Chaptr

Organ Function Tests

Leaming Chjetives
Upon completing this chapter, the learner will be able to:
Explain thyroid function test profile and e Describe the renal function test profile and
interpret the laboratory results interpret the laboratory results
Describe the liver function test profile and
interpret the laboratory results

Chupier Cutne
Thyroid Function Tests P Renal or Kidney Function Tests
Liver Function Tests

INTRODUCTION Kidney function test or RFT includes blood

Organ function tests are the test of the major urea, serum creatinin, uric acid, creatinine
clearance estimated by the glomerular filtration
organs, which help in maintaining the normal rate (GFR).
functioning of the body. Various biochemical tests
are carried out to assess whether particular organ Assessment of concentrating and diluting
is functioning normally or not. lhese inlude iver ability of the kidney provide most sensitive means
of detecting early impairment in renal function.
function tests (LFTs), renal function tests (RFTs)
and thyroid function tests.
The test used to investigate thyroid dysfunc
tion can be performed in vivo or in vitro. These
For LFT, the various tests are serum albumin, include serum T3, T4 and TSH, FT3, FT4, help to
serum globulin, A:G ratio. Unconjugated hyper
bilirubinemia with normai alanine transaminase assess the severity of thyroid disease.
(ALT) activity indicates the presence of hemolyuc THYROID FUNCTION TESTS
jaundice. Conjugated hyperbilirubinemia with
raised activity of the ALT indicates hepatic jaun- Thyroid hormones play akey role in metabolism
dire; however, conjugated hyperbilirubinemia and general functioning of the body. Thyroid
with marked elevation of alkaline phosphatase stimulaing hormone (TSH) regulates the thyroid
(ALP)activity suggests obstructive jaundice. hermones production. Hyperthyroidism and
 iodine are depicted in Figure 2.
othvroidism can be diagnosed by TFTs of Sources of
ich TSH is the most important.
rOid gland is depicted in Figure 1. nHAINT

IODIZED
SEA
SALT

Fig. 2: Sources of iodine

Thyroid
through saliva,
Excretion: Kidney and also
case of lactating
Fig. 1: Thyroid gland bile skin, and milk (in
women). Chapter
yroid Hormones of
by thyroid are Biochemical andPhysiologicalFunctions
Main hormones secreted Thyroid Hormones
triodothyronine (T3) and tetraiodothyronine rate (BMR):
Stimulation of basal metabolic BMR and 8
(T4), thyroxine. stimulate
functioning of all cells Thyroid hormones
Necessary for proper
increase the consumption ofoxygen and heat Organ
and for allbiological processes. production in most of the tissues.
from tyrosine
Thyroid hormones are derived protein synthesis: They
enhance
Effect on
byiodination.
is stimulated by protein synthesis and cause positive nitrogen
Function
hormone secretion increased by
Thyroid
pituitary thyrotropic hormone. balance. Protein biosynthesis is
they are
receptors on thyroid cells inducing the gene transcription. So,
TSH binds to hormnones.
production and considered as anabolic Tests
and stimulates all steps in carbohydrate metabolism: Thyroid
secretion of hormone. Effecton absorption of
hormones promote intestinal
and gluc0
mportant Takeaway glucose, increase glycogenolysis
effect of elevating
neogenesis with an overall
of thyroid
odine is required for the synthesis glucose levels in blood (hyperglycemia).
favors
normones (Fig.2). Effect on lipid metabolism: Thyroxine
jources of iodine are:
Seafood: Tuna, cod, prawns. lipolysis and lipid turnover. Hypothyroidism
cholesterol levels
Vegetables: Green beans, navy
beans,dried is associated with elevated
high-density
seaweed. due to adefective transport by
bananas.
Fruits: Strawberries, cranberries, lipoprotein (HDL).
Decreases. in
Plasma bound iodine (PBI): hyperthyroidism.
hypothyroidism and increases in Abnormalities of the Thyroid
Goiter
bsorption, Storage and Excretion Hyperthyroidism
Absorption: Small intestine.
Storage: lodothyroglobulin-a glycoprotein Hypothyroidisn
Cretinism: Children
months in
in nature can be stored for several
Myxedema: Adults
the thyroid gland.

183
 Goiter Hyperthyrodism
Abnomal enlargemen of the butlertly shaped Hyperthyroidism (overactive
glnd belon the Adam's upple (tbyroid). A when thyroid gland produces too
goiter conmonly develops as a result of éxcess hormoncthyroxine. It can increase.
thyroidmuch)
or deficiency bf jodide or inlammation of the metab
hyroid gland. Substances that interfere with the High Tip
production of thyroid hormone are known as Hyperthyroidism versus Thyrotoxicosis
goiterogenic substances) These includes nitrates, It Hyperthyroidism is characterised by increasea
thiocyanates and some drugs known as thiouracil,
thiourea etc. thyroid hormone synthesis and secretion from
the thyroid gland, whereas thyrotoxicosis refers
the clinical syndrome of excess circulating thyroi
High Tip hormones, irrespective of the source.
Key features Goitrogens
" Thyroid gland
Laboratory Findings in Hyperthyroidism
"
enlarges
lodine deficiency
Maize
Laboratory findings in hyperthyroidis,
Biochemistry " Millet
" Elevated TSH " Potato
depicted in Table 1.
" Mustard seed Table 1: Laboratory findings in hyperthyroidism
Goiter is depicted in igure 3. Condition Plasma Pl£sma
es
totalT3/T4 TSHto:
Applied Graves' disease Increased Decreased Nil

Toxic goiter Increase Decrease Nil

T3-toxicosis T3 increase, Decrease Slug

of T4 normal
Textbook
Decrease
Excess intake Increase
Slugg
of thyroxine

Features of Hyperthyroidism
-Goiter Overproduction of T3 and T4 and decrea
(visibly enlarged TSHlevels.
thyroid gland) Also known as thyrotoxicosis.
Thyroid gland
Causes
Increase in binding proteins
Increase in affinity of binding proteins
Effect of autoantibodies tiove
TSH secreting tumors
Defect in the receptor
Symptoms of Hyperthyroidism
Hyperthyroidism Can acclerate bo
metabolism, causing weight loss and a rapii
irregular heartbeat, nervousness, irritabl
anxiety, increase appetite but weight
Fig. 3: Goiter
diarrhea, rapid heart rate, sensitivity to

184
 atting.Importantsymptomsolhyperthyroidism Surgical removal of part or all of the thyroid.
depicted in Figure 4. Radiation treatment of the thyroid.
Intolerance to heat
High Tip
Fine, straight hair Less often, hypothyroidism is caused by too much
-Bulging eyes or too little iodine in the diet or by disorders of the
Facial flushing pituitarygland or hypothalamus iodine deficiency,
Enlarged thyroid however, it is extremely tare.
-Tachycardia Primary cause: Autoimmune.
nger -‘SystolicBP Secondary cause: Pituitary andhypothalamic
ubbing A Breast enlargement Causes.
Weight loss
Tremors Muscle wasting
‘Diarrhea Symptoms
enstrual changes. Reduced metabolic rate
menorrhea) Lethargy
Localized edema Tolerance to heat
Cold intolerance Chapter
Slow heart rate
Fig. 4: Symptoms of hyperthyroidism Weight gain
Dry, coarse skin 8
agnosis Laboratory findings in hypothyroidism are
perthyroidism is diagnosed by scanning
TSH
depicted in Table 2 Organ
destimation of T3, T4 (elevated) and hypothyroidism
Table 2: Laboratory findings in
ecreased) in plasma. Thyroid is surgically Response
moved in severe cases. Condition T3,T4 in TSH in
Function
bloodblood to TRH
pothyroidism Primary
Decreased Increased Exaggerated
-pothyroidism, also called underactive thyroid, hypothyroidism response
make
is occurs when the thyroid gland doesn't Secondary
Decreased Decreased No
Tests
ough thyroid hormones (T3 and T4) to meet hypothyroidism response
dy's needs.
Cretinism
mportantlakeaWau Congenital iodine deficiency syndrome charac
2crease in T3and T4 production cause terized by impaired physical and mental.develop
pothyroidism. ment, due to insufficient thyroid hormone (hypo
thyroidism) often caused by insufficient dietary
iodine during pregnancy. This cause underactivity
of thyroid at birth,called congenital hypothyroid
uses

pothyroidism has severalcauses, including: ism, and also referred to as cretinism (Fig. 5).
Hashimoto's disease (An autoimmune
disorder cause thyroid not to make enough Important TakeawaU
thyroid hormone). Hypothyroidism in children is associated with mental
Thyroiditis, or inflammation of the thyroid. retardation and retarded physical growth.
Congenital hypothyroidism.

198
 Iy ibe thyod glamd ontrolled by
hoonone, which is nae in the piluitary
called hyoid stinudtg hoone (ISH)
unoum of TSI thal tlhe pituilaly send,
the bloodsrcam depends on de amount
lhat the pituitary sees. If the pituitary sees
dittle 14, then it produces more TSH to tel
thyroid gland to produce more 14. Once h
in the bloodstreamgoes above a certain leve
pituitary's production of TSH is shut off. Typ
fig. 5: Cietinism thyroid function tests are depicted in Table3.
Myxoedema Table 3: Types of thyroid function test
I is a condition
of the skin and dharacterized the swelling Domain
by Description
underlying
waxy consistency, typical oftissues giving a Tests based on " Radioiodine uptake study
Biochemístry patients
underactive thyroid glands. In other words, itwith primary function of " PBI1 estimation
is a the thyroid T3suppression test
hypothyroidism in adults. TSH stimulation test
TRH stimulátiontest
Characteristic Features (Fig. 6) Serum PBI test
Bags under the eyes (mild Tests measuring
Appliedpuffiness under the eyes) swelling or blood level of T3 and T4 level
thyroid hormones TSH level
Puffy face Plasma Tyrosine level
Slowness in physical and mental activities. " In vitro resin uptake of T3
of Tests based on BMR
Textbook metabolic effect of Serum cholesterol level
thyroid hormones "Serum creatinine level
" Uricacid level
" Creatine kinase (CK) enzyme
Immunological WAgar gel diffusion test
test to detect mComplement fixation test
autoimmune Tanned red cell
disease of thyroid hemagglutination (TRCH)
gland
Scanning of thyroid " Radioimmunoassay (RIA)
gland " Enzyme linked
immunosorbent assay (ELIS
" Semi-automatic
? Antigen antibody reaction
" Chemiluminescence

Elisa Washer
Fig.6: Characteristic features of myxedema
The major thyroid hormone secreted by the
thyroid gland is thyroxine, also called T4 because
it contains four iodine atoms. To exert its effects,
T4 is converted to triiodothyronine (T3) by the
removal of an iodine particle. This occurs mainly Ellsa ReNcer
in the liver and in certain tissues where T3 acts,
such as in the brain. The amount ofT4produced
 ction RIA) RCH) st
(ELISA) test
enzymeOup el e T3 y (3 ble
jmalngesofT
dormone
jetabolic
isease) liver(tests
Special : hronic
2stfors roupIVIseases) liverfunction
ynthetic
(marker,
liver) firoteins
(testsPlasma
for SrouplIl: nzyme Liverl :
panelBroup unction
excretory
epatic roup Ssessment
assification
ble able
5): ate lood kcretory
|so pveral 0ver IVER (FreeT4)14(FreeT3) 3 4:
5: referred
of is Nomalanges
I: tests the
TestsClassification
a importantFUNCTION
patient's and 0.39-6.16
ulU/mL
TSH
that vital
of of of detoxification, as
liver Liver provide a organ 0.8-2.0
ng/dL 1.4-4.2
pg/ml 4.4-11.6Female: 0.52-1.85
4.4-10.8
ug/dL
Male: ng/mL Range
" ammonia liver. hepatic TESTS of
Ceruloplasmin Prothrombin
Blood time
" " Gamma-glutamyl
"transferase " " " " " of TFT ate
fetoprotein
(AFP)
AlphaFerritin " ratio
Serum
proteins
Total (GGT) aminotransferase
Aspartate "urobilinogen
Alanine and
Urine:
unconjugated
conjugated, Serum:
and function functions
Alkaline
cholestasis)
(marker (AST)
of (marker liver Function of descibedin
function information th e
and albumin, (marker (marker BileBilirubin; panel, liver body
phosphataseaminotransferase of tests
iron liver pigments, ug/dL
of of tests function
are tests, ofand
globulins,alcoholism) liver ihjury) total, are able4.
as groups
about metabolic,
performs
(ALP)injury) bile
follovws
A/G (ALT) salts
the of
Markers
liverGroup Table
Classification
depicted
of : Classilication
(sGot cholestasis
MarkersGroup
hepatocellular of
ofl : injury Markers dysfunction
Groupl :
indicate enzymeAlkaline
is indicate transaminase Li'Aspartate
ke bloodstream proteins
atenzyme the enzyme Alanine 6:
disorders.
todamagestream. 0Ccurs
Gamma-glutamyltransferase
L-lactate
enzyme alcoholism. (GGT): GGTisblocked
indicate highlyHigher-than-normal low Classification
multiple an important liver in
ALT, Table
enzyme levels.
liver elevated bile liver found liver that isintofound
transaminase
Elevated
but found liver phosphatase AST damaged, based Based
Extremely
organ dehydrogenase duct, damage, Anhelps and energy "
Alkaline "
b |eTotal 6.
Higher-than-normal
cansecreates or damage for is in phosphatase
Gammaaminotransferase
Aspartate
(AST) Prothrombin
Alanine
(ALT) Blood time ratio
A/G conjugated Serum:
total, based
UBGandUrine: Bilirubin,
in in in increase levels the
bile in the or normåly on on
failure. be th e breaking the for ammonia, protein,
levels glutamyl
Bile on Clinical
elevated
elevated liver. duct biliaryblood. certain levels or clinical
liver
muscle metabolize increase. ALT the liver aminotransferase
(ALP): is that (ALT): pigments, clinical
LD disease, present serum
may When damage. bone AST
in (AST): released intothe liver
(LD): down and damage. transferase when aspects
obstructionSerum of helps Aspects
aspects
levels indicatein into ALP aming_acids. cells. ALT albumin
bone levels AST indicated bile
many the any LDlevels
diseases. such ALP
proteins. in convert
can GGT When salts
darmage is mayblood is an
is and
other blood is as may Tests and
Function Organ Chapter 8 are
leads liver may and an an
an is a

187
 Bergh conjugated
aamounts,
purple
illness
illness in decreased conjugated
positive: alcohol.
adding
Serum JaundiceHepatocellular Berghden the this are
diabetic check serum
chronic
in is
produced is and
Normal
or bilirubinden Van Whencolor positive.bilirubinsimmediately
produced
is biphasic.
disease Coagulation
Alcoholic
liver to in
disorders Elevated
Elevated Hey'
+ve s while
Biphasic
Elevated direct be added, both
of statinsFindings
in 7. Van to
undiagnosed
checkup Table water the
positive: increased
with
findings + Bergh Whenis thesaid
Bilirubin
Reaction is indirect
unconjugated, on
called
colorwith alcohol f unconjugated
in 8. in intensified
Laboratory
Annual Therapy depicted
Laboratory Table den soluble. is
insoluble positive.
responseIndirect as Biphasic:serum
in is
reaction
Any mixing
purple whenknown
in jaundiceObstrúctive
Fouchet's
+ve
Van
are Elevated
Elevated Direct
+ve depicted is
Normal Absent
taken il blood-hinning
indicate cases +++ produced
cellsis thandifferent
normal
of about
isbilirubin
bilirubin
clevalcd is
Jaundice ++
and
tie cases cases blood Higher
range
jaundice liver variesbilirubin
PTmay jaundice the the tÍ (bilirubin-albumin
the Tests jaundice is indicate unconjugated 0.2 bilirubin)
be thatred the body. in
(P):is in +ve in
Indirect
in Hemolytic Ehrlich's
+ve problems from
conjugated
also certain Function serum Elevated Elevated Urine
Normal urine Elevated
of through
pigment
is
Increased breakdown bilirubin
conjugated varies
Suspected
liver
metastasis in AbsentAbsent Measurement
Bilirubin
of the may (indirectmg/dL.
cn warfarin, in in urine in
findings findings passes duct
of bilirubin the level bilirubinand
0.4
tine but taking Liver Findings
in yellowish out serum bilirubin)to
clot reaction findings bile
excreted
while bilirubin mg/dL
dannugeas for
Prothronubin Laboratory Conjugated
bilirubin normal
Bilirubin The
mg/dL. 0.1
is such Laboratory 0.2-0.6
ismg/dL, unconjugated
to of or of bilirubin)
mg/dL, serum (free0.7
Bergh Laboratory
blood someoneIndications Normal
laundice bilirubin Unconjugated
Total Laboratory Bile pigments Urobilinogen a liverconcentration
levels to
livet
drugs,
Category Bile
salts
Positive
test is the
Bilirubin eventually
(RBCs). of
Tip 0.8
High mg/dL. complex)
0.2
(direct
by 7: den 8: during normal 0.2-1.0
0.2-0.4
Table Van Table types The from
"
Biochemistry Applied Textbook
of 188
portant Takeaway into bloodstream; this is then
urine. So, in obstructive jaundice, excreted through
nhemolytic jaundice, unconjugated bilirubin is urine contains
hcreased and Van den Bergh test is Indirect positive.
bilirubin;it is called choluric jaundice.
nobstructive jaundice, conjugated bilirubin is Indirect positive
levated, and Van den Bergh test is direct positive. Hemolytic jaundice
nhepatocelular jaundice, a biphasic reaction Direct positive Obstructive jaundice
sobserved, because both conjugated and Biphasic Hepatic jaundice
unconjugated bilirubins are increased.
Urine Bile Salts
ary Bilirubin Normally bile salts (sodium salts of
llcases of jaundice, urine should be examined taurocholic acid and glycocholic acid)
are
he presence of bile pigments (bilirubin), bile present in the bile; but are not seen in urine.
Sand urobilinogen. Only conjugated bilirubin Bile salts in urine are detected by Hay's test.
luble in water and is excreted in urine. Hence, Positive Hay's test indicates the obstruction in
rehepatic jaundice, when the unconjugated the biliary passages causing regurgitation of
ubin is increased in blood, it does not appear bile salts into the systemic circulation leading
rine; hencecalled acholuric jaundice. But in to itsexcretion in urine.
ructive jaundice, conjugation of bilirubin is Useful tests to
distinguish different typesChapter
ng place, which cannot be excreted through jaundice are depicted Organ
of 8
in Table 9.
normal passage, and so it is regurgitated back
e9: Tests usefulto distinguish different types of jaundice
ecimen Test Prehepatic or hemolytic Hepatocellular Posthepatic or obstructive
or retention jaundice jaundice or regurgitation jaundice
od Unconjugated ++ Normal
bilirubin (Van den
Bergh indirect test) Function
od Conjugated bilirubin Normal Excretion is rate ++

(Van den Bergh limiting. It is the first

direct test) impaired activity.
In early phase, it is Tests
increased
bd Alkaline phosphatase Normal 2-3 times increased 10-12 times increased
(40-125 U/L)
sification of jaundiceare depicted in Table 10.
10: Classification of jaundice
Eofbltubin Cass.ofjaundice Causes

njugated Prehepatic or hemolytic Abnormal red cells

" Antibodies; drugs and toxins
" Thalassemia;hemoglobinopathies
" Gilbert's syndrome
" Crigler-Najar syndrome
njugated and Hepatic or hepatocellular " Viral hepatitis
gated . Toxic hepatitis
" Intrahepatic cholestasis
gated or obstructive Posthepatic Extrahepatic cholestasis; gallstones
" Tumors of bile duct
" Carcinoma of pancreas
" Lymph node enlargement in
 11)
Range of LFT(Table Glomerular function
Normal Beference Tubularr
Lable
Nomlrcleencetange of
LFT
tests
" Clearance test funcion tes
Liverfunctionntest
s.bilirubin (total)
S. bilirubin (conjugated)
Normal range
0.1-1.2 mg/dL
Up to 0.25 mg/dL
6.3-8.3 g/dL
" Inulin
. Urea
Creatinine
Protiens in urine
Phenolsulfonphtha.
. Acidification test

S. protein(total)
S. albumin 3.5-5.0 g/dL Routine Clinical Test
Urine examination
S. globulin 2.4-3.5 g/dL
(physical,
A:G ratio
SGOT (AST)
1.5-2.5

5-35 IU/L
microscopic examination) is done
Physical Characteristics of Urine
chemic:
SGPT (ALT) 5-40IU/L Volume: The
S. alkaline
151-471 U/L (children) about 1.5 litersaverage
per
output
day. Urine
of ,h
Biochemistry
Phosphatase 60-170 U/L (adult) may be increased in excess
water
diuretic therapy, diabetes mellit1s
RENAL OR KIDNEY FUNCTION TESTS chronic renal diseases. Urine
Renal function tests are done to access the
function
decreased in excess sweating,volume
dehvd
of kidney since kidney
performs many
edema of any etiology, kidney damage
Applied
functions to maintain bodies homeostasis. important Appearance:
Formationof urine as waste product. Production Clear: Normal urine is straw colore
ofhormones (ervthropoietin, renin and calcitriol). Cloudy: Urine turns cloudy on star
of It is vital to detect any abnormality in its Opalescent due to precipitatiop
at earlier stage. These tests
Textbook function
also help in monitoring phosphates on refrigeration. Presen
the progression of renal disease
dose of potentially renal toxic and adjusting the pus causes cloudiness.
drugs. High color: Concentrated
Examination of Urine Oxidation of urobilinogen to urobilin
Physicaland Chemical Examination Yellow: Bilirubinuria in
jaun
In clinical B-complex intake.
is given onbiochemistry,
urine is tested and report
a urine sample. The
procedure is called Smoky:Red Presence of blood.
urine analysis. Brownish red: Hemoglobinuria.
If the kidneys are not
waste products can accumulate functioning properly,
in the blood
Orange: High levels of bilir
fluid levels can increase to and Rifampicin.
causing damage to the body dangerous volumes,
or apotentially life
Red: Porphyria; Ingestion of red beet.
threatening situation. Numerous conditions and Black: Urine Alkaptonuria; Formic
diseases can result in damage to the poisoning.
Important renal function testskidneys. Milky: Urine chylurja.
examination)are depicted in Table 12. (chemical Odor: Normal urine has a faintly arom.
Table 12: Renal function tests smell due to presence of volatile orga
(chemical
examination)
Glomerular acids. Urine in diabetic Keto acidosis
tests
function Tubular function tests have fruity odor due to acetone.
. Blood urea
Urine concentration test
Color: Normal urine is straw-colored (amt
"Blood creatinine " Urine dilution test yellow) due to the pigment, urochron
Presence of bilirubin makes urine yellow
190 Contd.. jaundiced patients.
 Procedure: Take a clean test tube and
of
Specific gravity: Normal specific gravity
Theoretical extremes prepare Fehlings's reagent by mixing
urine is 1.015-1.025.
specific gravity will equal volumes (about 1mL) of Fehling
are 1.003 to 1.032. The
be decreased in
excessive water intake, in I(copper (1) sulfate) and Fehling I
insipidus. (NaOH, Nak tartarate). The reagent
chronicnephritis,and in diabetesmellitus, in without
prepared is dark blue in colour,
It is increased in diabetes another
phrosis and in excessive perspiration.
In any precipitate inside. Take
ml of the
ronic renal failure, the specific gravity of
urine is test tube and put there about l
edat 1.010. sample being tested. Add equal volume
the
emical Examination of Urine of Fehlings's reagent prepared in
the
previous step. Heat the content of
Proteins: Proteinuria is an important index test tube to boiling. If the test is
positive,
of renal diseases. In normal urine, protein reddish brown (orange, olive-green)
concentration is very low, which cannot be precipitate is formed.
detected by the usual tests. acetoacetic acid,
Ketone Bodies: They are
Measurement of urinary proteins may be and acetone.
carried out to: beta hydroxybutyric acid Chapter
diabetes mellitus,
Ketonuria is seen in
Know about the renal disease von Gierke's
starvation, persistent vomiting,
analyzed by
Define the nature of renal disease disease, etc. Ketone bodies are 8
Define the degree of renal dysfunction Rothera's test.
of urine
E Monitor the response to treatment.
Procedure: Transfer about5mL
Organ
i gm of Rotheras
Blood to a test tube. Add
nitroprusside
Hematuria is seen in nephritis and powder mixture (Sodium
20 gm)
postrenal hemorrhage. 0.75 gm, Ammonium sulphate Function
urine l-2mL
Hemoglobinuria is due to abnormal and mix well. Layer over the
hydroxide.
Occultest tablets of concentrated ammonium
amount of hemolysis.
available for rapid Observe the pink-purple ring at the
and Hemastix stripsare interface.
Tests
testing ofblood in urine. Bilirubin appears in the urine
Reducing sugars (glycosuria) Bilepigments:
known the during obstructive jaundice. It is detected by
Benedict's test is used to Hamarsten's test.
urine. Rosin's test, fouchet's test,
percentage ofreducing sugars in Procedure of Rosin's test: Place about
1
Benedict's
Procedure: Place about l mLof a test
4-5 drops ofthe ml of the sample being tested into
reagent in a test tube. Add tube. Carefully overlay with
alcoholic
the content
sample being tested and heat solution of iodine. Agreen ring at the
If the test is
of the test tube to boiling. interface of two layers indicates the
olive
positive, reddish brown (orange, presence of bilirubin,
green) precipitate is formed.
concentration of Procedure of fouçhet'stest:
The approximate tube,
1 g% Take 5 ml of fresh urine in a test
sugar willbe 0.5 g/i00 mL (green), chloride,
(yellow), 1.5 g% (orange) and 2g% (red). add 2.5 mlof 10% of barium
Many substances may occur in
urine
and mix well. Aprecipitate of sulphates
bound
Benedict's is
which willcause reduction of appears to which bilirubin
reagent.
(barium sulphate-bilirubin complex).
Fehlings's test: The test may be used " Filter to obtain the precipitate on a
as a semiquantitative method for sugar filter paper.
estimation in urine.
191
 lo the pcpitate on he liller paper.
uld I dop of louchets reagent. High Tip
Wohet steaenl consists ol 25gu)ls Pre-test Assessment
uhlowacci cid, T0 ml, of l09.
Lssie chloide, ad disilled water 100
Patient's history
" Oliguria, polyuria, nocturia, ratio of frequency ot
nl). urination in day time and night time.
Iuediate development of blue. " Appearance of edema is important.
lCncolor around the drop Physical examination
presence of bilirubin. indicates Analysis of the urine especially tor
of albumin and presence or abse.
Proccdure of hamarsten's test: Place microscopic examination of urinary
carefully about 0.5 ml of deposits specially for pus cells, RBC cells and casts
the
mixture
acids in a test tube. Add about 2 mL. of
of
ethanol and few drops of the
tested. In the presence of sample being Cleárance Tests
coloration appears. bilirubin, green Table 13: Classification of renal function test
Biochemistry
Urobilinogen: The oxidation of urobilinogen Tests
to urobilin is
Domain ncation

the supposed to be the cause of based Clearances

In
deepening of color of urine on standing. on glomerular " Urea clearance test

hepatocellular
absent in urine. Thejaundice, úrobilinogen is
filtration
Endogenous creatinine clearance
test
Applied is the earliest sign ofrecovery " Inulin clearance test
It re-appearance
isidentified by
of
urobilinogen in urine. Tests to
Ehrlich test. measure renal Para-aminohippurate (PAH) test
" Filtration fraction
of
Procedure of Ehrlich test:
Place about i plasma flow
ml of the sample being
tube. Add few drops of tested into a test
Textbook Tests based on Concentration and dilution tests
Ehrlich's aldehyde
reagent. Aredcolour suggests that'Ehrlich
tubular function 15 minutes
phenolphthalein test
positive substances' are present. This is a Tests for Glomerular Function
very sensitive test. They can be assessed by clearance tests.
Assessment of Kidney Function Serum Test
Extent of renal damage Uric acid increases first
followed by urea the
Monitoring the progression of renal damage creatinine. Other parameters are total plasm
Monitoring and adjusting the dose of proteins, albumin and globulin levels an
potentially toxic drugs. cholesterol. In nephrosis, there is marked fa.
in albumin and rise in serumcholesterol leve
Renal (Kidney)Function Tests Profile In renal diseases such as
Serum urea
glomerulonephritie
necrosis, malignant hypertension, chroni
Serum creatinine pyelonephritis, blood urea levels are higher thar
Uric acid
normalvalues.
Urea clearance
High Tip
Creatinine clearance The most common causes and main risk factors for
Preliminary investigations to renal function kidney disease are diabetics and hypertension.
tests

192
 arance clearance of urea and average nonal is 54. ILis
calculated bythelorDula
0s delined as a volume ot blood or plasa
hcontainsthe amomt ofthe substance which
wTetedby the kidney in one minute. Clearance Cs =Ux
sDeSsed as ml/minute. lis calculated by using P
lormula:
sent, Important Takeaway
C-0xp
concentration of the substance in urine.
Cs = 54 mL/min
Expression of Result as %
volumeof urinein mlexcreted in minute. " Cm = 1.33
" Cs =1.85
concentration of the substance in plasma.
The clearance of a substance is determined by Creatinine Clearance Test
mode of excretion. Creatinine is an excretory product derived from
ba Clearance Tests Creatine phosphate. This metabolite is filtered
at the glomerulus but neither secreted nor
we all know ureais the end product of protein reabsorbed by the tubules. Hence, its clearance is
ance tabolism. It is partially reabsorbed by the renal close to GFR. Chapter
les after being filtered by glomeruli. Blood It is a normal metabolite in the body.
ba clearance is an expression of the numberof Creatinine clearance may be defined as the
est of blood plasma which is completely cleared volume of plasma that would be completely
urea by the kidney per minute. cleared of creatinine per minute. 8f
Volume of blood cleared of urea per minute It does not require the intravenous adminis
Organ
ests n be calculated from the formula =UV/p tration of any iest material in this test creatinine
test Concentration of urea in urine (in mg/100 mL) concentration in urine andplasma are estimated.
Volume of urine in mL/mt Its can be calculated by using formula. Function
The concentration of urea in blood V
(in mg/100 mL) C=Uxp
nstituting average values, the number of mL of Estimation of creatinine: Tests
thenoodcleared of urea per minute = 1000 x 2.1/28 = Ccr =UV/P= y mg/dL x 1000 mL
asmamL/min. -Z mL/min
and =2mg/dL x 24 x 60
dfallportant akeawau U: Urine concentration in mg/dL for calculation.
Dilution factor is 10.
level. Maximum Clearance
hritis, eurine volume exceeds 2 mL/min, the rate of urea P: Serum creatinine in mg/dL
ronic the V: Volume of urine in mL/min
learance is at a maximum and is directly proportional
than the concentration of urea in the blood.
verage hormal value is 75 mL/min (Normal range 75 High Tip
20): Normal Value of Creatinine
95-140 m/min (males)
andard Clearance 85-125 mL/min (females)
hen the urinary volume is <2 mL/min, the rate Decreased creatinine clearance value serves
'urea elimination is reduced, because relatively as sensitive indicator of renal damage because of
ore urea is reabsorbed in the tubules, and is the decreased GFR. This test is used for the early
roportional to the square root of the urinary detection of imparement in kidney function.
olume. Such clearance is termed as the standard

193
 oilh
is
onassays(|RA
TSHa b
human miatropotntroleincarboh
performslipid/amino:
nutrientsS metabolism. metabolism
cirrhosis,
hepatocellular
carcinomain
forms
0.0-0.2 den
to When and
said positive.hepatitis
as
indirect
evaluation not theon added
known; cholesterol
serum TSH direct
eflects modern
physical (0.05-0.005 all the myocardial
the
immunoradiometric: and Van reaction. is
conjugated,positive.
immediately chronic
children,
Iny e
based
on
metabolic
hypothyroidism Serum hepatic of and does response is for
The of thealso
acid/protein levels and by alcohol with
unconjugated,
retardation organ liver : cause
ior
for
(BMR).
metabolic
Chemiluminescence
rate and6.16ulU/mL.1 processes but bilirubin reflects total0.0-0.2estimated
alcoholic
disease.
liver
serum
Bergh direct infection in
tests ofnormal functions. hyperbilirubinemia.adults.
prehepatic,
luid/urinefor in the
commnon observed disease,
range centralintestine
sensitives from
the
Normal is produced when isknown
response
laboratory
are
hormones respectively. ranges
are
den
respectively
reagent,
bilirubin Bergh
only the(viral
hepatitis).
the only metabolic of of is Van is
function ibased Diseases Disorders Reference
bilirubin.
serum Bilirubin obtained isjaundice are pancreatic
most
good isLivernot include reaction.
positiveis thedernbilirubin
andThe Totalspinal When
colorwithVan
(GGT)
The0.39 that The
in
lnulbn,
ahomopolysaccharide,
polymeroffructose
filtration
renal
theitinravenous theone
which
administration, affected theand levels
in in is in
in to inversely likely theit an autoimmune
hypothyToidism
in
by (T)
by in rough in blood
metabolized plasma
eguivalent decreased of are at secreted is in However, not
glomerular formed filtered It adults.
reabsorbed stages
levels urea not GFR.netabolized
is thyroxine
(T).T,
triodothyronine
secreted
inulin/minute. a is is it SUMMARY
CHAPTER
of providecreatinine than and it measure as
glomerulus. and in
mL/minute.
are
creatinine
early
serum freely outside
ElLISA. in
mL is fltrate Also, myxedema
not values damage. very
test reabsorbed
T, increased often
C=
UV/P
nor of inulin/minute
through so
and of of the
the is tubules.
creatinine
better to
nor
hormones or of
disease
as number
excreted glomerular of 150 concentration
clearance clearance when produoed
substance
intake. at
dietary
protein
from
or TSH,RIA
tetraiodothyronine cause
substance cleared Important
Inulin Takeawayfunction
glomerular 1n filteredsubstance.
endogenous
administered are
100 affected is not renal of by to
entirely
body.
Following
damageclearance
because
is is hypothyroidism.
doneCholesterol
gland Measurement thyroid
common leading
andby
of plasma neither
ideal freely
Hence. = renal
creatinine to main
neitherof Value to
be
normal.
proportional
is glomerular
anount are
of plasma glomerulus
jdeal eXCreted cleared
of clearance an is is be
measure ClearanceCreatinine thyroid blood primary
High
Tip of
Normal
impaired
is it It Most
nature,
tubules.
Volume
Iminute. ml large Inulin to
body.
inert, The
dn being The The has
125 by
IS IS 1s
Biochemistry Applied Textbook
of
194
 Sallailure,chronic obstructive pulmonary The clearanceis defined asthe volume ofthe
ent in
diabetes
mellitus.
and plasma that would be completely cleared of a
Voj,seaSe
hlevelsof alkaline phosphatase (ALP) are
with substance per minute.
asaoticedinpatients cholestasis or hepatic Inulin clearance represents glomerular
ACnoma.

function
normal of kidney filtration rate (GFR).
is vital to " Creatinine clcarance and urea clearance
an:
Weete
aealthand
lifeof individual. tests are often used to assess renal function.
renal (kidney) function is
MAs aesed by evaluating either the usually Adecrease in their clearance is an indication

iearance tests), i.., creatinine glomerular

of renal damage.
hav clearance, inulin clearance, Impairment in renal function is often
clearance. This
odguidedby blood analysis, i.e., bloodis urea,
often associated with elevated concentration of
inseum creatinine, serum uric acid) Or urine blood urea, serum creatinine and decrease in
specific gravity of urine.
-ersgnalysis.

ates
Self-evaluation
ttitis Chapter
Organ 8
anc

livengandShort Answer Questions 3. What is a feature of hypothyroidism?

patig, DDesscribe the renal function test. Enumerate a. Decreased T, levels in blood
the test in renal profile or kidney function b. Decreased TSM levei
sma/ test (KFT). C. Weight loss
s o Why creatinine clearance is better than d. Increased basal metabolic rate.
urea clearance? Function
Tests
4. Deficiency of thyroxine results in:
ubin, Narme the tests along with the normal a. Grave's disease
g/dI rangesof: b. Myxedema
a. LFT
G. Cushing's syndrome
ergh b. TET
RFT d. Thyrotoxicosis
ve a C 5. Normal value of blood urea is:
Define hypothyroidism and hyperthyroid a. 3-4 mg/dl.
ism along with their clinical features.
arple lassify b. 4-8 mg/dL
jaundice. Give an account of C. 8-10 mg/dL
xing
obe the biochemical tests which help in d. 20-40 mg/dL
the diferentiating the types of jaundice. hemolytic jaundice, van der bergh
Enumerate liver function tests and describe 6. In
r reaction is
this any two of them with clinical significance. a. Indirect positive
tiple Choice Questions b. Direct positive
ula Which substance would increase in C. Biphasic
uses d. None of these
plasma if jaundice is diagnosed? in urine in
a. Bile acids b. Bilirubin 7. Bilirubin is not excreated
erast
C. Stercobilin d. Urobilin a. Obstructive jaundice
jsm b. Hepatic jaundice
Ihe following are the indications of liver
tion c. Hemolytic jaundice
function except: b. Bilirubin
d. Allthree
Creatinine
C. Albumin d. Cholesterol 195