CLINICAL CHEMISTRYCHAPTER 9.ppt

CLINICAL CHEMISTRYCHAPTER 9 NON - PROTEIN NITROGEN Introduction NPN ( Non - Protein Nitrogen ) is a “funky” term that can be used for a bunch of different substances that have the element nitrogen in them, but are not proteins. This is a little unusual, because most of the body’s nitrogen is associated with proteins. There are many different unrelated NPNs, but we are only interested in 4 of them: Creatinine , Blood Urea Nitrogen ( BUN ) , Uric Acid and Ammonia In general, plasma NPNs are increased in renal failure and are commonly ordered as blood tests to check renal function Key Terms Allantoin Ammonia Azotemia BUN / Creat Ratio Creatinine Clearance Creatine Creatinine GFR Glomerulus Gout Hyper ( hypo ) uricemia NPN Pre-renal Post- renal Purines Renal absorption Renal secretion Uric acid Urea Uremic syndrome Reyes Syndrome Objectives List the origin and principle clinical significance of BUN, Creatinine, Uric Acid and Ammonia List the reference ranges for the 4 principle NPNs Discuss why creatinine is the most useful NPN to evaluate renal function Calculate Creatinine Clearance Discuss the common methodologies used to measure BUN, Creatinine, Uric Acid and Ammonia General ideas about the NPNs Antiquated term when protein – free filtrates were required for testing The NPNs were used for evaluating renal function The NPNs include about 15 different substances Most NPNs are derived from protein or nucleic acid catabolism Most important NPNs BUN ( Blood Urea Nitrogen ) Creatinine Uric acid Ammonia BUN ( Blood Urea Nitrogen ) Blood Urea Nitrogen = BUN = Urea 50% of the NPNs Product of protein catabolism which produces ammonia Ammonia is very toxic – converted to urea by the liver Liver converts ammonia and CO2 Filtered by the glomerulus but also reabsorbed by renal tubules ( 40 % ) Some is lost through the skin and the GI tract ( 10 % ) Plasma BUN is affected by Renal function Dietary protein Protein catabolism BUN disease correla