SGPT Alanine transaminase (ALT) Alanine transaminase (ALT), also called Serum Glutamic Pyruvate Transaminase (SGPT) or Alanine

aminotransferase (ALAT) is an enzyme present in hepatocytes (liver cells). When a cell is damaged, it leaks this enzyme into the blood, where it is measured. ALT rises dramatically in acute liver damage, such as viral hepatitis or paracetamol (acetaminophen) overdose. Elevations are often measured in multiples of the upper limit of normal (ULN). Normal values:5 - 40 IU/L Elevations of SGPT, an enzyme found within the liver cells, indicate that the liver cells are either leaky (internal contents are entering the blood) or damaged. A wide array of conditions can cause this problem. For example, viral hepatitis or alcohol can cause elevated SGPT. We know that patients can have elevated liver tests as a result of fatty liver, a condition that does not necessarily mean generalized obesity. Usually fatty liver is not a cause for significant liver problems. Serum creatinine Measuring serum creatinine is a simple test, and it is the most commonly used indicator of renal function.[3] A rise in blood creatinine level is observed only with marked damage to functioning nephrons. Therefore, this test is unsuitable for detecting early-stage kidney disease. A better estimation of kidney function is given by calculating the estimated glomerular filtration rate (eGFR). eGFR can be accurately calculated using serum creatinine concentration and some or all of the following variables: sex, age, weight, and race, as suggested by the American Diabetes Association without a 24-hour urine collection.[6] Many laboratories will automatically calculate eGFR when a creatinine test is requested. A concern as of late 2010 relates to the adoption of a new analytical methodology, and a possible impact this may have in clinical medicine. Most clinical laboratories now align their creatinine measurements against a new standardized isotope dilution mass spectrometry (IDMS) method to measure serum creatinine. IDMS appears to give lower values than older methods when the serum creatinine values are relatively low, for example 0.7 mg/dl. The IDMS method would result in a comparative overestimation of the corresponding calculated GFR in some patients with normal renal function. A few medicines are dosed even in normal renal function on that derived GFR. The dose, unless further modified, could now be higher than desired, potentially causing increased drug-related toxicity. To counter the effect of changing to IDMS, new FDA guidelines have suggested limiting doses to specified maxima with carboplatin, a chemotherapy drug.[7] In a recent Japanese study, a lower serum creatinine level was found to be associated with an increased risk for the development of type 2 diabetes in Japanese men.[8] Urine creatinine Creatinine concentration is also checked during standard urine drug tests. Normal creatinine levels indicate the test sample is undiluted, whereas low amounts of creatinine in the urine indicate either a manipulated test or low individual baseline creatinine levels. Test samples considered manipulated due to low creatinine are not tested, and the test is sometimes considered failed. Diluted samples may not always be due to a conscious effort of subversion,[citation needed] and diluted samples cannot be proved to be intentional, but are only assumed to be. Random urine creatinine levels have no standard reference ranges. They are usually used with other tests to reference levels of other substances measured in the urine. Diuretics, such as coffee and tea, cause more frequent urination, thus potently decreasing creatinine levels. A decrease in muscle mass will also cause a lower reading of creatinine, as will pregnancy. ESR The erythrocyte sedimentation rate (ESR), also called a sedimentation rate or Westergren ESR, is the rate at which red blood cells sediment in a period of one hour. It is a common hematology test, and is a non-specific measure of inflammation. To perform the test, anticoagulated blood was traditionally placed in an upright tube, known as a Westergren tube, and the rate at which the red blood cells fall was measured and reported in mm/h. Since the introduction of automated analyzers into the clinical laboratory, the ESR test has been automatically performed. The ESR is governed by the balance between pro-sedimentation factors, mainly fibrinogen, and those factors resisting sedimentation, namely the negative charge of the erythrocytes (zeta potential). When an inflammatory process is present, the high proportion of fibrinogen in the blood causes red blood cells to stick to each other. The

red cells form stacks called 'rouleaux,' which settle faster. Rouleaux formation can also occur in association with some lymphoproliferative disorders in which one or more immunoglobulins are secreted in high amounts. Rouleaux formation can, however, be a normal physiological finding in horses, cats, and pigs. The ESR is increased by any cause or focus of inflammation. The ESR is increased in pregnancy, inflammation, anemia or rheumatoid arthritis, and decreased in polycythemia, sickle cell anemia, hereditary spherocytosis, and congestive heart failure. It may be increased in kidney cancer. The basal ESR is slightly higher in females.[1] Target Lower Upper limit limit Unit Comments

Red cells (RBCs) erythrocytes

blood [4][9] / 0

2 3

[4]

[9]

May be present as intact RBCs, which indicate bleeding. Even trace amount of blood is enough to give the entire urine sample a red/pink hue, and it is difficult to judge the amount of bleeding from a gross examination. Hematuria may be due to a generalized bleeding diathesis or a urinary tract-specific problem (trauma, stone, infection, malignancy, etc.) or artefact of catheterization in case the sample is taken from a collection bag, in which case a fresh urine sample should be sent for a repeat test. If the RBCs are of renal or glomerular origin (due to glomerulonephritis), the RBCs incur mechanical damage per during the glomerular passage, and then osmotic damage High Power along the tubules, so get dysmorphic features. Field The dysmorphic RBCs in urine which are most (HPF) characteristic of glomerular origin are called "G1 cells", which are doughnut-shaped rings with protruding round blebs sometimes looking like Mickey Mouse's head (with ears). Painless hematuria of nonglomerular origin may be a sign of urinary tract malignancy, which may warrant a more thorough cytological investigation. Further information: Hematuria

RBC casts White cells(WBCs) leukocytes (pus cells)

n/a blood 0[4] / /

0 / [4] negative 2 / [4] negative 10 per l or 3 mm

[4]

Further information: Pyuria "Significant pyuria" at greater than or equal to 10 3 leucocytes per microlitre (l) or cubic millimeter (mm )

"Blood" / n/a (actuallyhemoglobin)

Hemoglobinuria is suggestive of in vivo hemolysis, but must be distinguished from hematuria. In case of hemoglobinuria, a urine dipstick shows presence of blood, dip-stick but no RBCs are seen on microscopic examination. If 0 / qualitative hematuria is followed by artefactual ex vivo or in [4] negative scale of 0 to vitro hemolysis in the collected urine, then the dipstick 4+ test also will be positive for hemoglobin and will be difficult to interpret. The urine color may also be red due to excretion of reddish pigments or drugs.

Proteinuria (/protinri/ or /protinjri/; from protein and urine) means the presence of an excess of serum proteins in the urine. The excess protein in the urine often causes the urine to become foamy, although

foamy urine may also be caused by bilirubin in the urine (bilirubinuria),[1] retrograde ejaculation,[2] pneumaturia (air bubbles in the urine) due to a fistula,[3] or drugs such as pyridium.[1] Up to 150 mg a day of protein may be excreted by a normal person, primarily the Tamm-Horsfall protein. Conventionally, proteinuria is diagnosed by a simple dipstick test, although it is possible for the test to give a false negative reading,[8] even with nephrotic range proteinuria if the urine is dilute.[citation needed] False negatives may also occur if the protein in the urine is composed mainly of globulins or Bence-Jones proteins because the reagent on the test strips, bromphenol blue, is highly specific for albumin.[9][10] Traditionally, dipstick protein tests would be quantified by measuring the total quantity of protein in a 24-hour urine collection test, and abnormal globulins by specific requests for protein electrophoresis.[1][11] Trace results may be produced in response to excretion of Tamm-Horsfall mucoprotein. Recent technologies used to detect human serum albumin (HSA) is through the use of liquid crystals (LCs). The presence of HSA molecules disrupts the LCs supported on the AHSA-decorated slides thereby producing bright optical signals which are easily distinguishable.=using this assay can be as low as 15 ug/mL.[12] Alternatively the concentration of protein in the urine may be compared to the creatinine level in a spot urine sample. This is termed the protein/creatinine ratio (PCR). The 2005 UK Chronic Kidney Disease guidelines states PCR is a better test than 24 hour urinary protein measurement. Proteinuria is defined as a protein/creatinine ratio greater than 45 mg/mmol (which is equivalent to albumin/creatinine ratio of greater than 30 mg/mmol or approximately 300 mg/g) with very high levels of proteinuria being for a PCR greater than 100 mg/mmol.[13] Protein dipstick measurements should not be confused with the amount of protein detected on a test for microalbuminuria which denotes values for protein for urine in mg/day versus urine protein dipstick values which denote values for protein in mg/dL. That is, there is a basal level of proteinuria that can occur below 30 mg/day which is considered non-pathology. Values between 30300 mg/day are termed microalbuminuria which is considered pathologic.[14] Urine protein lab values for microalbumin of >30 mg/day correspond to a detection level within the "trace" to "1+" range of a urine dipstick protein assay. Therefore, positive indication of any protein detected on a urine dipstick assay obviates any need to perform a urine microalbumin test as the upper limit for microalbuminuria has already been exceeded.[15 Protein dipstick grading Designation Trace 1+ 24hrs Ur_Pr 2+ Approx. amount Concentration 520 mg/dL 30 mg/dL 100 mg/dL Less than 0.5 g/day 0.51 g/day
[6] [7]

Daily

300 mg/dL 12 g/day Creatinine is a product of muscle metabolism. It is 3+ produced at a nearly constant rate and is excreted in the 4+ More than 2000 mg/dL More than 2 g/day urine. Because of it's constant rate of production, the amount of creatinine in the urine is an indirect measurement of kidney function (glomerular filtration rate). If kidney function is significantly reduced, the urine creatinine will fall. With more severe degrees of kidney failure, the serum creatinine will eventually rise. A 24-hour collection of urine is the most accurate way to assess renal function with creatinine. A blood (serum) creatinine is also measured during this time and used to calculated the volume of urine needed to "clear" the measured amount of creatinine from the blood and into the urine. This is called the "creatinine clearance." Vigorous exercise or muscular trauma occurring during the collection will cause an increased amount of creatinine in the blood and may lead to false creatinine clearance results. Serum proteins are normally extracted from urine prior to it being released from the kidney.

Because the renal glomeruli are imperfect, normal individuals may occasionally have "trace" amounts of protein in their urine. Larger amounts (1+ or more) are considered abnormal and may reflect an underlying kidney problem. Urine protein can be measured on any urine sample (a "spot urine"), but the most accurate measure is with a 24hour collection of urine. During pregnancy, due to the increased renal blood flow, some additional protein may be lost in the urine. This increased protein loss should not normally be in quantities exceeding 300 mg in 24 hours. If more than 300 mg in 24 hours is found, this may signal the development of pre-eclampsia. Normal Values* Urine Creatinine Men Women Creatinine Clearance Men Women Pregnancy Urine Protein 24 hours Spot Urine Spot Urine Dipstick Urine Protein (Pregnancy) 24 hours Spot Urine Spot Urine Dipstick * <300 mg/24 hours <30 mg/dL "Negative" or "Trace" 10-140 mg/24 hours 1-14 mg/dL "Negative" mg/24 hours <150 <250 ml/min 70-130 91-130 120-160