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



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