Liver & Kidney Health

Liver & Kidney Health, General Health & Wellness

Among entities in which AST and ALT increases occur, are therapeutic applications of bovine or porcine heparin. LD (LDH) abnormality with elevation of hepatic fractions was also reported.3In children with acute lymphoblastic leukemia, high ALT activity at diagnosis is associated with rapidly progressive ALL.4A number of drugs, including diphenylhydantoin, heparin therapy and many others, cause ALT increases. Acetaminophen hepatotoxicity may be potentiated in alcoholics, in whom coagulopathy and extremely abnormal aminotransferase levels are described, ALT less than AST.5The hepatitis C virion has been detected by polymerase chain reaction and reverse transcriptase of HCV-RNA sequences in patients with elevated ALT and positive anti-HCV.6

Nutrition & Vitamins, Liver & Kidney Health

Twenty-four hour urine collection to measure protein loss is helpful in work-up of some patients with hypoalbuminemia. Other testsuseful in assessment of nutritional statusinclude TIBC, transferrin, iron, absolute lymphocyte count, and vitamin B12/folate levels.

Liver & Kidney Health, Bone Health

Serum alkaline phosphatase is a member of a family of zinc metalloprotein enzymes that function to split off a terminal phosphate group from an organic phosphate ester. This enzyme functions in an alkaline environment (optimum pH of 10). Active center of ALP enzymes includes a serine residue. Mg and Zn ions are required for minimal activity. Enzyme activity is localized in the brush border of the proximal convoluted tubule of the kidney, intestinal mucosal epithelial cells, hepatic sinusoidal membranes, vascular endothelial cells and osteoblasts of bone. There are distinctive forms of ALP in the placenta and small intestine; hepatic, renal and osteoblast (bone) ALP are similar molecules.Serum ALP activity of intestinal origin occurs only in individuals of ABO blood type O or A. They are secretors of ABH RBC antigens and also carry the Lewis red cell antigen. Serum intestinal ALP level increases in these individuals about two hours following consumption of a fatty meal.Liver alkaline phosphatase is increased in cholestasis and inflammatory liver disease as well as in infiltrative liver disease. The enzyme is sensitive to obstructive biliary processes, even small secondary bile duct obstruction, and thus may be increased in those patients when the bilirubin is normal due to compensatory bilirubin excretion by the rest of the liver. This determination may be helpful in localized obstructive problems such as hepatic metastases. An electrophoretically slow moving isoenzyme with high relative mass may occur in some patients with bile duct obstruction and hepatic metastases and may result in false elevation of CK-MB.7To confirm biliary abnormality, an additional useful test is GT. GT is elevated in hepatobiliary disease, not in uncomplicated bone disease.Serum ALP is increased during pregnancy. Marked decline of high ALP of pregnancy is seen with placental insufficiency and imminent fetal demise.

Liver & Kidney Health, General Health & Wellness

AST has origin from heart, liver, skeletal muscle, kidney, pancreas, spleen, and lung. Very high values, >500 units/L, usually suggest hepatitis or other kinds of hepatocellular necrosis but can also be found with large necrotic tumors, other types of necrosis or extensive hypoxia, congestive failure, and shock. Unexplained AST elevations should first be investigated with ALT and GT. Mitochondrial AST (m-AST) may be useful in the diagnosis of alcoholic liver disease; it is reviewed by Rej.4

Liver & Kidney Health

Although creatinine is generally considered a more specific test to evaluate renal function, they are commonly used together.1Luke points out that clinical renal failure is variable between individual patients.1Drug effects have been summarized.6

Liver & Kidney Health, Nutrition & Vitamins

Drug effects have been summarized.10

Liver & Kidney Health, General Health & Wellness

Offered as part of multiple lab tests

Liver & Kidney Health, General Health & Wellness

Theoretically, direct bilirubin should not be increased in hemolytic anemias, in which bilirubin increase should be in the indirect bilirubin fraction in the absence of complications. In practice, some increase in the direct fraction may be encountered in patients with hemolytic anemia in whom complications have not been proven. Some methods have shown the direct bilirubin to be spuriously high. This may be due to different concentrations of sodium nitrite, which may convert some of the unconjugated bilirubin to conjugated bilirubin.1,2Direct bilirubin is the water soluble fraction. When increased in serum, bilirubin should become positive in the urine. Physiologic jaundice, occurring two to four days after birth, is due to lack of liver glucuronyl transferase.

Liver & Kidney Health, General Health & Wellness

Offered as part of multiple lab tests

Liver & Kidney Health

Offered as part of multiple lab tests

Liver & Kidney Health

Offered as part of multiple lab tests

Liver & Kidney Health

MICROSCOPY:Crystalluriais frequently observed in urine specimens stored at room temperature or refrigerated. Such crystals are diagnostically useful when observed in warm, fresh urine by a physician evaluating microhematuria, nephrolithiasis, or toxin ingestion.In abundance,calcium oxalateand/orhippurate crystalsmay suggest ethylene glycol ingestion (especially if known to be accompanied by neurological abnormalities, appearance of drunkenness, hypertension, and a high anion gap acidosis). Large numbers of calcium oxalate crystals occur, as well, with acute renal failure following methoxyflurane anesthesia. Urine is usually supersaturated in calcium oxalate, often in calcium phosphate, and acid urine is often saturated in uric acid. Yet crystalluria is uncommon (in warm, fresh urine) because of the normal presence of crystal inhibitors, the lack of available nidus, and the time factor. When properly observed in fresh urine, crystals may provide a clue to the composition of renal stones even not yet passed, the nidus for such stones, or, as such, have been associated with microhematuria.Leukocyturiamay indicate inflammatory disease in the genitourinary tract, including bacterial infection, glomerulonephritis, chemical injury, autoimmune diseases, or inflammatory disease adjacent to the urinary tract such as appendicitis1or diverticulitis.White cell castsindicate the renal origin of leukocytes, and are most frequently found in acute pyelonephritis. White cell casts are also found in glomerulonephritis such as lupus nephritis, and in acute and chronic interstitial nephritis. When nuclei degenerate, such leukocyte casts resemble renal tubular casts.Red cell castsindicate renal origin of hematuria and suggest glomerulonephritis, including lupus nephritis. Red cell casts may also be found in subacute bacterial endocarditis, renal infarct, vasculitis, Goodpasture syndrome, sickle cell disease, and in malignant hypertension. Degenerated red cell casts may be called“hemoglobin casts.”Orange to red casts may be found with myoglobinuria as well.Hyaline castsoccur in physiologic states (eg, after exercise) and many types of renal diseases.Renal tubular (epithelial) castsare most suggestive of tubular injury, as in acute tubular necrosis. They are also found in other disorders, including eclampsia, heavy metal poisoning, ethylene glycol intoxication, and acute allograft rejection.Granular casts:Very finely granulated casts may be found after exercise and in a variety of glomerular and tubulointerstitial diseases. Coarse granular casts are abnormal and are present in a wide variety of renal diseases.“Dirty brown” granular castsare typical of acute tubular necrosis.Waxy castsare found especially in chronic renal diseases, and are associated with chronic renal failure; they occur in diabetic nephropathy, malignant hypertension, and glomerulonephritis, among other conditions. They are named for their waxy or glossy appearance. They often appear brittle and cracked.Fatty castsare found in the nephrotic syndromes generally, diabetic nephropathy, other forms of chronic renal diseases, and glomerulonephritis. The fat droplets originate in renal tubular cells when they exceed their capacity to reabsorb protein of glomerular origin. Their inclusions have the features and significance of oval fat bodies.Broad castsoriginate from dilated, chronically damaged tubules or the collecting ducts. They can be granular or waxy.Broad waxy castsare called “renal failure casts.”Sperm isnotreported in routine urinalysis exams.Spermatozoamay be seen in male urine related to recent or retrograde ejaculation. For sperm reporting in males only, orderPostejaculatory Urine Microscopic Examination for Sperm [133116].

Liver & Kidney Health, Nutrition & Vitamins

Even mild renal failure decreases uric acid excretion. Uric acid excretion is decreased with hypertension.A young patient with acute gouty arthritis, uric acid stones, and any patient who excretes >1000 mg uric acid/24 hours, should be evaluated for HPRT deficiency.2The uric acid:creatinine ratio has been used as a test for Lesch-Nyhan syndrome (HPRTase deficiency). Normal control patients 0.21−0.59; partial enzyme deficient group 0.62−2.00; complete enzyme deficiency 1.98−5.35.3The ratio of uric acid:creatinine in morning samples of urine has been used as a test for detection of the Lesch-Nyhan syndrome, which is associated with virtually complete absence of activity of the enzyme hypoxanthine-guanine phosphoribosyltransferase. This ratio has also been applied to 24-hour urine samples from adult patients with gout for detection of partial deficiency of the same enzyme. The uric acid:creatinine ratio in the urine of normal control patients is reported to range from 0.21−0.59. Patients with gout exhibit ratios of 0.15−0.73, whereas those patients with hyperuricemia associated with another disorder such as leukemia or glycogen-storage disease have ratios of 0.25−1.77. The ratio is 0.27−0.58 for patients with nongouty arthritis. Patients with complete hypoxanthine-guanine phosphoribosyltransferase deficiency are reported to have urinary uric acid:creatinine ratios of 1.98−5.35, as compared to 0.62−2.00 for patients with gout accompanied by partial enzyme deficiency.The ratio of uric acid:creatinine concentration on a random urine specimen has also been shown to be >1.0 in patients with acute renal failure secondary to acute uric acid nephropathy, but <1.0 in patients with acute renal failure resulting from other causes.

Liver & Kidney Health

Urine creatinine is not ordered alone. Creatinine clearance, which requires a serum creatinine, offers useful renal function data. Serum creatinine alone is not an adequate index of glomerular filtration rate.1

Liver & Kidney Health

Offered as part of multiple lab tests

Liver & Kidney Health

Albumin accounts for approximately 50% of the protein in plasma.2The kidney works to prevent the loss of albumin into the urine through active resorption, but a small amount of albumin can be measured in urine of individuals with normal renal function.The prognostic value of consistently elevated albumin levels is particularly well established in diabetic patients.1Renal disease is a common microvascular complication of diabetes. Without specific interventions, 80% of type I diabetics with repeatedly elevated albumin levels will go on to end-stage renal disease. Twenty percent to 40% of type II diabetics with sustained albuminuria will progress to overt nephropathy.The American Diabetes Association (ADA) recommends that routine urinalysis be performed annually on adults with diabetes.1If the urinalysis is negative for protein, albumin measurement is recommended. The ADA also recommends annual screening of children beginning at puberty or after five years of disease duration. The reference intervals stated above reflect the diagnostic criteria prescribed by the ADA.1

Liver & Kidney Health, Diabetes & Blood Sugar

Albumin accounts for approximately 50% of the protein in plasma.2The kidney works to prevent the loss of albumin into the urine through active resorption, but a small amount of albumin can be measured in urine of individuals with normal renal function.The prognostic value of consistently elevated albumin levels is particularly well established in diabetic patients.1Renal disease is a common microvascular complication of diabetes. Without specific interventions, 80% of type I diabetics with repeatedly elevated albumin levels will go on to end-stage renal disease. Twenty percent to 40% of type II diabetics with sustained albuminuria will progress to overt nephropathy.The American Diabetes Association (ADA) recommends that routine urinalysis should be performed annually on adults with diabetes.1If the urinalysis is negative for protein, albumin measurement is recommended. The ADA also recommends annual screening of children beginning at puberty or after five years disease duration. The reference intervals stated above reflect the diagnostic criteria prescribed by the ADA.1

Liver & Kidney Health

Absolute values (g/dL), instead of relative percentages (%), should be used for interpretation.

Nutrition & Vitamins, Liver & Kidney Health

Ceruloplasmin is an α2-globulin containing copper. About 70% or more of total serum copper is associated with ceruloplasmin, 7% with a high MW protein, transcuprein, 19% with albumin, and 2% with amino acids.1Laboratory parameters of Wilson's disease include decreased serum ceruloplasmin, decreased serum copper concentration, increased 24-hour urine copper excretion, increased liver copper concentration, and abnormal liver function studies. Demonstration of failure to incorporate radiolabeled copper into ceruloplasmin is the definitive test for Wilson's disease. Liver and CNS manifestations of Wilson's disease need not both be present. Kayser-Fleischer rings are extremely helpful findings.Excessive therapeutic zinc may lead to block of intestinal absorption of copper and a copper deficiency syndrome characterized by hypochromic microcytic anemia with leukopenia/neutropenia and zero level of ceruloplasmin. A prolonged period of time may be required to eliminate the excess zinc, overcome the block of intestinal copper absorption and obtain increase in serum copper and ceruloplasmin levels.2

Liver & Kidney Health, Diabetes & Blood Sugar

This test is used to detect albuminuria by measuring albumin and creatine concentrations in a random (spot) urine sample and calculating the albumin-creatinine ratio (ACR). This test is useful for assessing kidney damage, especially at an early stage, and informing management and prognosis of chronic kidney disease (CKD) [1].Albuminuria, as a marker of kidney damage, provides a more specific and sensitive measurement of glomerular permeability than does proteinuria. An ACR measured from a spot urine sample acquired in the early morning is preferred for initial evaluation of albuminuria. This test can also be used to confirm a positive reagent strip urinalysis result. A moderately increased ACR (≥30 mg/g) for more than 3 months is diagnostic of CKD. The severity of albuminuria is also used for staging and prognosis of CKD [1,2].Albuminuria generally appears before the reduction of glomerular filtration rate in people with diabetic glomerulosclerosis but may appear later in people with hypertensive nephrosclerosis. Albuminuria is independently associated with an increased risk of cardiovascular events and mortality. In individuals with diabetes and/or hypertension, early identification of albuminuria that prompts blood pressure and glycemic control may subsequently reduce the risk of cardiovascular events and CKD progressing to end-stage renal disease. Referral to specialist kidney care services is recommended in individuals with a consistent finding of severely increased ACR (≥300 mg/g) [1-4].Factors that affect urinary ACR include menstrual blood contamination, symptomatic urinary tract infections, exercise, upright posture (orthostatic proteinuria), and other conditions that increase vascular permeability (eg, septicemia). Given the pathological and physiological causes of transient albuminuria, repeating ACR tests twice with early morning urine samples in the next 2 months is recommended. ACR from a timed urine sample can provide a more accurate estimate of albuminuria [1].The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings.References1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease.Kidney Int Suppl. 2013;3(1):1-150.2. Inker LA, et al.Am J Kidney Dis. 2014;63(5):713-735.3. American Diabetes Association. Standards of medical care in diabetes-2020.Diabetes Care. 2020;43(suppl 1):S135-S151.4. Shin JI, et al.Hypertension. 2021;78(4):1042-1052.

Liver & Kidney Health, Digestive Health

Alanine Aminotransferase (ALT) measurements are particularly useful in the diagnosis and management of certain liver diseases, e.g., viral hepatitis and cirrhosis. ALT activity in tissue is generally much lower than aspartate aminotransferase (AST) activity and is found in highest concentrations in the liver. Significant elevations of ALT occur only in diseases of the liver. ALT is often measured in conjunction with AST to determine whether the source of the AST is the liver or the heart. ALT is normally not elevated in cases of myocardial infarction, i.e., a normal ALT, in conjunction with an elevated AST, tends to suggest cardiac disease. However, slight elevations of ALT may occur if an infarct destroys a very large volume of heart muscle.

Liver & Kidney Health, General Health & Wellness

Serum creatinine is useful in the evaluation of kidney function and in monitoring renal dialysis. A serum creatinine result within the reference range does not rule out renal function impairment: serum creatinine is not sensitive to early renal damage since it varies with age, gender and ethnic background. The impact of these variables can be reduced by an estimation of the glomerular filtration rate using an equation that includes serum creatinine, age and gender.

Liver & Kidney Health

Offered as part of multiple lab tests

Liver & Kidney Health, General Health & Wellness

This panel is usually ordered to monitor patients with chronic kidney disease (CKD) or as part of a health examination for individuals at high risk of developing kidney diseases [1].Kidney disease is more likely to develop in individuals with certain conditions, such as high blood pressure, diabetes, heart disease, and a family history of kidney disease. Early symptoms of kidney diseases are often non-specific. This panel is commonly ordered during wellness checks and emergency-room admissions when symptoms and signs are suggestive of kidney diseases. National Kidney Foundation recommends a kidney profile containing estimated glomerular filtration rate and albumin-creatinine ratio for detecting and monitoring CKD [1].The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings.References1. Laboratory engagement plan: transforming kidney disease detection. National Kidney Foundation Laboratory Engagement Advisory Group. Published February 2018. Accessed January 6, 2022.https://www.ascp.org/content/docs/default-source/get-involved-pdfs/istp-ckd/laboratory-engagement-plan.pdf

Liver & Kidney Health

Normal urine protein consists of albumin (≤35 mg/24 hours), other plasma proteins (ie, globulins, haptoglobin, β2-microglobulin, and light chain). Tamm-Horsfall glycoprotein secreted by renal tubular cells may contribute ≤50 mg/24 hours. Urinary protein in normals tends to increase with age, exercise, and standing posture.Tests requiring a 24-hour urine collection with no preservative, such as creatinine, may also be performed on the same specimen. Although quantitative protein can be run on a random specimen or timed collections less than 24 hours, 24-hour collections are preferable for evaluation of the nephrotic states and inflammatory renal disorders. Creatinine, creatinine clearance, BUN, serum protein electrophoresis, ANA, anti-DNA antibodies, HIV, hepatitis C antibody, hepatitis B antigen, and complement levels (including total complement, C3, C4) are among useful tests to work up patients with proteinuria. Urine electrophoresis, immunofixation and immunoelectrophoresis are useful in patients older than 35 years of age to investigate possible diagnosis of amyloidosis, myeloma, and Waldenström macroglobulinemia.Some patients exhibit orthostatic proteinuria (ie, recumbent urine protein 100−180 mg in a 12-hour overnight urine collection and up to 1 g in the subsequent 12 hours while ambulatory). The presence of >200 mg of urinary protein in the overnight specimen or equally increased amounts of urine protein in both specimens indicates a need for further work-up.1Nephrotic syndromes are the causes of the most severe urinary protein losses. Nephrotic syndrome is defined now usually by degree of proteinuria (ie, proteinuria >50 mg/kg/day). After time, additional signs and symptoms occur including hypoproteinemia, hypoalbuminemia, elevation of α2-globulin with decreased γ-globulin on electrophoresis, hyperlipidemia, and edema. Urinary albumin is a more sensitive marker of progression and regression of renal disease than urine total protein, especially when urine total protein is <300 mg/g creatinine. In most laboratories, urine albumin is available from protein electrophoresis following concentration procedures; however, this method is not sensitive to low concentrations of albumin.2Albumin, 24-Hour Urine is the preferred test.

Liver & Kidney Health, Bone Health

Serum alkaline phosphatase levels are of interest in the diagnosis of hepatobiliary disorders and bone disease associated with increased osteoblastic activity. Moderate elevations of alkaline phosphatase may be seen in several conditions that do not involve the liver or bone. Among these are Hodgkin's disease, congestive heart failure, ulcerative colitis, regional enteritis, and intra-abdominal bacterial infections. Elevations are also observed during the third trimester of pregnancy.

General Health & Wellness, Liver & Kidney Health

Dipstick urinalysis is important in accessing the chemical constituents in the urine and the relationship to various disease states. Microscopic examination helps to detect the presence of cells and other formed elements.

General Health & Wellness, Liver & Kidney Health

Dipstick urinalysis is important in accessing the chemical constituents in the urine and the relationship to various diseases.

Nutrition & Vitamins, Liver & Kidney Health

Serum albumin measurements are used in the monitoring and treatment of numerous diseases involving primarily the liver and kidney. Its main value lies in the follow-up therapy where improvement in the serum albumin level is the best sign of successful medical treatment. There may also be a loss of albumin in the gastrointestinal tract, in the urine by the damaged kidney or direct loss of albumin through the skin. More than 50% of patients with gluten enteropathy have depressed albumin. The only cause of increased albumin is dehydration; there is no naturally occurring hyperalbuminemia.

General Health & Wellness, Liver & Kidney Health

This panel comprises a group of 8 specific tests that provide information on the status of an individual?s blood electrolytes, glucose levels, kidney status, and acid-base balance. The panel is usually ordered as part of a routine health examination or physical [1].The Basic Metabolic Panel is also commonly ordered during hospital and emergency-room admission, and to monitor the metabolism and vital signs of hospitalized individuals with conditions, such as hypertension, who are being treated with diuretics or other appropriate interventions. [1].Significant changes in electrolytes, acid-base balance, renal function, and blood glucose may be associated with kidney failure, respiratory distress, and impaired cognitive status. Changes in sodium, potassium, and calcium alter the excitability of neurons, cardiac, and skeletal muscles that can produce arrhythmias, weakness, and spasms/tremors [1].Basic metabolic panel test results are usually evaluated in conjunction with one another for patterns of results. A single abnormal test result could be indicative of something different than if more than 1 of the test results are abnormal. Many conditions can cause abnormal results, including kidney failure, respiratory distress, and diabetes-related complications [1].The section below outlines the roles of the analytes assessed with this panel [1].Sodium: Plays a central role in maintaining the normal distribution of water and osmotic pressure.Potassium: Essential for proper muscle and nerve function.Chloride: Helps keep the balance of fluids, maintain blood volume, stabilize blood pressure, and balance the pH of body fluids.CO2 (carbon dioxide, bicarbonate): Used to evaluate the total carbonate buffering system and acid-base balance.Glucose: A critical energy source for cells and organs. Used to diagnose diabetes and hypoglycemia.Calcium: Essential for nerve, muscle, and heart functions and bone formation.BUN (blood urea nitrogen): Evaluation of kidney function.Creatinine: Useful for diagnosis of renal insufficiency and estimation of glomerular filtration rate.References1. Rao LV, et al. Laboratory tests. In Rao LV, eds.Wallach's Interpretation of Diagnostic Tests. Pathways to Arriving at a Clinical Diagnosis.11th ed. New York, NY: Wolters Kluwer; 2020, 6-463.

Liver & Kidney Health, Digestive Health

This panel may be helpful in assessing liver injury, diagnosing liver diseases, and monitoring treatment of liver diseases and adverse effects of hepatotoxic drugs [1]. This panel includes total protein, albumin, globulin (calculated), albumin/globulin ratio, total bilirubin, direct bilirubin, indirect bilirubin (calculated), alkaline phosphatase (ALP), aspartate aminotransferase (AST), and alanine aminotransferase (ALT).⁠⁠⁠⁠⁠⁠⁠ALT, AST, ALP, and bilirubin are common liver chemistry analytes that can be used to evaluate liver injury. ALT is a more liver-specific marker than AST. The latter also is present in the peripheral circulation during episodes of skeletal, cardiac, and smooth muscle injury. Elevated ALT and AST levels disproportionate to ALP levels indicate hepatocellular injury; elevated ALP and bilirubin levels disproportionate to ALT and AST levels indicate cholestatic injury. In the absence of identifiable risk factors, ALT or AST levels above the upper limit of the normal range are associated with increased liver-related mortality [1]. Evaluation of direct and indirect bilirubin levels is helpful for assessing the possibility of hepatocellular disease [1]. Elevated direct bilirubin levels imply hepatocellular dysfunction or cholestasis.Albumin is a marker of liver synthetic function; low levels may indicate liver disease of more than 3 weeks' duration [1]. Total protein levels reflect the sum of albumin and globulins and may aid in the diagnosis of disorders involving the liver, kidney, or bone marrow.This panel may be useful in evaluating individuals who are taking hepatotoxic drugs as well as those with viral hepatitis, symptoms or signs of chronic liver disease, conditions associated with a high risk of developing liver disease, lifestyle risk factors for nonalcoholic fatty liver disease, or a family history of liver disease [2].Because many liver diseases cause characteristic abnormalities in selected liver chemistry analytes, results of individual analytes in this panel may aid in differential diagnosis. An abnormal test result may need to be confirmed by repeat testing and/or performing a clarifying test. For example, measurement of gamma-glutamyl transferase activity (not included in this panel) can help determine whether an elevated ALP result reflects hepatic disease [1].Note that liver enzymes are markers of liver injury, not direct measurements of hepatic function. Bilirubin, albumin, and prothrombin time are markers of liver synthetic function [1,2].The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings.References1. Kwo PY, et al.Am J Gastroenterol. 2017;112(1):18-35.2. Newsome PN, et al.Gut. 2018;67(1):6-19.

Liver & Kidney Health, Digestive Health

Elevated GGT is found in all forms of liver disease. Measurement of GGT is used in the diagnosis and treatment of alcoholic cirrhosis, as well as primary and secondary liver tumors. It is more sensitive than alkaline phosphatase, the transaminases, and leucine aminopeptidase in detecting obstructive jaundice, cholangitis, and cholecystitis. Normal levels of GGT are seen in skeletal diseases; thus, GGT in serum can be used to ascertain whether a disease, suggested by elevated alkaline phosphatase, is skeletal or hepatobiliary.

General Health & Wellness, Liver & Kidney Health

Dipstick urinalysis measures chemical constituents of urine. Microscopic examination helps to detect the presence of cells, bacteria, yeast and other formed elements.

Liver & Kidney Health, Nutrition & Vitamins

Serum uric acid measurements are useful in the diagnosis and treatment of numerous renal and metabolic disorders, including renal failure, gout, leukemia, psoriasis, starvation or other wasting conditions, and in patients receiving cytotoxic drugs.

Liver & Kidney Health

Offered as part of multiple lab tests

Liver & Kidney Health

Offered as part of multiple lab tests

Liver & Kidney Health, General Health & Wellness

Urea is the principle waste product of protein catabolism. BUN is most commonly measured in the diagnosis and treatment of certain renal and metabolic diseases. Increased BUN concentration may result from increased production of urea due to (1) diet or excessive destruction of cellular proteins as occurs in massive infection and fevers, (2) reduced renal perfusion resulting from dehydration or heart failure, (3) nearly all types of kidney disease, and (4) mechanical obstruction to urine excretion such as is caused by stones, tumors, infection, or stricture. Decreased urea levels are less frequent and occur primarily in advanced liver disease and in overhydration.

Nutrition & Vitamins, Liver & Kidney Health

Decreased levels of ceruloplasmin are found in Wilson's Disease, fulminant liver failure, intestinal malabsorption, renal failure resulting in proteinuria, chronic active hepatitis and malnutrition. Elevated levels are found in primary biliary cirrhosis, pregnancy (first trimester), oral contraceptive use and in acute inflammatory conditions since ceruloplasmin is an acute phase reactant.

General Health & Wellness, Liver & Kidney Health

Offered as part of multiple lab tests

Liver & Kidney Health, General Health & Wellness

Osmolality is a better measurement than specific gravity. Osmolality is a measure of renal tubular concentration, depending on the state of hydration.Simultaneous determination of urine and serum osmolalities facilitates interpretation of results.High urinary:plasma ratio is seen in concentrated urine. Normal ranges for the U:P ratio are given by Weisberg as approximately 0.2−4.7, and >3.0 with overnight dehydration.1With poor concentrating ability the ratio is low but still ≥1.0. In SIADH urine sodium and urine osmolality are high for plasma osmolality.3Low birthweight infants have been reported to have increased serum osmolality with normal urine osmolality.4Theurine osmolar gapis described as the sum of urinary concentrations of sodium, potassium, bicarbonate, chloride, glucose, and urea compared to measured urine osmolality. The gap is normally 80−100 mOsm/kg (SI: 80−100 mmol/kg) H2O. Determination of the urine osmolal gap is used to characterize metabolic acidosis.

Liver & Kidney Health, Diabetes & Blood Sugar

Proteinuria, mainly glomerular, is often a manifestation of primary renal disease although transient proteinuria may occur with fevers, thyroid disorders, and in heart disease. In the absence of renal disease, the degree of proteinuria is slight, usually amounting to less than 2 grams per day. In chronic glomerulonephritis and in the nephrotic syndrome including lipoid nephrosis and in some forms of hypertensive vascular disease, protein loss may vary from a few grams to as much as 30 g/day.

Liver & Kidney Health

Offered as part of multiple lab tests

Liver & Kidney Health

Erythropoietin (EPO), a glycoprotein (~30,400 daltons) produced primarily by the kidney, is the principal factor regulating red blood cell production (erythropoiesis) in mammals.3Renal production is regulated by changes in oxygen availability. Normally, EPO levels vary inversely with hematocrit. Under conditions of hypoxia, the level of EPO in the circulation increases, leading to increased production of red blood cells. Conversely, a high hematocrit should suppress the release of EPO.The over-expression of EPO may be associated with certain pathophysiological conditions.4Primary polycythemia (polycythemia vera) is a neoplastic (clonal) blood disorder characterized by EPO-independent, autonomous production of erythrocytic progenitors from abnormal bone marrow stem.5The majority of polycythemia vera cases are caused by oncogenic mutations that constitutively activate the JAKSTAT signal transduction pathway, such asJAK2V617F, or exon 12 mutations or LNK mutations. In most cases, decreased levels of EPO are found in the serum of affected patients.5Conversely, various types of secondary polycythemias are associated with the production of elevated levels of EPO.5-8The overproduction of EPO may be an adaptive response associated with conditions that produce tissue hypoxia, such as living at a high altitude, chronic obstructive pulmonary disease, cyanotic heart disease, sleep apnea, high oxygen affinity hemoglobinopathy, smoking, or localized renal hypoxia. In other instances, elevated EPO levels are the result of production by neoplastic cells. Tumors that have been associated with an inappropriate EPO production include cerebellar hemangioblastomas, uterine leiomyomas, pheochromocytoma, renal cell carcinoma, hepatocellular carcinoma, parathyroid adenomas, and meningiomas.6Deficient EPO production is found in conjunction with certain forms of anemia.9,10These include anemia of renal failure, end-stage renal disease,11hypothyroidism, and malnutrition. EPO levels are often measured in patients with chronic kidney disease to assess the kidneys' continued ability to produce erythropoietin. Anemias of chronic disease (chronic infections, autoimmune diseases, rheumatoid arthritis, AIDS, malignancies), are characterized by a blunted response of erythroid progenitors to EPO. Other forms of anemia can be associated with EPO-independent causes, and affected individuals show elevated levels of EPO. These forms include aplastic anemias, iron deficiency anemias, thalassemia, megaloblastic anemias, pure red cell aplasias, and myelodysplastic syndromes.12Recombinant human EPO (rhEPO) is administered clinically to stimulate red cell production in patients with chronic kidney disease, HIV-infected patients treated with zidovudine, patients undergoing myelosuppressive chemotherapy treatment, and other anemic patients (as an alternative to blood transfusion.)13,14Several investigators have reported that in chemotherapy-treated cancer patients, baseline EPO levels of greater than 500 mIU/mL predicts unresponsiveness to EPO therapy. Endogenous serum erythropoietin levels are measured as a qualification criterion for rhEPO treatment of anemia in HIV-infected patients taking zidovudine.13Pretransfusion erythropoietin levels have also been used to predict patients with myelodysplastic syndromes that are likely to respond to rhEPO treatment.12,15rhEPO is used by some athletes as a performance enhancing drug in an effort to increase endurance and oxygen capacity by increasing the red blood cell count.16This inappropriate use of the drug can result in adverse clinical consequences due to hypertension and increased blood viscosity. Its use has been prohibited by most sports organizations.

Nutrition & Vitamins, Liver & Kidney Health

The excretion of sodium varies with dietary intake. There is a diurnal variation of sodium excretion with excretion being greater during daytime than during the night. Decreased levels are seen in congestive heart failure, excessive sweating, diarrhea, pyloric obstruction, malabsorption and primary aldosteronism. Increased levels may be due to increased salt intake, failure of the adrenal glands, diabetic acidosis, salt losing renal disease and water deficient dehydration.

Liver & Kidney Health

Albumin excreted in the urine (Microalbumin) is a sensitive marker of nephropathy. It is used to screen for early renal disease in diabetic patients.

Nutrition & Vitamins, Liver & Kidney Health

The excretion of sodium varies with dietary intake. There is a diurnal variation of sodium excretion with excretion being greater during daytime than during the night. Decreased levels are seen in congestive heart failure, excessive sweating, diarrhea, pyloric obstruction, malabsorption and primary aldosteronism. Increased levels may be due to increased salt intake, failure of the adrenal glands, diabetic acidosis, salt losing renal disease and water deficient dehydration.

Infectious Diseases, Liver & Kidney Health

HAV is a picornavirus primarily transmitted via the fecal-oral route. HAV replicates in the liver and is shed in high concentrations in feces from 2-3 weeks before to 1 week after the onset of clinical illness. IgM antibody develops within a week of symptom onset, peaks around three months, and is usually no longer detectable after six months. Many cases of hepatitis A are subclinical, particularly in children. Antibody produced in response to HAV infection (anti-HAV) persists for life and confers protection against reinfection. The presence of IgM antibody to HAV is diagnostic of acute HAV infection. A positive test for total anti-HAV indicates immunity to HAV infection but does not differentiate current from previous HAV infection. Although usually not sensitive enough to detect the low level of protective antibody after vaccination, anti-HAV tests also might be positive after hepatitis A vaccination.

Liver & Kidney Health

Albumin excreted in the urine (Microalbumin) is a sensitive marker of nephropathy. It is used to screen for early renal disease in diabetic patients.

Liver & Kidney Health

Increased urine porphyrin excretion may be secondary to other diseases (eg, hepatobiliary diseases), especially coproporphyrin excretion. These are secondary porphyrinurias. They lack increased urinary porphobilinogen or Δ-ALA, with the important exception of lead poisoning.2The table provides an abbreviated overview of the porphyrias. Porphyrin fractionation of plasma can be done. Increases of urine porphyrins are found with congenital erythropoietic porphyria, acute intermittent porphyria, hereditary coproporphyria, variegate porphyria, and porphyria cutanea tarda.Porphyrias: OverviewDisorderInheritanceAge of Clinical OnsetPrimary Organ InvolvementUseful TestsPrimary SymptomsCongenital erythropoietic porphyriaAutosomal recessiveBirth−5 yErythroid cellsUrinary porphyrins;Fecal porphyrins;Uroporphyrinogen III synthase, erythrocytesSevere photosensitivity(Günther disease)RareFluorescence of a diaper under Wood lightRed urine;diaper stains;hemolytic anemiaAcute intermittent porphyriaAutosomal dominantAdultsHepatic, probably erythroid cellsUrine porphobilinogen;Porphobilinogen deaminase, erythrocyte;Urine porphyrins;Urinary δ-aminolevulinic acid;Erythrocyte uroporphyrinogen-1-synthase;Fecal porphyrinsMild/severe neurologic/visceral (autonomic) symptomsPrecipitating causes include barbiturates, hydantoins, sulfonamidesMost common acute hepatic porphyria in USAcute attacksHereditary coproporphyriaAutosomal dominantAdultsHepatic, possibly erythroid cellsUrine PBG and ALA in acute attacks;Urine porphyrins including coproporphyrin;Fecal porphyrins;Plasma porphyrinsSimilar to variegate porphyria;acute attacksVariegate porphyriaAutosomal dominantAdultsHepatic, possibly erythroid cellsUrine PBG and ALA in acute attacks;Urine porphyrins;Fecal porphyrins;Plasma porphyrins;Erythrocyte uroporphyrinogen-1-synthaseMild/severe photosensitivity, neurologic/visceral symptoms;acute attacksPorphyria cutanea tardaAutosomal dominant, type II (inherited type); sporadic type also known; most common porphyria in USAdultsHepatic, possibly erythroid cells; photosensitivityUrine porphyrins;Plasma porphyrins;Uroporphyrinogen decarboxylase, type II (RBCs)Similar to variegate porphyria;photosensitization;liver damageProtoporphyriaAutosomal dominantUsually childhoodErythroid cells, probably liverProtoporphyrin, free erythrocytePhotosensitization;liver damageAcquired (intoxication) porphyriaAcquiredChildren and adultsHepatic, erythroid cellsErythrocyte porphyrins;Urinary δ-aminolevulinic acid;Urine porphobilinogen;Urine porphyrins;Fecal porphyrinsMild photosensitivityFecal porphyrin examination for hereditary coproporphyria, variegate porphyria, and protoporphyria can be used for adult patients. Stool examination for coproporphyrin and protoporphyrin is recommended for diagnosis of variegate porphyria.3Neurologic dysfunction occurs in thehepatic porphyrias, the types of porphyria in which acute attacks develop: acute intermittent porphyria, variegate porphyria, hereditary coproporphyria, and ALA dehydrase deficiency. Abdominal pain, caused by autonomic neuropathy, occurs with acute attacks (eg, acute intermittent porphyria). It is the most common symptom of acute intermittent porphyria.2Cutaneous aspects of the porphyrias are caused by photosensitization (eg, porphyria cutanea tarda, protoporphyria).Hepatic complications are found withporphyria cutanea tardaandprotoporphyria. Fluorescence is demonstrable in liver biopsies from patients with the former, as well as siderosis. Crystalline deposits may be found in protoporphyria.2The amount of porphobilinogen excreted in acute intermittent porphyria is usually greater than the excretion of δ-aminolevulinic acid (Δ-ALA). When there is more Δ-ALA, another diagnosis should be considered, including lead poisoning, another type of porphyria, or hereditary tyrosinemia.2

Liver & Kidney Health

Creatinine is the endproduct of creatine metabolism. Creatine is present primarily in muscle and the amount of creatinine produced is related to total skeletal muscle mass. Daily creatinine production is fairly constant except when there is massive injury to muscle. The kidneys excrete creatinine very efficiently and blood levels and daily urinary excretion of creatinine fluctuates very little in healthy normal people. Since blood and daily urine excretion of creatinine shows minimal fluctuation, creatinine excretion is useful in determining whether 24-hour urine specimens for other analytes (e.g., protein) have been completely and accurately collected.

Liver & Kidney Health

A single culture is about 80% accurate in the female; two containing the same organism with a count of 100,000 cfu/mL or more represent a 95% chance of true bacteriuria; three such specimens mean virtual certainty of true bacteriuria. A single clean voided specimen from an adult male may be considered diagnostic with proper preparation and care in specimen collection. If the patient is receiving antimicrobial therapy at the time the specimen is collected, any level of bacteriuria may be significant. When more than two organisms are recovered, the likelihood of contamination is high; thus, the significance of definitive identification of the organisms and susceptibility testing in this situation is severely limited. A repeat culture with proper specimen collection including patient preparation is often indicated. Cultures of specimens from Foley catheters yielding multiple organisms with high colony counts usually represents colonization of the catheter and not true significant bacteriuria. Failure to recover aerobic organisms from patients with pyuria or positive Gram stains of urinary sediment may indicate the presence of mycobacteria or anaerobes.

Liver & Kidney Health

Urine chloride is often ordered with sodium and potassium as a timed urine. The urinary anion gap [Na+− (Cl−+ HCO3−)] or [(Na++ K+) − (Cl−)] is useful in the initial evaluation of hyperchloremic metabolic acidosis.4

Liver & Kidney Health

Urine chloride excretion approximates the dietary intake. The chloride content of most foods parallels that of sodium. An increase in urine chloride may result from water deficient dehydration, diabetic acidosis, Addison's Disease, and salt-losing renal disease. Decreased urine levels are seen in congestive heart failure, severe diaphoresis and in hypochloremic metabolic alkalosis due to prolonged vomiting.

Liver & Kidney Health, Diabetes & Blood Sugar

Proteinuria is characteristic of renal disease and concentrations may be increased with diabetes, hypertension, nephritic syndrome, and drug nephrotoxicity.

Liver & Kidney Health

Urine uric acid may supplement serum uric acid testing when trying to identify conditions in which there is alteration of uric acid production or excretion, e.g., gout, leukemia, renal disease. The amount of uric acid excreted may be useful in treating asymptomatic hyperuricemia. Measurement of urine uric acid is important in the investigation of urolithiasis.

Infectious Diseases, Liver & Kidney Health

This culture is designed to quantitate the growth of significant bacteria when collected by the Clean Catch Guidelines or from indwelling catheters.  Quantitative culturing of urine is an established tool to differentiate significant bacteruria from contamination introduced during voiding. This test has a reference range of less than 1,000 bacteria per mL. More than 95% of Urinary Tract Infections (UTI) are attributed to a single organism. Infecting organisms are usually present at greater that 100,000 per mL, but a lower density may be clinically important. In cases of UTI where more than one organism is present, the predominant organism is usually significant and others are probably urethral or collection contaminants. When multiple organisms are isolated from patients with indwelling catheters, UTI is doubtful and colonization likely.

Nutrition & Vitamins, Liver & Kidney Health

Prealbumin is decreased in protein-calorie malnutrition, liver disease, and acute inflammation. It may be used as an indicator of nutritional requirements and response to therapy during total parenteral nutrition and as a biochemical marker of nutritional adequacy in premature infants.

Blood Disorders, Liver & Kidney Health

Offered as part of multiple lab tests

Liver & Kidney Health

Urinary total proteins are negligible in healthy individuals. Concentrations are increased in patients with a wide variety of disease that impair renal function including diabetes, hypertension, nephritic syndrome, and drug nephrotoxicity.

Liver & Kidney Health

Offered as part of multiple lab tests

Liver & Kidney Health, General Health & Wellness

Glomerular filtration rate declines about 10% per decade after age 50. Some patients with significant impairment of glomerular filtration rate have only slightly elevated serum creatinine.3Creatinine clearance is calculated on the basis of the surface area of the patient. The estimated error of determining creatinine clearance utilizing serum and 24-hour urine collection has been found to be in the range of 10% to 15%. Any test requiring a 24-hour urine collection may also be run on this specimen (eg, protein, quantitative, 24-hour urine).

Liver & Kidney Health, Nutrition & Vitamins

This quantitative urea nitrogen test, performed with a 24-hour urine specimen, may help estimate nitrogen balance and determine protein need in patients in critical conditions or receiving intravenous administration of nutrition [1].Urea is the main nitrogen-containing product of protein breakdown and makes up over 75% of total nonprotein nitrogen excreted. Approximately 90% of the urea excretion is through the kidneys, and the rest is through gastrointestinal tract and skin. Because urea secretion is closely related to protein catabolism, urinary urea, commonly expressed by the concentration of urinary urea nitrogen, may be used to assess nitrogen balance and guide protein intake [1,2]. Blood and urinary urea levels were previously used as kidney function markers but are only considered useful in certain clinical scenarios; they have been generally replaced by creatine levels [1].Urinary urea nitrogen level may be increased in individuals with hyperthyroidism or excess protein intake or breakdown [3]. It may be decreased in individuals with malnutrition, kidney damage or insufficiency, low-protein and high-carbohydrate diet, or liver disease. Pregnant persons and healthy children may also have low urinary nitrogen levels [3].The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings.References1. Lamb EJ, et al. Kidney function tests. Rifai N, et al. eds.Tietz Textbook of Laboratory Medicine. 7th ed. Elservier Inc; 20222. Oh MS, et al. Evaluation of renal function, water, electrolytes, and acid-base balance. In: McPherson RA, et al, eds.Henry's Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Elsevier; 20213. Rao LV, et al. Laboratory tests. In: Rao LV, eds.Wallach's Interpretation of Diagnostic Tests. Pathways to Arriving at a Clinical Diagnosis. 11th ed. Wolters Kluwer; 2020.

Liver & Kidney Health, General Health & Wellness

Creatinine Clearance is used to evaluate the glomerular filtration rate (GFR). Clearance is defined as that volume of plasma from which a measured amount of substance could be completely eliminated into the urine per unit of time. Daily creatinine production is fairly constant except when there is massive injury to muscle.

Liver & Kidney Health

Excess urinary porphyrin excretion, or porphyrinuria, results from inhibition of key enzymatic steps in such clinical conditions as genetic deficiencies in heme production enzymes, hepatitis, renal disease, and erythroid disease, as well as by heavy metal inhibition of heme enzyme synthesis.1Both in experimental animals and in humans exposed to heavy metals, elevated levels of porphyrins have been found in urine.1

Infectious Diseases, Liver & Kidney Health

Hepatitis B surface antigen (HBsAg) is a protein on the surface of hepatitis B virus that can be detected in high levels in serum during acute or chronic hepatitis B virus infection. The presence of HBsAg indicates that the person is infectious. HBsAg can typically be detected in an infected person's blood an average of 4 weeks (range: 1-9 weeks) after exposure to the virus. Persistence of HBsAg, without anti-HBs, with combinations of positivity of anti-HBc, HbeAg, or anti-HBe indicates infectivity and the need for investigation for chronic persistent or chronic aggressive hepatitis.The presence of Hepatitis B surface antibody (anti-HBs) is generally interpreted as indicating recovery and immunity from hepatitis B virus infection. Anti-HBs also develops in a person who has been successfully vaccinated against hepatitis B.Total hepatitis B core antibody (anti-HBc) appears at the onset of symptoms in acute hepatitis B and persists for life. The presence of anti-HBc indicates previous or ongoing infection with hepatitis B virus in an undefined time frame. IgM antibody to hepatitis B core antigen (IgM anti-HBc) positivity indicates recent infection with hepatitis B virus (< 6 months) and its presence is consistent with acute infection.HBV Serology Interpretation: Key: Analyte present: + Analyte absent: - Test not indicated: TNIInterpretationHBsAganti-HBsanti-HBcIgM anti-HBc* Multiple possibilities: resolved infection (most common); false-positive anti-HBc (susceptible); "low-level" chronic infection; resolving acute infection.Susceptible/no evidence of infection---TNIImmune due to natural resolved infection-++TNIImmune due to vaccination-+-TNIAcute infection+-++Chronic infection+-+-Interpretation unclear*--+±

Liver & Kidney Health

Offered as part of multiple lab tests

Liver & Kidney Health, Diabetes & Blood Sugar

The estimated glomerular filtration (GFR) provides an assessment of the filtering capacity of the kidney. The eGFR is calculated from a serum cystatin C using the CKD-EPI equation, 2012.3

Liver & Kidney Health, Respiratory Health

Alpha-1-Antitrypsin level may be increased in normal pregnancy and in several diseases including chronic pulmonary disease; hereditary angioedema; renal, gastric, liver and pancreatic diseases; diabetes; carcinomas and rheumatoid diseases. Alpha-1-Antitrypsin may be decreased in emphysema, hepatic cirrhosis, respiratory distress syndrome of the newborn, nephrosis, malnutrition and cachexia. If a deficiency is present, aat phenotyping may be considered to confirm heterozygous versus homozygous deficiencies.

Blood Disorders, Liver & Kidney Health

Elevated levels of serum erythropoietin (EPO) occur in patients with anemias due to increased red cell destruction in hemolytic anemia and also in secondary polycythemias associated with impaired oxygen delivery to the tissues, impaired pulmonary oxygen exchange, abnormal hemoglobins with increased oxygen affinity, constriction of the renal vasculature, and inappropriate EPO secretion caused by certain renal and extrarenal tumors. Normal or depressed levels may occur in anemias due to increased oxygen delivery to tissues, in hypophosphatemia, and in polycythemia vera.

Digestive Health, Liver & Kidney Health

The concentration of bile acids in serum is elevated in patients with many structural liver diseases, due to the inability of the liver to extract bile acids efficiently from portal blood. Metabolic liver diseases such as Gilbert disease, Crigler-Najjar syndrome, or Dubin-Johnson syndrome do not appear to cause elevated bile acid concentrations. Bile acid levels may be altered even when other liver function tests are normal and may serve as a sensitive and specific indicator of liver disease.Intrahepatic cholestasis of pregnancy (ICP) is a temporary condition caused by maternal liver dysfunction during pregnancy. It is characterized by intense generalized pruritus (itchiness) which usually begins in the third trimester. ICP is also known as cholestatic jaundice of pregnancy, cholestatic hepatosis, icterus gravidarum, and obstetric cholestasis.There are several laboratory tests which can be done to confirm a diagnosis of cholestasis of pregnancy, including bile acids. Maternal blood levels of bile salts are often at least three times the normal level in ICP; however, the levels may be 10 to 100 times normal. Blood tests can also reveal increased levels of other liver enzymes that indicate general liver dysfunction, such as ALT, AST, and alkaline phosphatase. While ALT/AST levels may be normal or slightly elevated, alkaline phosphatase levels are almost always higher than normal (though this may be due, in part, to the alkaline phosphatase added to the mother's blood from the placenta). However, if the liver enzymes are extremely elevated, other causes, such as viral hepatitis, should be considered. In the absence of bile acid tests, elevated ALT, AST and/or alkaline phosphatase levels in the setting of intense pruritus are generally adequate to diagnose cholestasis of pregnancy.Though it may cause extreme discomfort, cholestasis of pregnancy is regarded as benign to the mother; however, it has been widely established that ICP poses a significant increased risk to the fetus and is associated with an increased incidence of stillbirth. Fetal death in ICP is a real risk and the primary objective of treatment is to make certain that the baby is born before stillbirth occurs. While the fetal death rate for untreated patients is around 10%, studies in which patients are induced before term have found fetal mortality rate to be 0% to 2%. The danger from ICP is eliminated when the child is safely delivered and labor is induced when the fetus' lungs are mature, regardless of any other test results.After delivery, the symptoms in the mother usually decrease within 48 hours of delivery and disappear completely within four weeks postpartum. Cholestasis of pregnancy does not cause permanent liver impairment to the mother and the liver returns to normal function, once the baby is delivered.

Liver & Kidney Health

For assessing the concentrating ability of the kidney.

Liver & Kidney Health

Beta-2-Microglobulin (B2M) is a low molecular weight protein that forms the light chain component of the histocompatibility antigen. It is synthesized by all nucleated cell types. It is an integral part of the class I MHC antigens and is present in all body fluids. B2M is filtered through the glomeruli of the kidney and is then reabsorbed and catabolised by the proximal tubular cells. In normal patients only trace amounts of B2M appear in the urine. Elevated urine B2M is seen in tubulo-interstitial disorders. Increased urine B2M is seen in cadmium exposure, diatrizoate, exercise, fever, nephrectomy, semen. There is evidence that monitoring B2M levels in HIV-infected individuals offers an independent predictor of progression to AIDS, leukemia and lymphoma.

Liver & Kidney Health

Plasma renin activity (PRA) is a measure of the activity of the plasma enzyme renin, which plays a major role in the body's regulation of blood pressure, thirst, and urine output.3,4Renin produced by the juxtaglomerular apparatus of the kidney converts angiotensinogen to angiotensin I in the plasma. Inactive angiotensin I is further converted to the active octapeptide angiotensin II, a potent vasopressor that is responsible for hypertension of renal origin. Angiotensin II also incites the zona glomerulosa of the adrenal cortex to release aldosterone as part of the renin-angiotensin-aldosterone system (RAS). Renin secretion by the kidney is stimulated by a drop in glomerular blood pressure, by decreased sodium concentration at the distal tubule, or by stimulation of sympathetic outflow to the kidney, as occurs in renal vascular diseases.Measurement of PRA is most frequently performed in the evaluation of patients with hypertension. Primary Aldosteronism (PA) is a common cause of resistant hypertension and is associated with an increased incidence adverse cardiovascular outcomes.3,5-7PRA levels are usually diminished in PA, a condition where aldosterone release by the adrenals is not controlled by the renin-angiotensin system and aldosterone production is excessive relative to body's sodium status.3,7-9The diagnosis of PA is based on measurement of the plasma aldosterone level, PRA, and the calculation of an aldosterone:renin ratio (LabCorp Test numberAldosterone:Renin Ratio [004354]).3,7Primary aldosteronism can result from an aldosterone-producing adrenocortical tumor (adenoma or, rarely, carcinoma), bilateral adrenal hyperplasia, or glucocorticoid-remediable aldosteronism. Primary aldosteronism is a common cause of hypertension, accounting for as many as 5% to 10% of cases. Most patients with primary aldosteronism do not suffer from hypokalemia.3PRA levels can be low in patients with forms of congenital adrenal hyperplasia (CAH) that are associated with excessive mineralocorticoid production (ie, 11-beta-hydroxylase or 17-alpha-hydroxylase deficiency). PRA levels can be low in patients with Cushing's syndrome who experience marked elevated cortisol levels. Diminished PRA levels can also be observed in patients with Liddle's syndrome11, congenital or acquired (eg, through ingestion of licorice) deficiency of 11-beta-hydroxysteroid dehydrogenase type 2,12and in patients with certain mutations of the mineralocorticoid receptor gene.12PRA levels can be increased in patients with primary adrenal insufficiency, including those with Addison's disease9with mineralocorticoid activity leads to salt-wasting. These salt-wasting forms of CAH include defects in steroid acute regulatory protein, side-chain cleavage enzyme, 3-beta-hydroxysteroid dehydrogenase, 21-hydroxylase13or aldosterone synthase.14PRA levels can be increased in a number of other conditions that are associated with salt wasting including Bartter syndrome, Gitelman syndrome and pseudohypoaldosteronism type I.9Markedly elevated PRA levels can be seen in patients with reninoma.15Reninoma is a tumor of the renal juxtaglomerular cell apparatus that causes hypertension and hypokalemia because of the overproduction of renin.15Reninoma is an uncommon cause of hypertension in a young adult and should be included in the differential diagnosis as a potential life-threatening and curable condition.16,17PRA is measured in the laboratory by incubating plasma at physiologic temperature in a buffer that facilitates its enzymatic activity. The natural substrate for the enzyme renin is angiotensinogen. Exogenous angiotensinogen is not added to the reaction mixture. This means that, in effect, the PRA results reported are dependent on both renin concentration and the concentration of its substrate in the patient's plasma. Renin cleaves angiotensinogen to produce a decapeptide, angiotensin I, the concentration of which is assayed using liquid chromatography accompanied by tandem mass spectroscopic detection (LC/MS/MS). PRA levels are reported as the amount of angiotensin I generated per unit of time.PRA measurement is different from direct renin immunoassays that are available from some laboratories.18Whereas activity assays measure only active renin, immunoassays measure both active and inhibited renin.18Also, the PRA measurement is affected by endogenous renin substrate (angiotensinogen) levels while the direct renin assays are not. This is important in some populations (eg, women during the luteal phase of menstruation or taking exogenous estrogen) because they tend to have relatively higher levels of renin substrate.19,20Samples from patients with raised substrate levels and reduced enzyme concentrations produce normal PRA levels. Direct renin levels measured in these patients are lower, resulting in the potential for producing inappropriately elevated aldosterone renin ratios.19,20

Autoimmune & Inflammation, Liver & Kidney Health

The presence of LKM-1 antibodies can be used in conjunction with clinical findings and other laboratory tests to aid in the diagnosis of autoimmune liver diseases such as autoimmune hepatitis (AIH-2).

Liver & Kidney Health

Serum protein electrophoresis (SPE) is an analytical technique that provides separation of serum protein into six fractions: Albumin, Alpha-1, Alpha-2, Beta-1, Beta-2, and Gamma. Interpretation of elevation, decreased, or visual change in different fractions can be used as a diagnostic aid for a variety of different disease states and protein abnormalities, including monoclonal gammopathies (MG).

Liver & Kidney Health, General Health & Wellness

Offered as part of multiple lab tests

Liver & Kidney Health, Bone Health

When the Total Alkaline Phosphatase activity is increased, the Isoenzymes are useful in determining the source of the increased activity.

Liver & Kidney Health, Diabetes & Blood Sugar

Cystatin C is a non-glycosylated, low molecular weight (13,250 kD) cysteine proteinase inhibitor that is produced by all nucleated cells and found in body fluids, including serum. Since it is formed at a constant rate and freely filtered by the kidneys, its serum concentration is inversely correlated with the glomerular filtration rate (GFR); that is,high values indicate low GFRs while lower values indicate higher GFRs, similar to creatinine. The renal handling of cystatin C differs from creatinine. While both are freely filtered by glomeruli, once it is filtered, cystatin C, unlike creatinine, is reabsorbed and metabolized by the proximal renal tubules. Thus, under normal conditions, cystatin C does not enter the final excreted urine to any significant degree. The serum concentration of cystatin C remains unchanged with infections, inflammatory or neoplastic states, and is not affected by body mass, diet, or drugs. Thus, cystatin C may be a more reliable marker of renal function (GFR) than creatinine.GFR can be estimated (eGFR) from serum cystatin C utilizing an equation which includes the age and gender of the patient. The CKD-EPI cystatin C equation was developed by Inker et al, and demonstrated good correlation with measured iothalamate clearance in patients with all common causes of kidney disease, including kidney transplant recipients. Cystatin C eGFR may have advantages over creatinine eGFR in certain patient groups in whom muscle mass is abnormally high or low (for example quadriplegics, very elderly, or malnourished individuals). Blood levels of cystatin C also equilibrate more quickly than creatinine, and therefore, serum cystatin C may be more accurate than serum creatinine when kidney function is rapidly changing (for example amongst hospitalized individuals).

Liver & Kidney Health, Diabetes & Blood Sugar

Offered as part of multiple lab tests

Liver & Kidney Health, Nutrition & Vitamins

A serum protein electrophoresis should be reviewed concurrently if one has not been recently studied. In nonselective glomerular proteinuria, the urine electrophoretic pattern is often a nonspecific one which may be called “mirror image” to that of the serum. Contamination of the urine with blood can give a similar pattern. With selective glomerular permeability, albumin, α1-proteins, and transferrin are the predominant proteins identified on the urine protein electrophoresis, with a relative absence of heavier molecular weight proteins (ie, α2-macroglobulin and immunoglobulins). With tubular proteinuria, low molecular weight proteins (α2- and β2-microglobulins) are predominant, with trace amounts of albumin. So called “overflow proteinuria” occurs when low molecular weight proteins are filtered through the glomerulus in increased amounts.

Liver & Kidney Health

ADH, produced in the supraoptic and paraventricular locations of the hypothalamus, acts on the collecting tubules of the kidney to cause increase in permeability to water and urea. ADH release is triggered by a number of both osmotic and nonosmotic stimuli. Measurement of ADH is useful in separating central diabetes insipidus, which is marked by polydipsia and polyuria and is caused by inadequate ADH production from nephrogenic diabetes insipidus caused by the inability of renal tubules to respond to ADH. In SIADH, release of ADH is disproportionate to a low serum osmolality. SIADH results due to a number of conditions such as pulmonary disease, head trauma, and cancer.

Blood Disorders, Liver & Kidney Health

A serum protein electrophoresis should be reviewed concurrently if one has not been recently studied. In nonselective glomerular proteinuria, the urine electrophoretic pattern is often a nonspecific one which may be called “mirror image” to that of the serum. Contamination of the urine with blood can give a similar pattern. With selective glomerular permeability, albumin, α1proteins, and transferrin are the predominant proteins identified on the urine protein electrophoresis, with a relative absence of heavier molecular weight proteins (ie, α2-macroglobulin and immunoglobulins). With tubular proteinuria, low molecular weight proteins (α2- and β2-microglobulins) are predominant, with trace amounts of albumin. So called “overflow proteinuria” occurs when low molecular weight proteins are filtered through the glomerulus in increased amounts.

Blood Disorders, Liver & Kidney Health

This test is used to analyze the protein content in urine. The proteins are separated into 5 major components: albumin, alpha-1, alpha-2, beta, and gamma. Interpretation of elevations, decreases, or visual changes in different components and/or associated patterns can provide information on various disease states, including inflammatory diseases, autoimmune diseases, different types of kidney injury, plasma cell disorders, and cancers [1,2].UPEP is used to evaluate an individual with symptoms associated with potential monoclonal gammopathy, or when an individual has abnormally high total protein, albumin, or immunoglobulin levels. This test can help with initial diagnosis, as well as monitoring disease progression and treatment effectiveness [1,2].Specifically, the use of 24-hour urine collection (vs random urine) is recommended by the National Comprehensive Cancer Network (NCCN) Panel as one of the tests for diagnosis for multiple myeloma and for monitoring response to treatment. The International Myeloma Working Group (IMWG) recommends ordering this test every 3 to 6 months, or as needed, for example, to establish baseline or if disease worsens [1].The advantage of analyzing urine that has been collected over a 24-hour period is that it provides insight into compositional changes in urine throughout the day. This allows for a more accurate assessment of urine composition, based on averages, making the test more sensitive than a random UPEP test (test code 8525).NOTE: The results of this test should not be used in isolation; these results alone are not enough to make a diagnosis or for monitoring. UPEP results should be evaluated along with other laboratory, clinical, and imaging findings as appropriate. Additional testing, such as bone marrow studies, serum protein electrophoresis (SPEP), and immunofixation (IFE), may be required for comprehensive evaluation [1,2].References1. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Multiple myeloma. Version 2.2020; October 9, 2019.https://www.nccn.org2. Rajkumar SV, et al.Lancet Oncol. 2014;15:e538-e548.

Infectious Diseases, Liver & Kidney Health

Hepatitis A virus (HAV) is a picovirus primarily transmitted via the fecal-oral route. HAV replicates in the liver and is shed in high concentrations in feces from 2-3 weeks before to 1 week after the onset of clinical illness. IgM antibody develops within a week of symptom onset, peaks around three months, and is usually no longer detectable after six months. The presence of IgM antibody to HAV is diagnostic of acute HAV infection.Hepatitis B surface antigen (HBsAg) is a distinctive serological marker of acute or chronic hepatitis B infection. HBsAg is the first antigen to appear following infection with HBV and is generally detected 1-10 weeks after the onset of clinical symptoms. HBsAg assays are routinely used to diagnose suspected HBV infection and monitor the status of infected individuals to determine whether the infection has resolved or the patient has become a chronic carrier of the virus. In patients that recover from HBV infection, HBsAg is undetectable 3-5 months after the onset of infection. In patients with chronic infection, HBsAg remains detectable for life.Anti-HBc IgM increases rapidly, peaks during the acute infection stage of HBV infection, and then falls to a relatively low level as the patient recovers or becomes a chronic carrier. Anti-HBc IgM is useful in the diagnosis of acute HBV infection even when HBsAg concentrations are below the sensitivity of the diagnostic assay.Detection of both HCV antibody and HCV RNA indicates current HCV infection. Detection of HCV antibody in the absence of HCV RNA is consistent with the absence of current HCV infection. Repeat HCV RNA testing is recommended if the person tested is suspected to have had HCV exposure within the past 6 months or has clinical evidence of HCV disease.

Liver & Kidney Health

Offered as part of multiple lab tests

Liver & Kidney Health

This quantitative test, performed with a 24-hour urine specimen, may help screen for hyperoxaluria, assess kidney function, determine the cause of kidney stones, and monitor treatment compliance and outcomes [1]. In general, 24-hour urine specimens are preferred to random urine specimens when measuring oxalic acid for diagnostic evaluation and monitoring of hyperoxaluria [1,2].Oxalic acid is an organic compound that naturally exists in many food sources. Because humans cannot metabolize oxalic acid, it must be excreted in urine as oxalate (the ionic form of oxalic acid). Excessive excretion of oxalates is called hyperoxaluria and can be attributed to primary or secondary causes. Primary hyperoxaluria (PH) is a rare condition resulting from enzymatic defects and can lead to chronic kidney disease, which may progress to kidney failure. Secondary hyperoxaluria can be caused by fat malabsorption, which may be due to inflammatory bowel disease, extensive resection of the small bowel, or excessive ingestion of substances that increase serum oxalates [3].PH is associated with significant morbidity and mortality, including end-stage kidney disease [1].Early diagnosis is associated with better outcomes, but more than 40% of PH diagnoses are delayed [1]. Screening for PH may be considered for children with their first episode of kidney stone, adults with recurrent calcium oxalate stones, and individuals with nephrocalcinosis or family history of stone disease [1].Urinary oxalic acid measurements may be inaccurate when estimated glomerular filtration rate declines [1]. Therefore, in patients with chronic kidney disease, plasma oxalate may be measured to help support the diagnosis of PH [1].Results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings.References1. Bhasin B, et al.World J Nephrol. 2015;4(2):235-244.2. Williams JC Jr, et al.Urolithiasis. 2021;49(1):1-16.3. Shchelochkov O, et al. Defects in metabolism of amino acids. In: Kliegman R, et al.Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2019:720-722.

General Health & Wellness, Liver & Kidney Health

“Total carbon dioxide” consists of CO2in solution or bound to proteins, HCO3−, CO32−, and H2CO3. In practice, 80% to 90% is present as bicarbonate (HCO3−). “Hypercapnia” means excessive carbon dioxide in the blood. Impaired elimination of CO2reflects interaction of abnormalities in respiratory drive, the muscles of respiration, and the function of the lung. Elimination of carbon dioxide from the lung involves alveolar ventilation but not dead-space ventilation. Partitioning of these spaces is expressed as a ratio between dead space and total volume per breath: the tidal volume. The tidal volume normally is <0.30. These and other aspects of pulmonary gas exchange, ventilation and their consequences are addressed as the partial pressure of arterial carbon dioxide, PaCO2, a part of arterial blood gases.1Note:Total CO2(Bicarbonate) results should be interpreted withcaution, because escape of dissolved CO2from the sample prior to analysis is inevitable and will vary among laboratory locations. This is because the measured total CO2in serum decreases relative to the amount of time that the sample is open to the atmosphere. CO2loss occurs the moment the stopper is removed from the vacutainer tube. Labcorp facilities follow rigorous quality processes in order to reduce the exposure of patient samples to the atmosphere and minimize CO2loss, but even minor logistical variations at our laboratory locations may cause differences in the degree of CO2loss.

General Health & Wellness, Liver & Kidney Health

Measurements are used in the diagnosis and treatment of numerous potentially serious disorders associated with changes in body acid-base balance.

Infectious Diseases, Liver & Kidney Health

HAV Serology Interpretation: Key - Analyte present: + Analyte absent: - Test not indicated: TNIInterpretationHAV Ab, TotalHAV Ab, IgMSusceptible/no indication of infection-TNIPreviously vaccinated against or infected with HAV+-Acute infection++HBV Serology Interpretation: Key - Analyte present: + Analyte absent: - Test not indicated: TNIInterpretationHBsAganti-HBsanti-HBcIgM anti-HBc* Multiple possibilities: resolved infection (most common); false-positive anti-HBc (susceptible); "low-level" chronic infection; resolving acute infection.Susceptible/no evidence of infection---TNIImmune due to natural resolved infection-++TNIImmune due to vaccination-+-TNIAcute infection+-++Chronic infection+-+-Interpretation unclear*--+±HCV Serology Interpretation: Key - Analyte present: + Analyte absent: - Test not indicated: TNIInterpretationHCV AbHCV RNA, NAA*For persons who might have been exposed to HCV within the past 6 months, testing for HCV RNA or follow-up testing for HCV antibody should be performed. For persons who are immunocompromised, testing for HCV RNA should be performed.**Repeat HCV-RNA testing if the person tested is suspected to have had HCV exposure within the past 6 months or has clinical evidence of HCV disease.No HCV antibody detected, no indication of infection*-TNIHCV antibody detected but no evidence of current infection**+-HCV antibody and viral RNA detected consistent with current infection++

Liver & Kidney Health, Nutrition & Vitamins

Offered as part of multiple lab tests

Liver & Kidney Health

Offered as part of multiple lab tests

Liver & Kidney Health

Overexposure/poisoning determination.

Genetic Testing, Liver & Kidney Health

Hereditary hemochromatosis (HFE related) is an autosomal recessive iron storage disorder. Patients may have a genetic diagnosis of hereditary hemochromatosis and never show clinical symptoms. Clinical symptoms typically appear between 40 to 60 years in males and after menopause in females. Signs and symptoms may include organ damage, primarily in the liver, risk for hepatocellular carcinoma, diabetes, and heart disease due to iron accumulation. Life expectancy may be decreased in individuals who develop cirrhosis. Treatment for clinically symptomatic individuals may include therapeutic phlebotomy. Liver transplant may be used to treat end stage liver failure. For preventive care, monitoring for iron overload is recommended for patients who are homozygous for c.845G>A (p.Cys282Tyr) and have yet to experience clinical symptoms. The most common HFE variants associated with hereditary hemochromatosis are c.845G>A (p. Cys282Tyr), c.187C>G (p.His63Asp), c.193A>T (p. Ser65Cys). While patients homozygous for c.845G>A (p.Cys282Tyr) are the most likely to present clinical symptoms, less than 10% develop clinically significant iron overload with tissue and organ damage. Genetic coordinators are available for health care providers to discuss results and for information on how to order additional testing, if desired, at 1-800-345-GENE.

Liver & Kidney Health

Offered as part of multiple lab tests

Genetic Testing, Liver & Kidney Health

Offered as part of multiple lab tests

Liver & Kidney Health, Digestive Health

Offered as part of multiple lab tests