liver and kidney Flashcards
(162 cards)
1
Q
The chief metabolic organ
A
liver
2
Q
functional unit of the liver
A
lobules
3
Q
2 major types of cells
A
Hepatocytes- majority of lobules
Kupffer cells (hepatic macrophage)
4
Q
2 blood supply
A
Hepatic artery-25%
- Portal vein- 75%
5
Q
blood supply in the liver
A
1,500 mL/min
6
Q
secretes plasma proteins,
carbohydrates, lipids, lipoproteins as well as ketone
bodies and enzymes; 12g of albumin is secreted by
the liver/ day
A
Synthetic Function-
7
Q
protects the
body from potentially toxic substances which are
absorbed by the intestine and toxic metabolic by
products such as ammonia
A
Detoxification and Drug Metabolism-
8
Q
Test for liver function includes albumin, as well as vit
K
Assessment of nutritional status and presence of
severe disease involving the liver, kidney and bone
marrow
A
Total Protein
9
Q
Transudates value
A
<3.0 g/dL
10
Q
Interference in TP
A
hemolysis & ictericia
11
Q
Methods for Total protein
A
Kjeldahl Method
2. Biuret Method
3. Folin-Ciocalteu (Lowry) Method
4. UV Absorption Method
5. Refractometry
6. Turbidimetry and Nephelometry
7. Salt Fractionation
8. Coomasie Brilliant Blue Dye
9. Ninhydrin
10. Serum Protein Electrophoresis
12
Q
principle of Serum Protein Electrophoresis
A
Migration of charged particles in an electric field
13
Q
pH of Serum Protein Electrophoresis
A
8.6 (majority of the serum protein are
negatively charged)
14
Q
fastest band to migrate in anode
A
albumin band (53-65%)
15
Q
2nd fastest band to migrate to anode
A
α1Globulin-α1-antitrypsin as the major contributor
(90%)
16
Q
Cancer of plasma cells
Increase of y globulin or gamma spike
Plasma cells produces too many immunoglobulins
A
MULTIPLE MYELOMA
17
Q
Decreased albumin due to decreased hepatic
synthesis.
Increased γ-globulin is also present
Abnormality in 3 bands (albumin, b globulin, and y
globulin)
A
HEPATIC CIRRHOSIS
18
Q
Decrease in albumin and other low-molecular weight
proteins due to increased renal excretion in the urine.
Significant increased of a2 globulin fraction of particularly a2 macroglobin and haptoglobin; and increased in beta globulin fraction particulary beta lipoprotein and complement protein
Decrease albumin and a significant increase of
α2-globulin and β-globulin fractions
A
NEPHROTIC SYNDROME
19
Q
Seen in juvenile cirrhosis
α1-Antitrypsin comprises 90% of the proteins found in
the α1-globulin band
We can observe a flat curve in electrophoretic pattern
A
a1-ANTITRYPSIN DEFICIENCY
20
Q
INCREASED TOTAL
PROTEIN
A
Malignancy, Multiple myeloma, Waldenstroms, & macroglobulinemia
21
Q
DECREASED TOTAL
PROTEIN
A
Hepatic cirrhosis, Glomerulonephritis, Nephrotic syndrome, Starvation
22
Q
Concentration is inversely proportional to the severity of hepatic disease.
A
ALBUMIN
23
Q
Salt Precipitation reagent
A
sodium sulfate salts
24
Q
Globulins are precipitated
Albumin in supernatant is
quantitated by biuret reaction
A
Salt Precipitation reagent
25
Nonspecific for Albumin
Methyl orange
26
Many Interferences
(salicylates, bilirubin)
Presence of drugs such as
aspirin, penicillin, and
sulfonamides’ may interfere
in dye binding activity
2,4’-hydroxyazobenzenebenzoic acid (HABA)
27
Sensitive
Overestimates low albumin
levels
Most commonly used dye
BCG (Bromcresol green)
28
Specific, Sensitive and Precise
BCP (Bromcresol purple)
29
Increased albumin in the
blood
HYPERALBUMINEMIA
30
Decreased albumin in the
blood
HYPOALBUMINEMIA
31
Prolonged tourniquet application causes?
pseudohyperalbuminemia
32
hereditary absence of albumin or inability to synthesized albumin
Analbuminuria
33
Presence of two albumin bands instead of a single
band in electrophoresis.
Associated with excess amount of therapeutic drug in
serum
BISALBUMINEMIA
34
Determine if globulin is higher than albumin
ALBUMIN OR GLOBULIN RATIO
35
originates from the liver; prolonged Prothrombin time
intrahepatic disorder
36
AG ratio formula
𝐴𝑙𝑏𝑢𝑚𝑖𝑛/𝐺𝑙𝑜𝑏𝑢𝑙𝑖n
37
not correlated to liver; normal prothrombin time
extrahepatic disorder
38
prolonged prothrombin
time signifies massive cellular damage
Acute/Chronic Hepatitis
39
Conjugated bilirubin bounded to albumin
Has longer half-life than other forms of bilirubin
Formed due to prolonged elevation of conjugated
bilirubin in biliary obstruction
DELTA BILIRUBIN
40
Delta bilirubin formula
Total bilirubin - direct bilirubin +
indirect bilirubin
41
yellow discoloration of the skin, sclera of the eye
Icterus
42
Indirect Bilirubin: increased
Direct Bilirubin: normal
Urobilinogen: normal
Urine bilirubin: Negative
PRE-HEPATIC JAUNDICE
43
Unconjugated hyperbilirubinemia
PRE-HEPATIC JAUNDICE
44
Failure of bile to flow in intestine or there is an impaired bilirubin excretion
POST-HEPATIC JAUNDICE
45
Indirect bilirubin: normal
Direct bilirubin: increased
Urobilinogen: decreased
Urine bilirubin: positive
POST-HEPATIC JAUNDICE
46
can cross blood brain barrier result
to cause Kernicterus; there will be bilirubin deposition in brain which cause mental retardation
Indirect Bilirubin
47
Caused by disorder of bilirubin metabolism as well as
transport defects; theres a hepatic injury caused by viruses, parasites, and also ?
HEPATIC JAUNDICE
48
Indirect bilirubin:increased
Direct bilirubin:increased
Urobilinogen:decreased
Urine bilirubin:positive
HEPATIC JAUNDICE
49
INHERITED DISORDERS of BILIRUBIN METABOLISM
Gilbert’s Syndrome
Crigler-Najjar Syndrome (Type I & II)
Dubin-Johnson Syndrome
Rotor Syndrome
Lucey-Driscoll Syndrome
50
Characterized by impaired cellular uptake of bilirubin due to genetic mutation in UGT1A1 gene (seen in chromosome 2)
Gilbert’s Syndrome
51
Bilirubin Transport Deficit
Gilbert’s Syndrome
52
Affected individuals may have no symptoms but may
have mild icterus and predisposed acetaminophen toxicity
Gilbert’s Syndrome
53
Conjugation deficit
Crigler-Najjar Syndrome
54
Chronic non-hemolytic unconjugated
hyperbilirubinemia
Crigler-Najjar Syndrome
55
Complete deficiency of the enzyme UDPGT
Crigler-Najjar Syndrome Type I
56
Partial deficiency of the enzyme UDPGT
Crigler-Najjar Syndrome Type II
57
Bilirubin Excretion Deficit
Dubin-Johnson Syndrome and Rotor Syndrome
58
Characterized by intense dark pigmentation of the
liver (Black liver); accumulation of the pigment called
lipofuscin
Dubin-Johnson Syndrome and Rotor Syndrome
59
similar with Dubin-Johnson
Syndrome without the “black liver
Rotor Syndrome
60
Familial form of unconjugated hyperbilirubinemia
caused by a circulating inhibitor of bilirubin conjugation
Lucey-Driscoll Syndrome
61
Principle: Van den Berg Reaction–diazotization of bilirubin to form azobilirubin
BILIRUBIN ASSAY
62
methanol (pink to purple azobilirubin)
Evelyn and Malloy Method
63
caffeine, sodium benzoate? (most commonly used
method, popular technique for discrete
analyte) more sensitive technique than
evelyn and malloy method (pink to blue
azobilirubin)
Jendrassik and Grof Method-
64
Colorless end product of bilirubin metabolism that is
oxidized by intestinal flora to urobilin or stercobilin
UROBILINOGEN
65
responsible for the pigmentation of feces
urobilin or stercobilin
66
Reagent for urobilinogen
p-dimethyl aminobenzaldehyde
67
Test for hepatocellular function and potency of bile duct
BROMSULPHTHALEIN (BSP) DYE EXCRETION TEST
68
Also known as Double
Collection Method
Rosenthal White Method
69
BSP Dose of Rosenthal white method
2mg/Kg body weight
70
After 5 minutes in Rosenthal white method
50% dye retention
71
After 30 minutes in Rosenthal white method
0% dye retention
72
Also known as Single
collection method
Mac Donald Method
73
After 45 minutes in Mac Donald Method
+/-5% dye retention
74
Used to assess the extent of liver damage and to differentiate hepatocellular functional of the ?, which of the mechanical disease
Enzyme Test
75
Hepatic enzymes
- Alanine aminotransferase (ALT)]
- Aspartate aminotransferase (AST)
- 5’ Nucleotidase
- Gamma glutamyl transferase
- Lactate dehydrogenase
- Ornithine Carbamoyl Transferase
76
Diagnostic marker of hepatic failure
Produced by the catabolism of amino acids and by bacterial metabolism in the intestine.
Also released from metabolic reactions in the skeletal muscle
Not useful for renal studies
ammonia
77
increased plasma levels and associated
in encephalopathy
Neurotoxic(ammonia)
78
Preferred specimen in ammonia
Arterial blood w/ heparin or EDTA as
anticoagulant
Serum sample-fist clenching avoided and the
use of tourniquet should be minimal
79
Specimen precautions in ammonia
- Smoking- increased by 100-200ug/L/cigar
- Exercise
- Probing of vein
- Under filing of tube
- Hemolysis
80
common method of ammonia
Berthelot & Glutamate
Dehydrogenase
81
TEST FOR DETOXIFICATION FUNCTION
(ammonia)
Digestion Method
Nesslerization Reaction
Berthelot Reaction
Glutamate dehydrogenase
82
Nitrogen ion in a protein-free filtrate of the specimen
is converted to ammonia using hot concentrated
sulfuric acid in the presence of catalyst
Kjeldahl Method
83
catalyst of Kjeldahl Method
copper sulfate, mercury, and selenium
84
gum ghatti
nesslerization rxn
85
sodium nitroprusside
berthelot rxn
86
yellow end color of nesslerization rxn
low to moderate n2
87
orange to brown end color of nesslerization rxn
high N2
88
produced by berthelot rxn
indephenol blue
89
Main function of kidneys
urine formation; excretion of urine
waste products
90
regulates water and salt in the body,
promotes reabsorption of sodium and excretion of potassium by the kidney
Aldosterone
91
prevents water loss also known as ADH
vasopressin
92
produce by endocrine gland
erythropoietin
93
hormone that stimulates
bone marrow to produce RBCs
erythropoietin
94
Each kidney contains how many nephrons?
1-1.5 million nephrons
95
Functional unit of the kidney
nephrons
96
5 basic parts of nephrons
1. Glomerulus
2. Proximal Convoluted Tubule
3. Loop of henle
4. Convoluted Tubule
5. Collecting duct
97
final site or either
concentrating of urine.
collectingduct
98
major exchange of water and salt
takes place.
LOOP OF HENLE
99
reabsorbs sodium,
chloride, bicarbonate, glucose, amino acid, proteins,urea, and uric acid.
Proximal Convoluted Tubule
100
NPN PERCENT OF PLASMA
contains 20-35 mg/dL of NPN compound
101
MOST ABUNDANT NPN
UREA-45%
102
two second most abundant NPN
Uric acid & Amino acid-20%
103
3RD NPN
CREATININE-5%
104
4TH NPN
CREATINE-1-2%
105
LAST NPN
AMMONIA-0.2%
106
Produced by the catabolism of amino acids and by
bacterial metabolism in the intestine
Excreted by the kidney or consumed by the liver to
produce urea
AMMONIA
107
At normal blood pH, most ammonia exist as?
AMMONIUM IONS
108
liver is unable to detoxify ammonia to
become urea
HEPATIC FAILURE
109
AMMONIA IS USED FOR DIAGNOSIS OF?
hepatic failure
Inherited deficiencies of urea cycle enzymes
Reye’s syndrome
110
acute metabolic disorder of the
liver; most common on children
Reye’s syndrome
111
Major end product of protein and amino acid catabolism
BUN ( Blood Urea Nitrogen)
112
easily removed by dialysis
BUN
113
Formed through the Krebs-Henseleit (Urea) cycle in the liver
BUN
114
First metabolite to increase in kidney disease
BUN
115
Bun:Creatinine Ratio
10:1-20:1
116
End product of muscle metabolism derived from
creatine and creatine phosphate
It is produced as waste product of creatine and
creatine phosphate
CREATININE
117
Creatine is converted to become creatinine in the process called?
dehydration or simply removal of water
118
Creatine phosphate is converted to become creatinine in the process called?
dephosphorylation or simply
removal of phosphate group
119
Synthesized primarily by the liver from
arginine,glycine and methionine
creatinine
120
Measure the completeness of 24 hour urine collection
creatinine
121
Elevated creatinine is found in?
abnormal renal function
122
functional or structural
abnormalities or markers of kidney damage (seen in blood, urine, tissue test, imaging studies) present for less than three months.
Acute Kidney Injury
123
Heating converts creatine to creatinine and the
difference between the two samples is the creatine
concentration.
It is a specialized testing, it is not a part of routine
laboratory procedure
creatine
124
Elevated creatine is seen in?
Muscular dystrophy,
hyperthyroidism, trauma.
125
anything that causes a decrease
Pre-renal azotemia
126
characterized by damage within the kidney
renal azotemia
127
elevated plasma urea
concentration accompanied by renal failure
Uremia/Uremic syndrome
128
It is the major product of purine (adenine and
guanine) catabolism.
It is the final breakdown of nucleic acids catabolism in humans.
URIC ACID
129
It is formed from xanthine by the action of xanthine oxidase in the liver and intestine
URIC ACID
130
Increased BUA and over production of uric
acid
HYPERURICEMIA
131
PERCENT OF INCREASE OF BUA & URIC ACID IN HYPERURICEMIA
25-30% increase
132
- Pain & inflammation of joints by precipitation of
sodium urates in tissues
- Definitive diagnosis: presence of “birefringent crystal
in synovial fluid”
- Increased risk of renal calculi/nephrolithiasis
Gout
133
occurs in patients on chemotherapy for diseases such as leukemia & multiple myeloma
Increased nuclear metabolism
134
an enzyme in the uric acid synthesis pathway, is used to treat these patients.
Allopurinol inhibits xanthine oxidase
135
causes elevated levels of uric acid because filtration and secretion are hindered.
Chronic Renal Disease
136
- Inborn error of purine catabolism
- It is deficiency of hypoxanthine-guanine
phosphoribosyl transferase (HGPRT)
Lesch-Nyhan Syndrome
137
Other Causes of hyperuricemia
1. Secondary to glycogen storage disease
2. Toxemia of pregnancy and lactic acidosis
3. Increased dietary intake
4. Ethanol consumption
138
Decreased BUA
HYPORURICEMIA
139
HYPORURICEMIA includes?
Fanconi’s syndrome
Wilson’s disease
Hodgkin’s disease
Chemotheraphy
Alzheimer’s disease
Parkinson’s disease
140
Disorder of reabsorption in the PCT of the
kidney
Fanconi’s syndrome
141
Overtreatment with allopurinol
Hodgkin’s disease
142
6-mercaptopurine, azathioprine
Chemotheraphy
143
BEST OVERALL INDICATOR OF THE LEVEL OF
KIDNEY FUNCTION
Measures of the clearance of substances not bound to protein
GLOMERULAR FILTRATION RATE
144
how many liters of glomerular filtrate is produced daily?
150 liters of glomerular filtrate is produced daily
145
Removal of the substance from plasma into urine over a fixed time (24 HRS)
CLEARANCE
146
Plasma concentration is inversely proportional to?
CLEARANCE
147
time required to collect urine IN CLEARANCE
1440 minutes
148
ave. body surface of adult individual
1.73
149
ave. body surface of CHILDREN
0.717
150
Reference method FOR TESTING GFR
INULIN CLEARANCE
151
exogenous substance (never produced by the body) produced via IV (500 mL of 1.5%
after administration, urine is collect)
INULIN
152
Alternatives to Inulin
- Radioactive marker: 125I-iothalamate &
99mTc-DTPA
- Iohexoland Chromium 51-labelled EDTA
- Nonradiolabeled iothalamate
153
Best alternative method for inulin
CREATININE CLEARANCE
154
endogenous substance freely filtered by
the glomeruli but not reabsorbed.
CREATININE
155
GRAMS OF creatinine are excreted/day
1.2 -1.5 g
156
Demonstrate progression of renal disease or
response to therapy
Not reliable GFR–urea is freely filtered but variably reabsorbed by the tubules
UREA CLEARANCE
157
Low molecular weight protease inhibitor and produced
at
a constant rate by all nucleated cells.
Indirect estimate of GFR
CYSTATIN C
158
NOT SEEN IN HEALTHY URINE
CYSTATIN C
159
SPECIMEN OF CYSTATIN C
SERUM OR PLASMA
160
GFR is computed using?
Modified Cystatin C Equation
161
Prostaglandin D synthase
A low molecular weight glycoprotein; primarily a 168 amino acids
Belongs to the lipocalin protein family Isolated primarily from CSF
Accurate marker of CSF
Freely filtered by the glomerulus but completely reabsorbed and catabolized by the proximal tubule
B TRACE PROTEIN
162
Not a diagnostic efficient test for glomerular filtration rate, this is increased in condition such as renal disease
B TRACE PROTEIN
