DR. HAILIN WUDR. YOSEPH FELEKE

Kidney Function Panel

Kidney Function Panel

Kidney Function Panel (blood urea nitrogen (BUN), creatinine, glucose)

Blood Urea Nitrogen (BUN)Test Range and Collection

serum (BUN) 10–20 mg/dL

Increased in: Renal failure (acute or chronic), urinary tract obstruction, dehydration, shock, burns, CHF, GI bleeding. Nephrotoxic drugs (eg, gentamicin).

Decreased in: Hepatic failure, nephrotic syndrome, cachexia (low-protein and high-carbohydrate diets).

Creatinine

Test Range and Collection serum (Cr) Female: 0.5-1.1 mg/dL Male: 0.6–1.2 mg/dL

Increased in: Acute or chronic renal failure, urinary tract obstruction, nephrotoxic drugs, hypothyroidism.

Decreased in: Reduced muscle mass

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Metabolic Panels - Glucose

Normal value: (fasting) 70-110 mg/dLCasual: <or = 200mg/dL

Causes of elevated values: Diabetes mellitus Corticosteroid therapy Cushing syndrome

Causes of decreased values: Insulin overdose Hypothyroidism Addison Disease

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HbA1C

Normal findings: Nondiabetic adult: 2.2-4.8% Good control diabetic: 2.5-5.9% Fair control diabetic: 6-8% Poor control diabetic: >8%

This is the percentage of total hemoglobin that appears as glycohemoglobin.

Uric acid

Normal Finding:BloodMale: 4.0-8.5 mg/dLFemale: 2.7-7.3 mg/dLUric acid is a product of the metabolism (breakdown) of

purines. Purines are chemicals that come from both the breakdown of foods and nucleic acids (DNA) in the body.

Excess uric acid can cause the condition called gout.

Increase: leukemia or multiple myeloma, hypertension during pregnancy, alcoholism, Down syndrome, lead poisoning, poor diet, liver disease, obesity, and psoriasis. Stress or very strenuous exercise, kidneys failure.

Parathyroid Panel (PTH)

Normal finding:Intact (whole): 10-65pg/ml

HyperparathyroidismTumors in the parathyroids elevate the level of PTH causing a

rise in the level of blood Ca2+ at the expense of calcium stores in the bones. So much calcium may be withdrawn from the bones that they become brittle and break.

HypoparathyroidismCauses: accidental removal of or damage to the parathyroids

during neck surgery; inherited mutations in the PTH gene; inherited predisposition to an autoimmune attack against the parathyroids; inherited defect in the embryonic development of the parathyroids (DiGeorge syndrome)

total prostate specific antigen (PSA)

Normal findings:0-2.5ng/mL is low2.6-10ng/mL is slightly to moderately elevated10-19.9 ng/mL is moderately elevated>or =20ng/mL is significantly elevated

Elevated: prostate cancer; enlarged or inflamed prostate

The PSA test is used primarily to screen for prostate cancer. A PSA test measures the amount of prostate-specific antigen (PSA) in the blood. PSA is a protein produced in the prostate, a small gland that sits below a man's bladder.

Reproductive hormones panel (pregnancy test (Beta HCG), estrogen, progesterone, testosterone)

pregnancy test

Human Chorionic Gonadotropin, Serum (HCG)Normal, < 3.0 mIU/mL 10 d after conception > 3 mIU/mL Thereafter levels slowly decline Collection: Tiger top tube

Increased:PRG, some testicular tumors (nonseminomatous germ cell tumors, but

not seminoma),trophoblastic disease (hydatidiform mole, choriocarcinoma levels

usually > 100,000 mIU/mL)

estrogen

Normal finding:Female: 4-60 Urine mcg//24 hours

Estrogens are steroids. They are primarily responsible for the conversion of girls into sexually-mature women.

Increase:Feminization syndromes, precocious puberty, ovarian tumor, testicular

tumor, adrenal tumor, normal pregnancy, hepatic cirrhosis, hepatic necrosis, hyperthyroidism

Decrease: Failing pregnancy, turner syndrome, menopause, anorexia nervosa

progesterone

ProgesteroneFollicular phase:,50ng/dLLuteal:300-2500ng/dLpostmenopausal:<40ng/dL

First trimester: 725-4400 ng/dLSecond trimester: 1950-8250 ng/dLThird trimester: 6500-22,900 ng/dL

Progesterone is an endogenous steroid hormone involved in the menstrual cycle, pregnancy, and embryogenesis of humans and other species. 

Increase: ovulation, pregnancy, luteal cysts of ovary, choriocarcinoma of ovary, hydatidiform mole of the uterus

Decrease: preeclampsia, toxemia of pregnancy, threatened abortion, placental failure, fetal death, ovarian neoplasm, amenorrhea, ovarian hypofunction.

testosterone

Normal findings:Free testosterone:Male:1.6%-2.9%

Testosterone is a steroid hormone from the androgen group and is found in mammals. In mammals, testosterone is secreted primarily by the testicles of males and the ovaries of females, although small amounts are also secreted by the adrenal glands. It is the principal male sex hormone and an anabolic steroid.

Increase: idiopathic sexual precocity, Pinealoma, Encephalitis, congenital adrenal hyperplasia, Adrenocortical tumor, Hyperthroidism, Testosterone resistance syndromes

Decreased: klinefelter syndrome, cryptorchidism, primary and secondary hypogonadism, trisomy 21 (down syndrome) hepatic cirrhosis

Thyroid Panel

Thyroid Panel (TSH, T3, T4)

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Thyroid Panel

The thyroid panel focuses on three tests to measure thyroid function. The main function of the thyroid is to regulate and control metabolism. The tests included in the panel are: TSH – thyroid stimulating hormone T4 - thyroxine T3 - triiodothyronine

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Thyroid Panel - TSH

Normal values: 0.3-3 microunits/mL

Causes of increased levels:Primary hypothyroidism (thyroid dysfunction)Thyroiditis, large doses of iodine, radioactive iodine

injection

Causes of decreased levels:2º hypothyroidism (pituitary or hypothalamus

dysfunction)Hyperthyroidism

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Thyroid Panel – T4

Normal value: 0.8-2.8 ng/dL

Causes of increased levels:1º hyperthyroidism

Grave disease, thyroid tumor

Acute thyroiditisFactitious hyperthyroidism

Causes of decreased levels:HypothyroidismPituitary or hypothalamic insufficiencyIodine insufficiency

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Thyroid Panel – T3

Normal value: 70-205 ng/dLCauses of increased levels:

1º hyperthyroidism Grave disease, thyroid tumor

Acute thyroiditis Factitious hyperthyroidism

Causes of decreased levels: Hypothyroidism Pituitary or hypothalamic insufficiency Iodine sufficiency/malnutrition

Indications of a Urinalysis

1.  Appearance: "Dark yellow or amber in color and clear"2.  Specific Gravity

a. Neonates: 1.012b. Infants: 1.002–1.006c. Children and Adults: 1.001–1.035 (typical with normal fluid intake 1.016–1.022)

3.  pHa. Neonates: 5–7b. Children and Adults: 4.6–8.0

4.  Negative for: Bilirubin, blood, acetone, glucose, protein, nitrite, leukocyte esterase, reducing substances

5.  Trace: Urobilinogen6.  RBC: Male 0–3/hpf, female 0–5/hpf7.  WBC: 0–4/hpf8.  Epithelial Cells: Occasional9.  Hyaline Casts: Occasional10.  Bacteria: None11.  Crystals: Some limited crystals based on urine pH (see Differential Diagnosis for

Routine Urinalysis)