fibrosis
COPD
Causes of preparatory alkalosis
Hysteria
Fever
Salicylate poisoning
Asthma
What are the four parts of a nephron?
Glomerulus
Proximal tubule
LoH
Distal Tubule
What four factors can affect renal function?
Blood flow
Glomerular filtration
Tubular reabsorption
Tubular secretion
What are the four types of nonprotien nitrogen?
NH3
Uric Acid
Urea- majority 75%
Creatinine
How does hyperammonemia occur?
Defect of urea cycle, manifests as neurological abnormality
Majority of ammonia produced in the body is excreted as ? but is not useful for determinating ?
Urea
Kidney function
How is creatinine formed?
Where is creatinine synthesized?
Cyclic anhydride produced as final product of decomposition of phsphocreatine
Kidney, Liver, Pancreas
Creatinine is proportional to ? but is not?
What is the final end state product of purine catabolism?
Muscle mass, Reabsorbed
Uric acid
Define Hyperuricemia
What are the three physiological components of renal function?
Precipitation of salt crystal monosodium urate; Gout
GFR, Renal blood flow, Glomerular permeability
What are four methods of testing renal function on a routine basis?
eGFR
Assess glomerular permeability
Measure non-protein nitrogen containing compounds
Measurement of tubules concentrating ability
What test is a reliable measure of functional capacity of the kidney and is indicative of number of functioning nephrons?
GFR
Urine concentration x urine flow/plasma concentration
Rate of formation of glomerular filtrate depends on ?
Balance between hydrostatic and oncotic forces along afferent arteriole and across glomerular filter
What are four uses of an acquired GFR?
Detect renal insufficiency
Adjust drug doses
Eval therapies for chronic RDz
Pts for PTs waiting kidney transplants
What are the three lab tests to determine eGFR?
Insulin clearance test
Creatinine clearance test
Cystatin C
What test is indicative of the number of functioning nephrons?
The lower a GFR is, ? is present or increasing?
Creatinine clearance from 24hr collection
Kidney function/failure
What are the four methods to assess glomerular permeability?
Dipstick- qualitative, sensitive for detecting albumin
Spot urine ablumin:creatinine ratio
24hr urine protein test- quantitative
Bence-Jones protein
What are the two methods in measuring the tubules concentrating ability?
SpecGrav
Osmolality- more valid
What is the role of Phosphorus and what does an inc indicate?
Strutural integrity of cell membranes
Renal tubular damage and nonrenal acidosis
Definition of CKD
Damage or GFR less than 60mL/min for at least 3mon
What are the three types of acute renal failure?
Pre-renal: hypovolemia
Renal: glomerulonephritis
Post-renal: obstruction of lower UT
What are the causes of chronic renal failure?
Primary glomerular Dz Renal vascular Dz Metabolic Dz w/ renal impairement HTN nephrotpathy Nephrotoxins
What are the two key markers for CKD?
Estimated glomerular filtration
Urine Albumin
AMA renal function panel includes ? tests?
Albumin Ca CO2 Cl Creatinine Urea Nitrogen/creatinine ration Glucose Phosphorus K Na Urea Nitrogen eGFR
What are the three historical marker combos for the diagnosis of acute myocardial infarction?
Myoglobin
Total CPK
CK-MB
What are the seven steps of the pathogenesis of an acute MI
Endothelial injury/inflammation Plaque formation Plaque rupture/thrombogenesis Reduced blood and inc o demand Ischemia Necrosis AMI
What is the gold standard of cardiac biomarkers
Troponins Troponin C- Ca binding Troponin 1- inhibitory component Troponin T 1 and T- derived from myocardium
When do troponin levels peak and reside after a MI?
Inc: 3-12hrs
Peak: 24-48hrs
Return to baseline: 5-14days
What are causes of acute cTN elevation in the absence of acute ischemic heart disease
Trauma CHF Severe valve disease HTN/HOTN Sepsis Vital exhaustion
Which inflammatory marker is secreted into bloodstream within a few hours of infection/inflammation?
C reactive protein- acute phase reactant made by liver
When is CRP levels elecated?
After MI
Sepsis
After surgical procedure
Characteristics of Pentraxin 3
Marker of vascular inflammation made by vascular endothelial cells, smooth muscles, macrophages and neutrophils
More specific the CROP for vessel wall inflammation
Which inflammatory marker is a prognostic biomarker of adverse outcomes in PTs with unstable angina pectoris, MI or CHF?
Pentraxin 2
Characteristics of Homecysteine
Inc risk of coronary heart dz, stroke, vascular disease
Inc due to B9, B6 or b12 deficiencies
More useful as a “potential” marker when family Hx is present
Characteristics of interleuking
Early atherosclerosis marker
Stimulates liver to produce acute phase protein
Elevated IL-6 and CRP associated with development of atherosclerosis and Type 2 diabetes
Characteristics of Myeloperoxidase
Produced by polymorphonuclear leukocytes and macrophages
Inc level is marker of plaque instability
Predictive marker for future CV adverse events
Characteristics of soluble cluster of differentiation 40 ligand
Release indicated plaque rupture and subesquent MI
Characteristics of TNF-a
Pleiotropic cytokine produced by endothelial cell, smooth muscle and macrophage
Produces tissue inhibitors of metalloproteinases by fibroblasts
Elecated levels are indicative of recurrent non-fatal MI or fatal CV event
Characteristics of H-FABP
Transport of FAs, inc levels appears 30min after MI and peaks 6-8hrs, return to normal at 24hrs
Predictive biomarker of mortality after acute coronary syndrome
Characteristics of BNP
32 aa secreted by heart ventricles in response to excessive stretching
Marker for identifying PTs with CHF
Characteristics of IMA
Inc during ischemic conditions
Occur immediately after onset of ischemia and enables early identification of ischemia
Define Stellate cells and their function
AKA Ito cells, located between endothelial lining of sinusoids and hepatocytes
Store Vit A
Synth NO
What are the excretory, synthetic and metabolic functions of the liver?
How are organic anions excreted from the body?
E- bile production, S- plasma proteins, M- barb, aa, lipid, drugs
Extracted from sinusoidal blood, transformed and excreted in bile or urine
How is liver excretory functions assessed?
Plasma concentration of bilirubin and bile acids
Determination of rate of clearance (aminopyrine, lidocaine, caffeine)
Drug metabolic tests in liver transplant/liver dz
Unconjugated bilirubin is tranported to ? by ?
What are the major sources of circulating ammonia is ?
Liver, On albumin, Excreted in bile or urine
Bacterial proteases, Ureases, Amine oxidases
Most ammonia is metabolized into ? by the ?
Urea
In hepatocytes
Krebs-Henseleit urea cycle
The common acquired causes of hyperammonemia are?
Advanced liver disease
Renal failure
Characteristics of Reye Syndrome
Abnormal ? is common in liver disease?
CNS disorder with minor hepatic dysfunction
Abnormal hemostasis
Elevations in unconjugated bilirubin pose greater risk for development of ?
When/how does prehepatic jaundice occur?
Kernicterus
Increased amounts of unconjugated bilirubin are brought to liver cells most commonly from RBC destrution
What are five situations that can cause prehepatic jaundice?
Hemolytic anemia
Chemical exposure
Transufusion reaction
Infant hemolytic Dz
How will prehepatic jaundice present clinically?
Increase: Total bilirubin Conjugated bilirubin Unconjugated bilirubin Urine urobilinogen
Urine Bilirubin- Neg
What causes Hepatic Jaundice
Direct damage to liver cell
Gilberts Dz
Crigler Najjar Syndrome- dec UDP-G transferase
Dubin Johnson Syndrome- no con-bilirubin removal
Rotor’s Syndrome- reduced intracellular binding
Cirrhosis
Hepatitis
Drug induced liver Dz
Neonatal physiological jaundice
How will hepatic jaundice present clinically?
Total bilirubin- inc
Conjugated bilirubin- inc
Unconjugated bilirubin- norm/inc
Urine urobilinogen- norm, inc/dec
Urine Bilirubin- Pos or Neg
How will post-hepatic jaundice present clinically?
Total bilirubin- inc
Conjugated bilirubin- inc
Unconjugated bilirubin- norm/inc
Urine urobilinogen- dec or none
Urine Bilirubin- Pos
What are the liver enzymes AST and ALT responsible for?
Metabolizing aspartate and alanine
ALT- primarily liver and kidney
AST- liver, heart, kidney, pancreas and skeletal muscle
An increased level of AST or ALT is seen in what issues?
Any involving necrosis or hepatocytes, myocardial cells, erythrocytes, or skeletal muscle cells
____ is the most important cause of increase transaminine activity in serum
Liver Dz- ALT is higher than AST
ALT is more specific to hepatocyte damage
Under what conditions to AST levels rise above ALT?
Hepatic Hypoxia in CHF
Liver neoplasia
Alcoholic hepatitis
Active cirrhosis
Increase AST and ALT indicates liver Dz while an increased ALP and GGT indicates?
Biliary disease
Function of GGT
Increased before noticeable increase of AST/ALT in obstructed bile ducts
Common elevation in chronic alcohol abuse (parallel to intake)
Highest in cases of intrahepatic/posthepatic obstruction in liver Dzs
Function of ALP
On cell surfaces of most tissues and catalyzes alkaline hydrolyses of substrates especially in small intestine, bone, liver and placenta
Elevated during bone disorders and liver Dz, Cholestasis, Pagets Dz, disorders involving osteoblasts
Function of Glutamate dehydrogenase (GLD)
Mitochondrial enzyme found in liver, heart and kidney and small amounts in brain, muscle and leukocytes
When are GLD increases seen?
Chronic hepatitis- 4-5x
Cirrhosis- 2x
When are NTP increases seen?
3-6x in hepatobiliary Dz with interference in bile secretion
Function of Glutathione S-Transferases
Catalyze nucleophilic addition for detox reactions
A-GST signals hepatocellular damage of any type of injury
What kind of elevations will be seein in Hepatitis or Alcoholic Liver Disease?
H: Inc AST and ALT
ALD: Inc GGT
Define Cholestatic Liver Dz
Stoppage/inpeded flow of bile
Extrahepatic- obstruction of duct
Lab indicators- Inc Canalicular enzymes (ALP and GGT)
What labs are in an AMA Hepatic Function panel?
Albumin Total protein Prothrombin time Bilirubin GGT ALT AST ALP
Elevated level of amylase indicates?
Acute pancreatitis, mumps or parotitis
Level inc 5-8hrs of Sx and return to normal in 3-4days
Function of Amylase
Function of Lipase
Catalyze breakdown of glycogen and starch
Hydrolyze ester linkage of fats to make alcohols and FAs
How does lipase levels increase with acute pancreatitis?
In 4-8hrs, peak at 24hrs and dec in 7-14 days
Trypsin levels rise in conjunction with what other enzyme?
Amylase
Used to determine severity but of limited clinical value due to delayed results
Done with
Lect 4
