Blood urea nitrogen

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"BUN" redirects here. For other uses, see bun (disambiguation).

The blood urea nitrogen (BUN, pronounced "B-U-N") test is a measure of the amount of
nitrogen in the blood in the form of urea, and a measurement of renal function. Urea is a
substance secreted by the liver, and removed from the blood by the kidneys.

Contents
[hide]

 1 Physiology
 2 Interpretation
 3 Units
 4 Methodology
 5 External links
 6 See also
 7 References

[edit] Physiology
The liver produces urea in the urea cycle as a waste product of the digestion of protein.
Normal human adult blood should contain between 7 to 21 mg of urea nitrogen per 100 ml
(7–21 mg/dL) of blood. Individual laboratories may have different reference ranges, and this
is because the procedure may vary.[1][2]

Reference ranges for blood tests, comparing urea (yellow at right) to other blood constituents.

[edit] Interpretation
The most common cause of an elevated BUN, azotemia, is poor kidney function, although a
serum creatinine level is a somewhat more specific measure of renal function (see also renal
function).
A greatly elevated BUN (>60 mg/dL) generally indicates a moderate-to-severe degree of
renal failure. Impaired renal excretion of urea may be due to temporary conditions such as
dehydration or shock, or may be due to either acute or chronic disease of the kidneys
themselves.

An elevated BUN in the setting of a relatively normal creatinine may reflect a

physiological response to a relative decrease of blood flow to the kidney (as seen in heart
failure or dehydration) without indicating any true injury to the kidney. However, an isolated
elevation of BUN may also reflect excessive formation of urea without any compromise to
the kidneys.

Increased production of urea is seen in cases of moderate or heavy bleeding in the upper
gastrointestinal tract (e.g. from ulcers). The nitrogenous compounds from the blood are
resorbed as they pass through the rest of the GI tract and then broken down to urea by the
liver. Enhanced metabolism of proteins will also increase urea production, as may be seen
with high protein diets, patients on total parenteral nutrition, steroid use, burns, or fevers.

When the ratio of BUN to creatinine (BUN:Cr) is greater than 20, the patient is suspected
of having prerenal azotemia. This means that the pathologic process is unlikely to be due to
intrinsic kidney damage.

A low BUN usually has little significance, but its causes include liver problems, malnutrition
(insufficient dietary protein), or excessive alcohol consumption. Overhydration from
intravenous fluids can result in a low BUN. Normal changes in renal bloodflow during
pregnancy will also lower BUN.

Urea itself is not toxic. This was demonstrated by Johnson et al. by adding large amounts of
urea to the dialysate of hemodialysis patients for several months and finding no ill effects.[1].
However, BUN is a marker for other nitrogenous waste. Thus, when renal failure leads to a
buildup of urea and other nitrogenous wastes (uremia), an individual may suffer neurological
disturbances such as altered cognitive function (encephalopathy), impaired taste (dysgeusia)
or loss of appetite (anorexia). The individual may also suffer from nausea and vomiting, or
bleeding from dysfunctional platelets. Prolonged periods of severe uremia may result in the
skin taking on a sallow, yellowish discoloration or even forming frank urea crystals ("uremic
frost") on the skin.

Because multiple variables can interfere with the interpretation of a BUN value, GFR and
creatinine clearance are more accurate markers of kidney function. Age, sex, and weight will
alter the "normal" range for each individual, including race. In renal failure or chronic kidney
disease (CKD), BUN will only be elevated outside "normal" when more than 60% of kidney
cells are no longer functioning. Hence, more accurate measures of renal function are
generally preferred to assess the clearance for purposes of medication dosing.

[edit] Units
BUN is reported as mg/dL in the United States. Elsewhere, the concentration of urea is
reported as mmol/L. To convert from mg/dL of blood urea nitrogen to mmol/L of urea,
divide by 2.8 (each molecule of urea having 2 nitrogens, each of molar mass 14g/mol)
 Urea (in mmol/L) = BUN (in mg/dL of nitrogen) / 2.8

convert BUN to urea in mg/dL by using following formula: Urea= BUN*2.14 MW of urea
=60 urea nitrogen : 28 = 60/28

[edit] Methodology
See also: Wikibooks:How to make a blood urea nitrogen (BUN) test

The test as originally carried out was by flame photometry; now chemical colorimetric tests
are more widely used. Three methods are common: Diacetyl Monoxime, Urograph and
Modified Berthelot Enzymatic methods.

[edit] External links

 Blood Urea Nitrogen Information

[edit] See also

 BUN-to-creatinine ratio
 Kt/V
 Urea reduction ratio (URR)
 Standardized Kt/V

[edit] References
1. ^ Last page of Deepak A. Rao; Le, Tao; Bhushan, Vikas (2007). First Aid for the USMLE
Step 1 2008 (First Aid for the Usmle Step 1). McGraw-Hill Medical. ISBN 0-07-149868-0.
2. ^ Normal Reference Range Table from The University of Texas Southwestern Medical
Center at Dallas. Used in Interactive Case Study Companion to PATHOLOGIC BASIS of
DISEASE.

1. ^ Johnson WJ, Hagge WW, Wagoner RD, Dinapoli RP, Rosevear JW. Effects of urea
loading in patients with far-advanced renal failure. Mayo Clin Proc. 1972
Jan;47(1):21-9. PMID 5008253

Retrieved from "http://en.wikipedia.org/wiki/Blood_urea_nitrogen"

Categories: Chemical pathology | Nitrogen metabolism | Nephrology

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