Urinalysis IN Liver Disease: by Rika Nilapsari

URINALYSIS
IN
LIVER DISEASE
by
Rika Nilapsari
Live
r
Largest & most complex internal organ

About 1.4 kg
Involved in most of the metabolic
functions
Laboratory tests of liver function are
more sensitive than clinical signs &
symptoms
Normal Liver Function
1. Metabolism of carbohydrate, lipid &
protein
2. Synthesis of coagulation factors
3. Synthesis of bile salts
4. Processing of drugs & hormones
5. Excretion of bilirubin
6. Strorage of glycogen, certain vitamins (A,
B12, D, E, K) & minerals (Fe & Co)
7. Phagocytosis
8. Activation of vitamin D
Laboratory in liver disorder
Liver damage
Blood Urine
- Bilirubin - Bilirubin
- Enzymes - Urobilin/
Urobilinogen
Bilirubin
Major metabolite of heme (Hb, myoglobin &

cytochromes)
Produced 250-350 mg/day
Types:
-bilirubin (Unconjugated bilirubin)
bilirubin (Monoglucuronida bilirubin)
bilirubin (Diglucuronida bilirubin =
conjugated bil)
bilirubin (Bilirubin tightly bound
albumin: irreversible albumin bound)
Laboratory tests of bilirubin: diazotized
sulfanilic acid
The pathway of Bilirubin metabolism
Pathophysiology :
Inflammation
liver cell oedem
Liver cell necrosis pressed

cholangioles
increased
permeability
Tests of Liver Injury
Commonly measured enzymes:

1. ASTm: aspartate aminotransferase
mitochodrial
2. ASTc: aspartate aminotransferase
cytosol
3. ALT: Alanine aminotransferase
4. ALP: Alkaline phosphatase
5. GGT: -glutamyltransferase
6. LDH: Lactate dehydrogenase
Tests of Liver Injury
Cellular Locations of Enzymes
ASTm
ALT & ASTc
GGT
ALP & GGT

URINALYSI
S
Urine test strip:
Rapid, easy, specific,cheap
SPECIFIC GRAVITY
PROTEIN
NITRITE
KETOBODY
GLUCOSE
UROBILINOGEN
BLOOD
PLASTIK ROD
NYLON COVER
TEST FIELD
(PAPER CONTAIN REAGENT)
FILTER PAPER
DIPSTICK TEST
Dipstick urine test
1. Specific gravity
2. pH
3. Leukocytes
4. Nitrates
5. Protein
6. Glucose
7. Ketones
8. Urobilinogen
9. Bilirubin
10. Blood
Specific Gravity (1.003-1.035)
specific gravity is a means by which the

kidney's ability to concentrate urine is
measured
In the presence of cations, protons are
released by a complexing agent in the test
and produce a color change. The indicator
bromthymol blue changes from blue via
blue-green to yellow.
pH (4.6-8)
Symbol "pH" expresses the strength of the

urine as a dilute acid or base solution and
measures the free hydrogen ion (H+)
concentration in the urine.
Dipstick contains the indicators methyl

red and bromthymol blue. These
indicators give clearly distinguishable
colors over the pH range of 5-9.
Leukocytes (negative)
leukocytes (esterase) + indoxylcarbonic

acid ester
indoxyl.
indoxyl + diazonium salt a
purple color; any shade of purple is
considered a positive test
Nitrates (negative)
Specific groups of bacteria create nitrates as

a by-product of their metabolism.
When present, these bacteria can be
indirectly detected by screening for nitrate
levels.
Nitrate + aromatic amine diazonium
salt
Diazonium salt + 3 hidroxy-tetrahidro-
benzoquinolin
yields a red-violet azo dye.
Protein (negative)
in health, the urine contains no protein

or only trace amounts of protein
the detection of protein is based on the
protein error of pH indicators in which
tetrachlorophenol and
tetrabromosullfophthalein react with one
another to change from yellow to light
green/green
Glucose (negative)
Glucose is normally present in glomerular

filtrate, but it is reabsorbed by the
proximal tubule.
D-Glucose + O2 GOD -D
gluconolactone + H2O2
POD
H2O2 + 0-tolidine H2O + co
Ketones (negative)
in healthy individuals, ketone bodies are

formed in the liver and are completely
metabolized so that only negligible amounts
appear in the urine
sodium nitroprusside and glycerin +

acetoacetate and acetone alkaline medium
violet dye complex.
Urobilinogen (random sample : negati
one of the most sensitive tests used to

determine impaired liver function
urobilinogen + 4-methoxybenzene-
diazonium-tetrafluoroborate acid medium a
red azo dye.
Bilirubin (negative)
Normally, there is a small amount of

urobilinogen, not bilirubin, in the urine
the detection of bilirubin is based on the

coupling reaction of diazonium salt with
bilirubin in an acid medium. The reaction
yields a pink to red-violet color
proportional to the total bilirubin conc.
Blood (negative)
blood in the urine is usually occult blood

that has been hemolyzed or dissolved
Hb(2,5 dimethyl 2,5 dihydroperoxyhexa

+
tetramethylbenzidi
ne
Green-blue

Urinalysis IN Liver Disease: by Rika Nilapsari

Uploaded by

Copyright:

Available Formats

Urinalysis IN Liver Disease: by Rika Nilapsari

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Urinalysis IN Liver Disease: by Rika Nilapsari

Uploaded by

Copyright:

Available Formats

URINALYSIS

Largest & most complex internal organ

Major metabolite of heme (Hb, myoglobin &

liver cell oedem

Liver cell necrosis pressed

Commonly measured enzymes:

Cellular Locations of Enzymes

ALT & ASTc

ALP & GGT

specific gravity is a means by which the

Symbol "pH" expresses the strength of the

Dipstick contains the indicators methyl

leukocytes (esterase) + indoxylcarbonic

Specific groups of bacteria create nitrates as

in health, the urine contains no protein

Glucose is normally present in glomerular

in healthy individuals, ketone bodies are

sodium nitroprusside and glycerin +

one of the most sensitive tests used to

Normally, there is a small amount of

the detection of bilirubin is based on the

blood in the urine is usually occult blood

Hb(2,5 dimethyl 2,5 dihydroperoxyhexa

You might also like