1. I NTRODUCTION TO LABORATORY MEDICINE LECTURE 3

2. R ENAL PROFILE RENAL PANEL Glucose BUN Creatinine Potassium Phosphorous Sodium Albumin BUN/Creatinine Ratio Calcium Chloride Carbon Dioxide (CO2), Total

3. G LUCOSE (4.1- 5.6 MMOL /L) To find out the cause of renal disease. Diabetic nephropathy. BUN (7 to 20 mg/dl) Formed in the liver by the metabolism of the proteins. Kidney function May be low if there is liver pathology even if kidneys are normal

4. BUN/C REATININE R ATIO BUN-to-Creatinine ratio dehydration, that may cause abnormal BUN and creatinine levels. High BUN-to-Creatinine ratios sudden (acute) kidney failure,shock or severe dehydration. A low BUN-to-creatinine ratio, diet low in protein, severe muscle injury called rhabdomyolysis, Pregnancy Cirrhosis syndrome of inappropriate antidiuretic hormone secretion (SIADH). Normal Results: 10:1 to 20:1

5. C REATININE (0.8 TO 1.4 MG / DL ) It is a breakdown product of creatine (muscle protein). Formed in liver and kidney. Excretion is via kidneys so level raises when kidney is diseased. POTASSIUM ( 3.7 to 5.2 mEq/L) the amount of potassium in the blood High blood potassium levels may be caused by damage or injury to the kidneys PHOSPHORUS (0.81- 1.45 mmol/L) Phosphorus is a mineral that makes up 1% of a person's total body weight. High levels of phosphorus in blood only occur in people with severe kidney disease or severe dysfunction of their calcium regulation. Along with excess calcium they may calcify in the soft tissues.

6. S ODIUM (135 TO 145 M E Q /L) High levels of sodium can increase the chance of high blood pressure. If your total body water is low, high sodium levels excessive sweating Diarrhea use of diuretics or burns. If your total body water is normal, high sodium levels may diabetes insipidus Low level of hormone vasopressin. If your total body water is high, high sodium levels may hyperaldosteronism Cushing syndrome, diet that's too high in salt or sodium bicarbonate Low total body water and sodium levels may be due to dehydration, vomiting, diarrhea, over diuresis, or ketonuria An increase in total body water and low sodium levels may indicate congestive heart failure, nephrotic syndrome or cirrhosis of the liver

7. A LBUMIN (3.4 TO 5.4 G / DL ) The albumin test measures the amount of albumin in serum, determines liver synthetic function. liver disease kidney disease, if not enough protein is being absorbed by the body. o It can also result from kidney disease which allows albumin to escape into the urine. Decreased albumin may also be explained by malnutrition or a low protein diet

8. CO2 ( TOTAL ) This test measures the amount of carbon dioxide in the liquid part of your blood. Comes from metabolism. The blood carries carbon dioxide to your lungs, where it is exhaled. Changes in your CO2 level suggest you may be losing or retaining fluid, cause an imbalance in your body's electrolytes. Abnormal levels of carbon dioxide suggest your body is having trouble maintaining its acid-base balance and your electrolyte balance is upset. Normal Results: 20 to 29 mEq/L

9. C ALCIUM (8.5 TO 10.2 MG / DL ) To build and fix bones and teeth help nerves work make muscles contraction help blood clot and help the heart to work. The Calcium test screens for problems with the parathyroid glands or kidneys, certain types of cancers and bone problems, inflammation of the pancreas (pancreatitis), and kidney stones. CHLORIDE (96 to 106 mEq/L) Chloride levels help monitor high blood pressure, heart failure kidney disease. High levels of chloride (hyperchloremia) dehydration, metabolic acidosis Decreased levels of chloride, known as hypochloremia, kidney disorder Addison's disease congestive heart failure

10. B ONE METABOLISM Bone is constantly remodelling Bone resorption= bone formation Why remodelling is necessary? To withstand changing environment To cope with workload To repair damage caused by recurrent microtraumas BONE METABOLISM Osteoclasts and Osteoblasts Osteocytes Encased osteoblasts which are connected to each other by long cellular processes forming a network connected by gap junctions.

12. B IOCHEMICAL MARKERS a) enzyme activity markers of bone formation (connected with osteoblast activity) bone resorption (connected with osteoclast activity) b) bone matrix proteins and resorption products of organic skeletal matrix, which are released into circulation during bone formation and resorption c) inorganic skeletal matrix markers Calcium phosphorus

13. B ONE FORMATION MARKERS

14. C LINICAL SIGNIFICANCE ( BONE ALP) Present in bone, liver, intestine, kidney and placenta. Bone form is produced by the osteoblasts during the bone formation Raised in Osteoporosis. Osteomalacia and rickets Hyperparathyroidism. Renal osteodystrophy Thyrotoxicosis. Acromegaly Bone metastasis and other conditions with increased bone formation. No diurnal variations.

15. B ONE RESORPTION MARKERS MarkerTissue of origin Anlytic al sample Analytical method Hydroxy proline specific for all fibrillar collagen and part of all collagen proteins, present in newly synthesized and mature collagen Bone, skin, cartilage, soft tissue. Urinecolorimetric., HPLC Pyridinoline present in cartilage and bone collagen not present in skin, mature collagen Bone, tendon, cartilage UrineHPLC, ELISA Deoxypyridinoline high concentration in bone collagen, not in cartilage or skin only found in mature collagen. Bone, dentine UrineHPLC, ELISA Telopeptides (N- telopeptide, C- telopeptide) high proportion from bone collagen type collagen Bone, cartilage Serum, urine RIA, ELISA, ECLIA Tartarate resistant Acid Phosphate osteoclasts, thrombocytes, erythrocytes Bone, blood Plasma, serum RIA, ELISA,