Prabhakar Singh- IV_SEM-FUNCTION TEST OF KIDNEY AND PANCREAS

1. TEJASVI NAVADHITAMASTU
“Let our (the teacher and the taught) learning be radiant”
Let our efforts at learning be luminous and filled with joy, and endowed with the force of purpose
Paper XII: CLINICAL AND DIAGNOSTIC BIOCHEMISTRY
Dr. Prabhakar Singh. D.Phil. Biochemistry
Department of Biochemistry, VBSPU, Jaunpur
FUNCTION TEST OF KIDNEY AND PANCREAS

2. FUNCTION OF KIDNEY
The kidneys are the vital organs of the body, performing the following major functions.
1. Maintenance of homeostasis :The kidneys are largely responsible for the regulation of
water, electrolyte and acid-base balance in the body.
2. Excretion of metabolic waste products : The end products of protein and nucleic acid
metabolism are eliminated from the body. These include urea, creatinine, creatine, uric
acid, sulfate and phosphate.
3. Retention of substances vital to body :The kidneys reabsorb and retain several
substances of biochemical importance in the body e.g. glucose, amino acids etc.
4. Hormonal functions :The kidneys also function as endocrine organs by producing
hormones.
• Erythropoietin: a peptide hormone, stimulates hemoglobin synthesis and formation
of erythrocytes.
• Calcitriol (1,25-Dihydroxycholecalciferol)– the biochemically active form of vitamin
D – is finally produced in the kidney. It regulates calcium absorption from the gut.
• Renin,a proteolytic enzyme liberated by kidney, stimulates the formation of
angiotensin II which, in turn, leads to aldosterone production. Angiotensin II and
aldosterone are the hormones involved in the regulation of electrolyte balance.

3. MAJOR RENAL SYNDROMES:

4. ABNORMAL CONSTITUENTS OF URINE

6. PANCREATIC FUNCTION TESTS
The pancreas is a specialized organ with exocrine and endocrine functions. The
endocrine functions are discussed under the topic diabetes mellitus.
The exocrine functions involve the synthesis of pancreatic juice containing several
enzymes (for the digestion of foodstuffs) and bicarbonate.
The major enzymes of pancreatic juice are trypsin, chymotrypsin, elastase,
carboxypeptidase, amylase and lipase.
Pancreatic enzymes in serum : Serum amylase and lipase measurements are
commonly employed to assess the pancreatic function. Both these enzyme activities
are elevated in acute pancreatitis, obstruction in the intestine and/or pancreatic duct.
A puncture of the pancreas, which may lead to the secretion of digestive enzymes such
as lipase and amylase into the abdominal cavity as well as subsequent pancreatic self-
digestion and digestion and damage to organs within the abdomen, generally requires
prompt and experienced medical intervention.
It is possible for one to live without a pancreas, provided that the person takes insulin
for proper regulation of blood glucose concentration and pancreatic enzyme
supplements to aid digestion.

7. PANCREATIC INFLAMMATION
Inflammation of the pancreas is known as pancreatitis. Pancreatitis is most often
associated with recurrent gallstones or chronic alcohol use, although a variety of
other causes, including measles, mumps, some medications, the congenital
condition alpha-1 antitrypsin deficiency and even some scorpion stings, may cause
pancreatitis. Pancreatitis is likely to cause intense pain in the central abdomen,
that often radiates to the back, and may be associated with jaundice. In addition,
due to causing problems with fat digestion andbilirubin excretion, pancreatitis often
presents with pale stools and dark urine.
In pancreatitis, enzymes of the exocrine pancreas damage the structure and tissue
of the pancreas. Detection of some of these enzymes, such
as amylase and lipase in the blood, along with symptoms and findings on X-ray,
are often used to indicate that a person has pancreatitis. A person with pancreatitis
is also at risk of shock. Pancreatitis is often managed medically with analgesics,
removal of gallstones or treatment of other causes, and monitoring to ensure a
patient does not develop shock.

8. PANCREATIC CANCER
Pancreatic cancers, particularly the most common type, pancreatic adenocarcinoma, remain very
difficult to treat, and are mostly diagnosed only at a stage that is too late for surgery, which is the
only curative treatment. Pancreatic cancer is rare in those younger than 40, and the median age
of diagnosis is 71. Risk factors include: smoking, obesity,diabetes, and certain rare genetic
conditions including: multiple endocrine neoplasia type 1 and hereditary nonpolyposis colon
cancer among others. About 25% of cases are attributable to tobacco smoking, while 5-10% of
cases are linked to inherited genes.
There are several types of pancreatic cancer, involving both the endocrine and exocrine tissue.
Pancreatic adenocarcinoma, which affects the exocrine part of the pancreas, is by far the most
common form. The many types of pancreatic endocrine tumors are all uncommon or rare, and
have varied outlooks. However the incidence of these cancers has been rising sharply; it is not
clear to what extent this reflects increased detection, especially through medical imaging, of
tumors that would be very slow to develop. Insulinomas(largely benign) and gastrinomas are the
most common types. In the United States pancreatic cancer is the fourth most common cause of
deaths due to cancer. The disease occurs more often in the developed world, which had 68% of
new cases in 2012. Pancreatic adenocarcinoma typically has poor outcomes with the average
percentage alive for at least one and five years after diagnosis being 25% and 5% respectively. In
localized disease where the cancer is small (< 2 cm) the number alive at five years is
approximately 20%.
A solid pseudopapillary tumour is a low-grade malignant tumour of the pancreas
of papillary architecture that typically afflicts young women.

9. PANCREASES AND DIABETES
Type 1 diabetes
Diabetes mellitus type 1 is a chronic autoimmune disorder in which the immune
system attacks the insulin-secreting cells of the pancreas. People with type 1
diabetes therefore lack the insulin needed to keep blood sugar levels within
optimal ranges. If left untreated, this leads to high blood sugar and the array of
associated symptoms. Type 1 diabetes develops in people of all ages but is most
often diagnosed before adulthood. For type 1 diabetics, insulin injections are
critical for survival.
Type 2 diabetes
Diabetes mellitus type 2 is the most common form of diabetes. The causes for high
blood sugar in this form of diabetes usually are a combination of insulin
resistance and impaired insulin secretion, with both genetic and environmental
factors playing an important role in the development of the disease. The
management of type 2 diabetes relies on a series of changes in diet and physical
activity with the purpose of reducing blood sugar levels to normal ranges and
increasing insulin sensitivity. Biguanides such asmetformin are also used as part of
the treatment along with insulin therapy.