chemistryl
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| Nitrogenous waste that is excreted by the kidney via | glomerular filtration.
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| Tubule reabsorption occurs | 40-60percent, depending on flow rate.
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| Urea | important for renal medullary concentration gradient (Na too).
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| BUN primarily used as | an indicator of GFR.
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| Azotemia | (increased circulating nitrogenous waste, BUN.
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| Pre-renal | reduced renal perfusion.
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| Renal | primary kidney disease.
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| Post-renal | ureter, bladder, urethral obstruction or rupture
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| BUN interpreted in light of | urine SG.
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| Adequate min SG that is consistently | attained in healthy animal when faced with a need for water conservation.
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| Dog SG | > 1030.
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| Cat SG | >1035.
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| Others SG | > 1025.
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| Increased BUN and adequate SG | Renal tubules are concentrating = pre-renal azotemia,Decreased GFR.
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| Increased BUN and inadequate SG (isosthenuric1008-1012, concentration of plasma | Primary renal disease suspected.
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| Low sensitivity and specificity | BUN.
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| 3/4 of both kidneys must be non-functional before BUN will | elevate.
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| Many other factors influence level of circulating levels of | BUN.
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| Production of BUN Primary source is | dietary protein.
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| Ingested protein is converted to | ammonia by bacteria in the gut.
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| Ammonia diffuses across the gut into | portal circulation and carried to the liver.
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| Liver converts ammonia to | urea.
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| Minor elevations of BUN | High protein diet,GI hemorrhage acts as a high protein meal.
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| Liver disease | Decrease hepatic conversion of ammonia to urea,Low urea and high ammonia seen.
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| Portosystemic shunt | Ammonia absorbed by the gut is not carried to the liver.
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| Diuresis | Increased glomerular filtration rate.
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| Creatinine | By product of muscle metabolism.
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| Excreted almost exclusively by glomerular filtration | creatinine.
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| No tubule reabsorption | creatinine.
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| Like BUN, used to estimate GFR | creatinine.
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| Less influenced by non-renal factors then BUN | creatinine.
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| Creatinine levels elevated when BUN is normal | Substances known as non-creatinine chromogens are sometimes present in the blood; false elevated levels.
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| Creatinine Production related to | muscle metabolism.
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| Creatinine is degradation product of | creatine energy source of muscle.
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| Freely diffuses out of muscle cells | creatinine.
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| Takes creatinine about 4 hours to | equilibrate throughout body BUN about 1,5 hrs.
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| Specific Gravity Solute concentration Defined | density of urine/density of water.
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| Measured by refractometer | SG.
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| SG is a measure of | tubular function.
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| Adequate concentration min SG that should occur with | need to conserve.
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| Dog sg | > 1030.
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| Cat sg | >1035.
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| Others sg | > 1025.
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| Isosthenuria | SG = 1008-1012.
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| SG Solute concentration is similar to | glomerular filtrate.
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| No tubular function required | sg.
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| Do not describe SG as low or dilute but as | Unconcentrated.
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| Hyposthenuria SG = < 1005 Indicates | dilutional function.
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| Hepatobiliary system Injury Small animal | ALT, AST.
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| Large animal liver | SDH, AST, GGT.
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| ALT alanine aminotransferase only | small animal.
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| increased serum values indicate cell injury cytosolic enzyme | ALT.
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| Dog and Cat ALT primarily from | hepatocytes, muscle can infrequently contribute.
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| muscle contains modest amounts of | ALT.
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| severe muscle injury eg HBC or congenital myopathies may cause increase | ALT.
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| mild to moderate muscle injurty unlikely to cause significant | ALT changes.
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| T 1/2 = 2,5 days in dog, 3,5 hours in cat | ALT.
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| ALT generally magnitude parallels number of cells affected, not | severity or reversibility.
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| AST aspartate aminotransferase both large and small animal | Increased serum levels indicate cell injury cytosolic and mitochondrial.
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| AST highest values occur with severe | cellular injury that includes mitochondrial injury.
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| High activity in liver and muscle | AST.
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| high serum level can result from injury to either organ | AST.
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| must be used in combo with other tests ALT, SDH, CK muscle | AST.
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| also present in RBC hemolyzed samples can contribute to increase values | AST.
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| T 1/2 = < 24 hours in dog and cat,7-10 days in horse | AST.
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| SDH sorbitol dehydrogenase large and small increase indicates | hepatocellular injury cytosolic in all species.
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| T 1/2 very short minutes to hours | SDH.
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| use with other injury enzyme AST having a longer half life | SDH.
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| useful to follow progression | SDH.
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| helpful to determine if AST is increased because of muscle or liver injury | SDH.
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| GGT gamma glutamyltransferase large animal increase mainly due to | chlosestasis but may increase with acute, severe hepatic injury.
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| T 1/2 = 3 days in horse | GGT.
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| Cholestasis | ALP, GGT, bilirubin, urine bilirubin.
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| sensitivity of tests dog | ALP > GGT > urine bilirubin > serum bilirubin.
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| ALP alkaline phosphatase inducible enzyme mostly | bound to hepatocellular membranes less in biliary cells chloestais marker.
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| T 1/2 dog = 3 days,cat = 6 hours,horse = between dog and cat, but more like cat | ALP.
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| Not liver specific | ALP.
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| found in liver | hALP, bone bALP, placenta, intestine, kidney, and leukocytes.
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| also induced by both endogenous and exogenous corticosteroids | cALP in dog.
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| Drugs, steroids and anticuvulsants Phenobarbital | ALP.
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| Interpretation of increased ALP- dog general | < 4X increase is non-specific could be from any of the above sources.
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| > 4 x increase = cholestasis and/or isoenzyme induction | hALP, cALP.
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| ALP 4X increase,3 possibilities | pure cholestasis,pure isoenzyme induction corticosteroids, anticonvulsants,both cholestasis & isoenzyme induction.
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| must interpret ALP with other heptobiliary tests | injury, cholestatis, conjugated bilirubin.
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| ALP-cat | any increase is significant =cholestasis.
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| Cat ALP T 1/2 is | short.
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| Feline liver ALP activity is | 3x lower compared to dogs.
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| GGT gamma glutamyltransferase | inducible enzyme bound to membranes of bile duct epithelial cells and , to a lesser extent hepatocytes.
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| Dogs and cats increased serum levels are liver specific and indicate chlestasis | GGT.
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| GGT large animal increase mostly due to | cholestatsis, but may increase with acute, severe injury.
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| T 1/2 = 3 days in horses probably in dog and cat | GGT.
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| Bilirubin | less sensitive indicators of cholestasis than ALP, GGT.
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| Bilirubin Production and excretions produced during | phagocytoses of senescent RBCs.
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| hemoglobin converted is converted to | heme and globin.
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| globin a protein degreaded to its | amino acid constituents and recycled.
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| heme, degraded to free | unconjugated bilirubin.
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| Unconjugated bilirubin is complexed with | albumin and carried to liver.
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| conjugated by liver with glucuronic acid and excreted in | bile.
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| increase in total circulating bilirubin may result from | prehaptic, intrahepatic, or posthepatic causes.
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| pre-hepatic = | hemolysis increased RBC breakdown, 75 unconjugated.
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| intrahepatic = | both conjugated and unconjugated bilirubin.
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| posthepatic = | 75 conjugated bilirubin.
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| urine bilirubin only conjugated bilirubin passes the | glomerulus.
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| increased urine bilirubin used as indicator for | cholestasis.
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| dog normally renal threshold for bilirubin is | low any increase is significant.
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| cat high renal threshold urine bilirubin only present in | severe cases of liver disease.
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| Decreased Functional Mass loss of functional hepatocytes from severe cirrhosis for example, or from an infiltrative process such as | hepatic lipidosis or neoplasia OR vascular shunt that bypasses hepatocytes.
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| at least 70-80 of functional liver mass must be lost before signs and/or functional assays are altered | urine bilirubin.
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| decreased BUN as compared to creatinine which is often unaffected, unless animal has | very low muscle mass or medullary washout from low urea, causing increased GFR & low creatinine.
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| Can also see Decreased BUN with normal creatinine if | low protein diet or decreased intake, mild anorexia. AMMONIA should be increased along with decreased BUN because of
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| dec albumin from dec synthesis OTHER DDx | inflammation mild dec neg acute phase protein,renal loss,intestinal loss panhypoproteinemia,sequestration exudates,inc vascular permeability,peritonitis,3rd space dz.
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