Topic - Liver function & kidney function test

Submitted to -
RADDL, Vizag
Submitted by – Proddatur
2k18 batch
Synonyms Of LFT’s
• Liver panel
• Liver injury tests
• Liver profile

Tests commonly included

• Alanine aminotransferase ( ALT ) or Serum glutamic pyruvic transaminase ( SGPT )
• Alkaline phosphatase ( ALP )
• Aspartate aminotransferase ( AST ) or Serum glutamic oxaloacetic transaminase ( SGOT
• Albumin
• Bilirubin

Specimen
• Serum is the specimen of choice .
Importance of liver function test

1. To assess the severity of liver damage.

2. To differentiate different types of jaundice.
3. To find out the presence of latent liver diseases.

ALT & AST

• These are sensitive indicator of hepatocellular injury but they lack specificity as
they are also present in muscles, kidney, & RBCs.
• Hepatocyte cytoplasm AST is more abundant than ALT.
• These aminotransferase may be increased in patients present with cirrhosis,
chronic hepatitis, alcoholic hepatitis, acute viral hepatitis &toxic ischemic injury.
• Alcoholic hepatitis – AST & ALT ratio is 2:1 & gamma glutamyl transpeptidase is
twice of normal level.
Alkaline phosphatase ( ALP )
• ALP found in liver, bone, kidney, intestine & placenta.
• Liver ALP, found on canalicular surfaces, is raised in any condition of biliary
obstruction ( intra hepatic & extra hepatic ).
• In hepatocyte injury, ALP is often normal or marginally elevated.
• This feature used to differentiate liver parenchymal disease from biliary
dysfunction.
• ALP increase in biliary disease.

Bilirubin
• Serum bilirubin is a mixture of alpha, beta, gamma & delta fragments.
• Direct bilirubin ( DB ) refers to the conjugated bilirubin‘s that react directly
with the
diazo reagent, while indirect bilirubin is derived value obtained from the difference of
the total bilirubin & DB.
• Serum bilirubin is useful in separating the causes of jaundice.
• In prehepatic jaundice due to haemolysis, unconjugated bilirubin is increased with
Albumin

• Synthesized in the liver & is an indicator of liver function.

• Albumin is decreased by trauma, inflammatory conditions &
malnutrition.

Limitations of LFT’s
• Abnormal levels of albumin & bilirubin's may be obtained
only when the liver
damage is so far.
• Falsely elevated AST & ALT levels may be occur due to pre-analytical such as
obtaining the blood sample after a intramuscular injection or a haemolysed
blood sample.
 Kidney function tests
• Renal/kidney function test are done to assess the functional capacity of kidney
( blood flow to the kidney, glomerular filtration & tubular function ).
• The aim of renal function tests is to detect impairment of renal function as
early as possible.
• The kidney function can be assessed by examination of blood & urine.

Commonly used kidney function tests

1. Urine examination
2. Blood/serum analysis
3. Glomerular function tests
4. Tubular function tests
5. Others
1. Urine examination

• Simple routine examination of urine for volume, pH, concentration test/specific

gravity test, osmolality & presence of certain abnormal constituents ( proteins,
ketone bodies, blood, glucose etc. ).

2. Blood/ serum analysis

• Estimation of blood urea nitrogen, serum creatinine, protein & electrolyte.

1. Glomerular function tests – Clearance test ( urea, inulin, creatinine )

Inulin clearance test –
• This test is done to find the glomerular filtration rate.
• Inulin is given s/c or by I/V infusion.
• The amount of inulin excreted in each minutes is equal to the amount filtered by
the amount filtered by the glomeruli.
• Normal rate is 110-150 ml per minute.
4. Tubular function tests
• Urine concentration or dilution test, urine acidification test.

Others:-

• Phenol sulfonaphthalein (PSP) test

• It indicates a general loss of nephron function.

• A measured amount of phenol sulfonaphthalein is injected I/V & then
urine is collected at intervals of 40-60 minutes.
• The rate of disappearance of the dye from the plasma can be
determined from blood sample taken prior to & then at regular
intervals
of 30 minutes following its injection.
• The dye clearance time is prolonged in kidney disease.
• Methylene blue excretion test :

• Methylene blue ( 2% @ 0.4ml/kg ) is injected I/M & examined for clearance of

dye.
• In normal condition the excretion of dye reaches its maximum after 1 hour &
the clearance is complete within 24 hours.
• Delay in time indicates kidney dysfunction.