Liver function test

Liver Function Tests (LFTs) are a group of blood tests that provide information
about the health of your liver by measuring various enzymes, proteins, and
substances it produces. These tests are essential for diagnosing liver
diseases, monitoring treatment, and assessing liver damage. Below are the
key components of LFTs:

1. Alanine Aminotransferase (ALT)

Function: Measures the level of ALT, an enzyme found in the liver.

Significance: Elevated ALT indicates liver cell damage, as seen in hepatitis,

fatty liver disease, or alcohol-related liver issues.

Normal Range: 7-56 U/L.

2. Aspartate Aminotransferase (AST)

Function: Measures AST, an enzyme found in the liver and other tissues like
the heart and muscles.

Significance: Elevated AST suggests liver or muscle damage. The AST/ALT

ratio helps differentiate between liver and non-liver causes.

Normal Range: 10-40 U/L.

3. Alkaline Phosphatase (ALP)

Function: Enzyme related to bile ducts; measures ALP levels.

Significance: Elevated ALP may indicate bile duct obstruction, gallstones, or

liver diseases.

Normal Range: 44-147 IU/L.

4. Total Bilirubin

Function: Measures bilirubin levels, a byproduct of red blood cell breakdown.

Significance: Elevated bilirubin causes jaundice and indicates liver

dysfunction or bile flow obstruction.

Normal Range: 0.1-1.2 mg/dL.

5. Direct (Conjugated) Bilirubin

Function: Measures the direct portion of bilirubin that is processed by the

liver.
Significance: High levels suggest bile duct issues or liver diseases.

Normal Range: 0.0-0.3 mg/dL.

6. Albumin

Function: Measures albumin, a protein made by the liver.

Significance: Low levels indicate poor liver function or chronic diseases.

Normal Range: 3.5-5.0 g/dL.

7. Total Protein

Function: Measures all proteins in the blood, including albumin and globulins.

Significance: Low levels may suggest liver or kidney issues.

Normal Range: 6.3-7.9 g/dL.

8. Gamma-Glutamyl Transferase (GGT)

Function: Measures GGT, an enzyme involved in bile production.

Significance: Elevated levels often indicate alcohol-related liver disease or

bile duct issues.

Normal Range: 9-48 U/L.

9. Prothrombin Time (PT)

Function: Measures the time it takes for blood to clot.

Significance: Prolonged PT indicates liver damage or vitamin K deficiency.

Normal Range: 11-13.5 seconds.

Indications for LFTs

Symptoms: Jaundice, fatigue, dark urine, abdominal pain.

Conditions: Hepatitis, cirrhosis, fatty liver, liver infections, and alcohol or

drug toxicity.

Monitoring: During treatment for liver diseases or when taking liver-toxic

medications.

Renal function test

Renal Function Tests (RFTs) assess kidney function by measuring substances
in the blood and urine that are regulated or eliminated by the kidneys. These
tests are critical for diagnosing kidney diseases, monitoring progression, and
evaluating the effects of treatments. Below are the details of the most
common renal function tests:

1. Blood Urea Nitrogen (BUN)

Function: Measures the amount of urea nitrogen in the blood, a waste

product formed during protein metabolism.

Significance: Elevated BUN levels may indicate kidney dysfunction,

dehydration, or high protein intake, while low levels may suggest
malnutrition or liver disease.

Normal Range: 7-20 mg/dL.

2. Serum Creatinine

Function: Measures the level of creatinine, a waste product of muscle

metabolism, in the blood.

Significance: Elevated creatinine indicates reduced kidney function. It is a

key marker for kidney health.

Normal Range:

Men: 0.7-1.3 mg/dL

Women: 0.6-1.1 mg/dL.

3. Glomerular Filtration Rate (GFR)

Function: Estimates how well the kidneys filter blood.

Significance:

GFR <60 mL/min/1.73 m² indicates kidney disease.

GFR <15 mL/min/1.73 m² indicates kidney failure.

Normal Range: 90-120 mL/min/1.73 m²

4. Electrolytes

Function: Measures key electrolytes regulated by the kidneys.

Common Electrolytes:

Sodium (Na): Maintains fluid balance.

Normal Range: 135-145 mEq/L.

Potassium (K): Critical for muscle and nerve function.

Normal Range: 3.5-5.0 mEq/L.

Chloride (Cl): Helps maintain acid-base balance.

Normal Range: 96-106 mEq/L.

Significance: Imbalances suggest kidney dysfunction or dehydration.

5. Uric Acid

Function: Measures uric acid levels, a waste product from purine metabolism.

Significance: Elevated levels may indicate kidney disease, gout, or excessive

protein metabolism.

Normal Range:

Men: 3.4-7.0 mg/dL

Women: 2.4-6.0 mg/dL.

6. Urinalysis

Function: Examines urine for physical, chemical, and microscopic

characteristics.

Significance:

Proteinuria: Indicates kidney damage.

Hematuria: Suggests infection, stones, or trauma.

Glucose or Ketones: May indicate diabetes or metabolic disorders.

7. Creatinine Clearance

Function: Compares blood and urine creatinine levels to measure GFR

directly.

Significance: Low clearance indicates impaired kidney function.

Normal Range: 90-140 mL/min.

8. Albumin-to-Creatinine Ratio (ACR)

Function: Detects small amounts of albumin in urine.

Significance: High ACR indicates early kidney damage, often due to diabetes
or hypertension.

Normal Range: <30 mg/g.

Indications for RFTs

Symptoms: Swelling (edema), high blood pressure, fatigue, decreased urine

output.

Conditions: Chronic kidney disease (CKD), acute kidney injury, diabetes,

hypertension, urinary tract infections.

Monitoring: During treatment for kidney disease or when using nephrotoxic

medications.

Cardiac Enzymes (CPK, MB, LDH)

Cardiac Enzymes and Markers are substances released into the bloodstream
when the heart muscle is damaged, typically during a heart attack or other
cardiac conditions. Key markers include Creatine Phosphokinase (CPK), CK-
MB, and Lactate Dehydrogenase (LDH). Below are their details:

1. Creatine Phosphokinase (CPK)

Function: An enzyme found in the heart, brain, and skeletal muscles,

involved in energy production.

Significance:

Elevated CPK levels may indicate muscle damage (including heart or skeletal
muscles), physical trauma, or strenuous exercise.

Non-specific unless isoenzymes like CK-MB are measured.

Normal Range: 20-200 U/L (varies slightly by laboratory).

2. CK-MB (Creatine Kinase-Muscle/Brain)

Function: A specific isoenzyme of CPK primarily found in heart muscle.

Significance:

Elevated CK-MB levels are highly specific for myocardial (heart muscle) injury.

Levels rise 4-6 hours after heart muscle damage, peak at 12-24 hours, and
return to normal within 48-72 hours.
Used to diagnose and assess the severity of heart attacks (myocardial
infarction).

Normal Range: <5% of total CPK or 3-5 ng/mL.

3. Lactate Dehydrogenase (LDH)

Function: An enzyme present in nearly all body tissues, including the heart,
that converts lactate to pyruvate during energy production.

Significance:

Elevated LDH levels indicate tissue damage, including myocardial infarction,

liver disease, or hemolysis.

LDH-1 (Heart-specific Isoenzyme): High levels suggest heart muscle injury.

LDH is less specific compared to CK-MB or troponins but can be used if other
markers are unavailable.

Levels rise 12-24 hours after damage, peak at 2-3 days, and normalize within
5-10 days.

Normal Range: 140-280 U/L.

Clinical Use of These Markers

Diagnosis of Myocardial Infarction (Heart Attack):

Elevated CK-MB with symptoms like chest pain suggests a heart attack.

LDH-1/LDH ratio helps confirm late-stage myocardial infarction.

Monitoring Muscle Damage: CPK can indicate general muscle injuries.

Supplementary Role: Modern practice often prioritizes troponins over

these markers due to higher specificity.