1. DR. HAILIN WU DR. YOSEPH FELEKE Kidney Function Panel

2. Kidney Function Panel (blood urea nitrogen (BUN), creatinine, glucose)

3. Blood Urea Nitrogen (BUN) Test Range and Collection  serum (BUN)  10–20 mg/dL Increased in: Renal failure (acute or chronic), urinary tract obstruction, dehydration, shock, burns, CHF, GI bleeding. Nephrotoxic drugs (eg, gentamicin). Decreased in: Hepatic failure, nephrotic syndrome, cachexia (low- protein and high-carbohydrate diets).

4. Creatinine Test Range and Collection  serum (Cr)  Female: 0.5-1.1 mg/dL  Male: 0.6–1.2 mg/dL Increased in: Acute or chronic renal failure, urinary tract obstruction, nephrotoxic drugs, hypothyroidism. Decreased in: Reduced muscle mass

5. 5 Metabolic Panels - Glucose Normal value: (fasting) 70-110 mg/dL Casual: <or = 200mg/dL Causes of elevated values:  Diabetes mellitus  Corticosteroid therapy  Cushing syndrome Causes of decreased values:  Insulin overdose  Hypothyroidism  Addison Disease

6. 6 HbA 1C Normal findings:  Nondiabetic adult:2.2-4.8%  Good control diabetic:2.5-5.9%  Fair control diabetic:6-8%  Poor control diabetic:>8%  This is the percentage of total hemoglobin that appears as glycohemoglobin.

7. Uric acid Normal Finding: Blood Male: 4.0-8.5 mg/dL Female: 2.7-7.3 mg/dL Uric acid is a product of the metabolism (breakdown) of purines. Purines are chemicals that come from both the breakdown of foods and nucleic acids (DNA) in the body. Excess uric acid can cause the condition called gout. Increase: leukemia or multiple myeloma, hypertension during pregnancy, alcoholism, Down syndrome, lead poisoning, poor diet, liver disease, obesity, and psoriasis. Stress or very strenuous exercise, kidneys failure.

8. Parathyroid Panel (PTH) Normal finding: Intact (whole): 10-65pg/ml Hyperparathyroidism Tumors in the parathyroids elevate the level of PTH causing a rise in the level of blood Ca 2+ at the expense of calcium stores in the bones. So much calcium may be withdrawn from the bones that they become brittle and break. Hypoparathyroidism Causes: accidental removal of or damage to the parathyroids during neck surgery; inherited mutations in the PTH gene; inherited predisposition to an autoimmune attack against the parathyroids; inherited defect in the embryonic development of the parathyroids (DiGeorge syndrome)

9. total prostate specific antigen (PSA) Normal findings: 0-2.5ng/mL is low 2.6-10ng/mL is slightly to moderately elevated 10-19.9 ng/mL is moderately elevated >or =20ng/mL is significantly elevated Elevated: prostate cancer; enlarged or inflamed prostate The PSA test is used primarily to screen for prostate cancer. A PSA test measures the amount of prostate-specific antigen (PSA) in the blood. PSA is a protein produced in the prostate, a small gland that sits below a man's bladder.

10. Reproductive hormones panel (pregnancy test (Beta HCG), estrogen, progesterone, testosterone)

11. pregnancy test Human Chorionic Gonadotropin, Serum (HCG) Normal, < 3.0 mIU/mL 10 d after conception > 3 mIU/mL Thereafter levels slowly decline Collection: Tiger top tube Increased: PRG, some testicular tumors (nonseminomatous germ cell tumors, but not seminoma), trophoblastic disease (hydatidiform mole, choriocarcinoma levels usually > 100,000 mIU/mL)

12. estrogen Normal finding: Female: 4-60 Urine mcg//24 hours Estrogens are steroids. They are primarily responsible for the conversion of girls into sexually-mature women. Increase: Feminization syndromes, precocious puberty, ovarian tumor, testicular tumor, adrenal tumor, normal pregnancy, hepatic cirrhosis, hepatic necrosis, hyperthyroidism Decrease: Failing pregnancy, turner syndrome, menopause, anorexia nervosa

13. progesterone Progesterone Follicular phase:,50ng/dL Luteal:300-2500ng/dL postmenopausal:<40ng/dL First trimester: 725-4400 ng/dL Second trimester: 1950-8250 ng/dL Third trimester: 6500-22,900 ng/dL Progesterone is an endogenous steroid hormone involved in the menstrual cycle, pregnancy, and embryogenesis of humans and other species. Increase: ovulation, pregnancy, luteal cysts of ovary, choriocarcinoma of ovary, hydatidiform mole of the uterus Decrease: preeclampsia, toxemia of pregnancy, threatened abortion, placental failure, fetal death, ovarian neoplasm, amenorrhea, ovarian hypofunction.

14. testosterone Normal findings: Free testosterone: Male:1.6%-2.9% Testosterone is a steroid hormone from the androgen group and is found in mammals. In mammals, testosterone is secreted primarily by the testicles of males and the ovaries of females, although small amounts are also secreted by the adrenal glands. It is the principal male sex hormone and an anabolic steroid. Increase: idiopathic sexual precocity, Pinealoma, Encephalitis, congenital adrenal hyperplasia, Adrenocortical tumor, Hyperthroidism, Testosterone resistance syndromes Decreased: klinefelter syndrome, cryptorchidism, primary and secondary hypogonadism, trisomy 21 (down syndrome) hepatic cirrhosis

15. Thyroid Panel Thyroid Panel (TSH, T3, T4)

16. 16 Thyroid Panel The thyroid panel focuses on three tests to measure thyroid function. The main function of the thyroid is to regulate and control metabolism. The tests included in the panel are:  TSH – thyroid stimulating hormone  T 4 - thyroxine  T 3 - triiodothyronine

17. 17 Thyroid Panel - TSH Normal values: 0.3-3 microunits/mL Causes of increased levels: Primary hypothyroidism (thyroid dysfunction) Thyroiditis, large doses of iodine, radioactive iodine injection Causes of decreased levels: 2º hypothyroidism (pituitary or hypothalamus dysfunction) Hyperthyroidism

18. 18 Thyroid Panel – T 4 Normal value: 0.8-2.8 ng/dL Causes of increased levels: 1º hyperthyroidism Grave disease, thyroid tumor Acute thyroiditis Factitious hyperthyroidism Causes of decreased levels: Hypothyroidism Pituitary or hypothalamic insufficiency Iodine insufficiency

19. 19 Thyroid Panel – T 3 Normal value: 70-205 ng/dL Causes of increased levels:  1º hyperthyroidism  Grave disease, thyroid tumor  Acute thyroiditis  Factitious hyperthyroidism Causes of decreased levels:  Hypothyroidism  Pituitary or hypothalamic insufficiency  Iodine sufficiency/malnutrition

20. Indications of a Urinalysis 1. Appearance: "Dark yellow or amber in color and clear" 2. Specific Gravity a. Neonates: 1.012 b. Infants: 1.002–1.006 c. Children and Adults: 1.001–1.035 (typical with normal fluid intake 1.016–1.022) 3. pH a. Neonates: 5–7 b. Children and Adults: 4.6–8.0 4. Negative for: Bilirubin, blood, acetone, glucose, protein, nitrite, leukocyte esterase, reducing substances 5. Trace: Urobilinogen 6. RBC: Male 0–3/hpf, female 0–5/hpf 7. WBC: 0–4/hpf 8. Epithelial Cells: Occasional 9. Hyaline Casts: Occasional 10. Bacteria: None 11. Crystals: Some limited crystals based on urine pH (see Differential Diagnosis for Routine Urinalysis)