NONPROTEIN NITROGENOUS COMPOUNDS Flashcards
Give me the 4 NPNS
- Urea
- Creatine
- Uric acid
- Ammonia
________ is an amino acid
Creatine
Chemical name of creatine
Methyl guanidine-acetic acid
__________ can be converted into the phosphocreatine
creatine
___________ is storage mechanism muscle cells use to regenerate the cells primary source of energy ATP
Phosphocreatine
ATP meaning
Adenosine triphosphate
__________ is the waste product formed muscle from high energy storage compound, creatine phosphate (phosphocreatine)
Creatinine
Creatine synthesized primarily in the liver from _______, _______, and _______
arginine, glycine, methionine
AGM
transported tissues and is converted to phosphocreatine which serves as __________
Creatine - high energy source
It is an endogenous substance with a MW of 113 Da
Creatinine
It is a waste product of muscle metabolism
Creatinine
Released into the circulation at a relative constant rate in proportional to an individuals muscle mass
Creatinine
what are the disease correlated with creatine
Muscle disease
Muscular dystrophy
Poliomyelitis
Hyperthyroidism
Trauma
What are the disease correlated with creatinine
abnormal renal function
Give me the advantages of GFT
Endogenous substance with constant rate of production
Not bound to plasma protein
Not reabsorbed by the tubules
Only a small amount is secreted by the tubules
Give me the disadvantages of GFT
Depends mainly on muscle mass
Quantity of meat ingestion can substantially influence the total daily production
Method is subjected to many interferences
Why we need to measure the creatinine
To determine the sufficiency of kidney function and the severity of kidney damage
To monitor progression of kidney disease
What happens to creatinine level in both blood and urine if the patient has renal function
decrease in urine
and increase in blood
Remedy: increased creatinine
dialysis or kidney transplant
Creatinine: below normal range =
muscle
dystrophy
is an important diagnostic tool to
assess renal function
serum creatinine level
Most widely used marker for Glomerular Filtration Tests
(GFTs)
CREATININE
Measures how well creatinine is removed from blood by
kidneys (which reflects glomerular filtration rate (GFR))
Creatinine Clearance Test
Ucr
Urine Creatinine
Vur
Urine Volume
Pcr
- Plasma Creatinine
1440 mins/24 hrs -
Constant number
1.73 -
constant number
A
Area or service of area
Creatinine reacts with __________ (trinitrophenol) in alkaline
solution to form a ___________ chromogen
picric acid
red-orange
Creatinine reacts with picric acid (trinitrophenol) in alkaline
solution to form a red-orange chromogen
DIRECT JAFFE REACTION (1886)
PFF + Aluminum Magnesium Silicate
Fuller’s Earth
PFF + Sodium Aluminum Silicate
■ Eluted and reacted with alkaline picrate
Method of Hare (Addition to Lloyd’s Reagent)
______ is mixed with alkaline picrate and the rate of change
in absorbance is measured
Serum
interferences of folin-wu method
Acetoacetate, Acetone, Ascorbate,
Glucose, Pyruvate
kinetic jaffe reaction
alpha-ketoacids and cephalosporins
More than one enzyme used in reaction process to
quantitate creatinine.
COUPLED-ENZYMATIC METHOD
2 most commonly used enzymatic production:
Creatininase-CK Method
Creatininase-Hydrogen Peroxide Method
measurement of creatine from reduced
form to oxidized form at 340nm. The
reaction happens only if an oxidized
form of NAD is achieved
● Creatininase-CK Method
Has a MW of approx. 11,800 Daltons
BETA-2-MICROGLOBULIN
● Has a MW of approx. 13,000 Da
CYSTATIN C
Polymer of fructose
● Extremely stable substance that is not reabsorbed or
secreted by the tubules
● Not a normal body constituent
● Not routinely done because necessary for continuous IV
infusion
● Ideally reference method but not usually done due to its
laborious procedure
INULIN
● Also known as prostaglandin D2 synthase
BETA TRACE PROTEIN
● 2-(alpha-mannopyranosyl)-L-tryptophan (MPT)
TRYPTOPHAN GLYCOCONJUGATE
USE OF RADIOISOTOPES
● ex. technetium diethylenetriaminepentaacetic
REFERENCE STANDARD
Isotope dilution-mass spectrometry
● Requires a lot of sample (large sample of pre-incubation)
● sample used: plasma or serum (actual set-up: serum only)
Creatinine in serum or urine is stable for at least __________
at least 7 days at 4 oC
Urine specimens should be refrigerated or frozen if
longer than ___________
4 days
avoid starving
● Alpha-keto acids/ketones
avoid because it can potentially falsely increase
creatinine
Cephalosporins, Dopamine, Lidocaine
False Decrease
Hemoglobin and Bilirubin
Decreased in kinetic methods
Uric Acid
interfere Peroxidase
Ascorbic acid
Inhibitor of cysteine proteinase
● Produced by all nucleated cells at constant rate
● Freely filtered and completely reabsorbed in the PCT
(normally not seen in urine)
● Plasma concentration appear to be unaffected by gender,
race, age, and muscle mass
● Measurements are difficult and expensive - NOT routinely
used
cystatin C
Dissociates from human leukocyte antigens at a constant
rate
● Rapidly removed from the plasma by glomerular filtration
then reabsorbed completely by the PCT
● Not reliable in patients with immunologic conditions >
multiple myeloma & lymphoma (increased production of
WBC which has nucleus)
● found in nucleated cells
Beta2-microglobulin
PFF meaning
Peptide fragment fingerprinting
Addition to Lloyd’s Reagent
Methods of Hare
Eluted and reacted with alkaline picrate
Methods of hare
IBW
Ideal Body weight
SCR
Serum creatinine concentration
_________ produce erroneous results
Lipemic samples