Transcript BLI-404-Lecture

Kidney Function Panel
DR. HAILIN WU
DR. YOSEPH FELEKE
Kidney Function Panel
 Kidney Function Panel (blood urea nitrogen
(BUN), creatinine, glucose)
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 (lowprotein and high-carbohydrate diets).
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
Metabolic Panels - Glucose
5
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
HbA1C
6
 Normal findings:
 Nondiabetic adult:
 Good control diabetic:
 Fair control diabetic:
 Poor control diabetic:

2.2-4.8%
2.5-5.9%
6-8%
>8%
This is the percentage of total hemoglobin that appears as
glycohemoglobin.
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.
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 Ca2+ 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much calcium may be withdrawn from the bones that they become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)
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.
Reproductive hormones panel (pregnancy test
(Beta HCG), estrogen, progesterone, testosterone)
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)
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
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.
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
Thyroid Panel
 Thyroid Panel (TSH, T3, T4)
Thyroid Panel
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 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
T4 - thyroxine
T3 - triiodothyronine
Thyroid Panel - TSH
17
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
Thyroid Panel – T4
18
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
Thyroid Panel – T3
19
 Normal value: 70-205 ng/dL
 Causes of increased levels:
 1º hyperthyroidism

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
Grave disease, thyroid tumor
Acute thyroiditis
Factitious hyperthyroidism
 Causes of decreased levels:
 Hypothyroidism
 Pituitary or hypothalamic insufficiency
 Iodine sufficiency/malnutrition
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)
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