Serum Protein and Albumin-Globulin RatioASHIKH SEETHY
For MBBS Biochemistry Practical. Explains various methods of protein estimation and estimation of AG ratio, conditions leading to alterations in AG ratio etc.
billirubin production billirubin transport and metabolism, different laboratory methods of billirubin estimation ,normal and abnormal levels of billirubin, different classification and types of jaundice and liver diseses, liver functioning, enterohepatic circulation, billirubin production and degradation, benefits and diseases of abnormal level of billirubin
Serum Protein and Albumin-Globulin RatioASHIKH SEETHY
For MBBS Biochemistry Practical. Explains various methods of protein estimation and estimation of AG ratio, conditions leading to alterations in AG ratio etc.
billirubin production billirubin transport and metabolism, different laboratory methods of billirubin estimation ,normal and abnormal levels of billirubin, different classification and types of jaundice and liver diseses, liver functioning, enterohepatic circulation, billirubin production and degradation, benefits and diseases of abnormal level of billirubin
Pathological analysis of body fluids with lab investigations,
Including Amniotic fluid, Semen analysis, Synovial fluid, Gastric fluid
Other body fluids: Sweat,saliva,tear
It is characterized by a yellow appearance of the (1) Skin (2) Mucous membranes and (3) Sclera caused by bilirubin deposition. It is the most specific clinical manifestation of Hepatic dysfunction.
Jaundice is usually present clinically when the plasma bilirubin concentration reaches 2 to 3 mg/dl.
When bilirubin clearance from the Liver to the Intestinal tract is impaired (as in acute hepatitis and bile duct obstruction) it may be accompanied by alcoholic (Gray coloured) stools.Solubility increases in water , soluble conjugated bilirubin leads to Tea coloured urine.
these clearance test plays an very important role in determining the functioning capacity and working status of kidney.
and we estimate how amount of compund is excreted in the urine and absorption too.
and i also attached the mathematical caluculation to identify the metabolic valuve of urea, creatinine, inulin clearance by kidney.
Pathological analysis of body fluids with lab investigations,
Including Amniotic fluid, Semen analysis, Synovial fluid, Gastric fluid
Other body fluids: Sweat,saliva,tear
It is characterized by a yellow appearance of the (1) Skin (2) Mucous membranes and (3) Sclera caused by bilirubin deposition. It is the most specific clinical manifestation of Hepatic dysfunction.
Jaundice is usually present clinically when the plasma bilirubin concentration reaches 2 to 3 mg/dl.
When bilirubin clearance from the Liver to the Intestinal tract is impaired (as in acute hepatitis and bile duct obstruction) it may be accompanied by alcoholic (Gray coloured) stools.Solubility increases in water , soluble conjugated bilirubin leads to Tea coloured urine.
these clearance test plays an very important role in determining the functioning capacity and working status of kidney.
and we estimate how amount of compund is excreted in the urine and absorption too.
and i also attached the mathematical caluculation to identify the metabolic valuve of urea, creatinine, inulin clearance by kidney.
Liver function tests and interpretation is a very important topic for students of medical and allied fields. It is essential for efficient practice of clinical and laboratory medicine.
Proteinuria - Mechanisms , Causes and Approach.pdfJim Jacob Roy
Proteinuria can occur due to various reasons.
The normal urinary excretion of protein is less than 150 mg / day.
If the daily excretion rate is > 3.5 g / day , it is termed as nephrotic range proteinuria.
In this document , I have described about the mechanisms of proteinuria , the methods to measure urinary protein and the various causes of proteinuria.
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2. Albumin
Most of the body’s total protein is a combination of albumin and
globulins.
Albumin, the protein present in the highest concentrations, is the
main transport protein in the body for hormones, therapeutic drugs,
calcium, magnesium, heme, and waste products such as bilirubin.
Albumin also significantly affects plasma oncotic pressure, which
regulates the distribution of body fluid between blood vessels, tissues,
and cells.
Albumin is synthesized in the liver.
Low levels of albumin may be the result of either inadequate intake,
inadequate production, or excessive loss.
Albumin levels are more useful as an indicator of chronic deficiency
than of short-term deficiency.
3. Hypoalbuminemia or low serum albumin, a level less than
3.4 g/dL, can stem from many causes and may be a useful
predictor of mortality.
Normally albumin is not excreted in urine. However, in
cases of kidney damage some albumin may be lost due to
decreased kidney function as seen in nephrotic syndrome,
and in pregnant women with pre-eclampsia and
eclampsia.
Albumin levels are affected by posture.
Results from specimens collected in an upright posture are
higher than results from specimens collected in a supine
position.
4. The albumin/globulin (A/G) ratio is useful in the
evaluation of liver and kidney disease.
The ratio is calculated using the following formula:
albumin/(total protein – albumin) where globulin is the
difference between the total protein value and the
albumin value.
For example, with a total protein of 7 g/dL and albumin
of 4 g/dL, the A/G ratio is calculated as 4/(7 – 4) or 4/3 =
1.33. A reversal in the ratio, where globulin exceeds
albumin (i.e., ratio less than 1.0), is clinically significant.
’s
5. INDICATIONS
Assess nutritional status of hospitalized
patients, especially geriatric patients
Evaluate chronic illness
Evaluate liver disease
6. POTENTIAL DIAGNOSIS
Increased in:
Any condition that results in a decrease of plasma water (e.g.,
dehydration); look for increase in hemoglobin and hematocrit.
Decreases in the volume of intravascular liquid automatically
result in concentration of the components present in the
remaining liquid, as reflected by an elevated albumin level.
Hyperinfusion of albumin
7. Decreased in
Insufficient intake:
Malabsorption (related to lack of amino acids available for protein
synthesis)
Malnutrition (related to insufficient dietary source of amino acids
required for protein synthesis)
• Decreased synthesis by the liver:
Acute and chronic liver disease (e.g., alcoholism, cirrhosis, hepatitis)
Genetic analbuminemia (related to genetic inability of liver to synthesize
albumin)
8. Inflammation and chronic diseases
Inflammation and chronic diseases result in production of acute-
phase reactant and other globulin proteins; the increase in
globulins causes a corresponding relative decrease in albumin:
Amyloidosis
Bacterial infections
Monoclonal gammopathies (e.g., multiple myeloma, Waldenström’s
macroglobulinemia)
Neoplasm
Parasitic infestations
Peptic ulcer
Prolonged immobilization
Rheumatic diseases
Severe skin disease
9. Increased loss over body surface
Burns (evidenced by loss of interstitial fluid albumin)
Enteropathies (e.g., gluten sensitivity, Crohn’s disease, ulcerative colitis, Whipple’s disease)
(evidenced by sensitivity to ingested substances or related to inadequate absorption
from intestinal loss)
Fistula (gastrointestinal or lymphatic) (related to loss of sequestered albumin from general
circulation)
Hemorrhage (related to fluid loss)
Kidney disease (related to loss from damaged renal tubules)
Pre-eclampsia (evidenced by excessive
renal loss)
Rapid hydration or overhydration (evidenced by dilution effect)
10. Increased catabolism:
Cushing’s disease (related to excessive cortisol induced protein metabolism)
Thyroid dysfunction (related to overproduction of albumin binding
thyroid hormones)
Increased blood volume (hypervolemia):
Congestive heart failure (evidenced by dilution effect)
Pre-eclampsia (related to fluid retention)
Pregnancy (evidenced by increased circulatory volume from placenta and fetus)
11. INTERFERING FACTORS
Drugs that may increase albumin levels include
carbamazepine, furosemide, phenobarbital, and
prednisolone.
Drugs that may decrease albumin levels include
acetaminophen (poisoning), amiodarone, asparaginase,
dextran, estrogens, ibuprofen, interleukin-2,
methotrexate, methyldopa, niacin, nitrofurantoin, oral
contraceptives, phenytoin, prednisone, and valproic acid.
