1. 224 PHL Lab#5

2. Non-protein nitrogen (NPN) NPN includes the nitrogen from all nitrogenous substances other than proteins. The NPN could be measured as a group or individually. Major Constituents: Urea, uric acid, creatinine, ammonia etc.

3. Importance of NPN: Testing NPN in blood served as a test for kidney functions. Now it is replaced by determination of urea nitrogen because: (1) The route of elimination of various NPN compounds differs considerably. Some are excreted by glomerular filtrations only e.g. creatinine. Uric acid is excreted by tubular excretion. Urea is excreted by glomerular filtration and then partially absorbed by the tubules. (2) The increase of NPN is mainly a reflection of increase of urea nitrogen which normally makes up 45% of the total NPN.

4. Determination of Serum Urea Concentration Urea is the end product of protein metabolism in the body. It is synthesized in the liver from the (NH 2 ) amino group resulting from deamination of amino acids.

5. Principle: urease Urea + H2O ----------> 2NH4 + CO2

6. Procedure: standardsample 0.1 ml Serum sample 0.1 ml standard 1 ml Working reagent Incubate for at 37° C for 5 min, then read the absorbance against blank at λ= 520nm. Normal serum level: 3.5 – 7.2 mg/dl. * Incubate at 37° C for 5 min, then read the absorbance after 30 seconds (A1), then read after 60 seconds (A2) against blank at λ= 340 nm. Normal serum level: 3.5 – 7.2 mg/dl.,

7. Calculation: Serum Urea conc. = A sample /A standard x Conc. Of St. (53.57) = mg/dl. Normal value: (10-50 mg/dl)

8. Clinical Significance: Increase in blood urea nitrogen could be due to: Pre-Renal Causes: 1) Salt and water depletion. 2) Protein catabolism as in fever. Renal Causes: 1)Glomerulonephritis. 2) Mercury poisoning. 3) Hyperparathyroidism. 4)Hypervitiminosis D. cause ↑ in serum Ca and precipitation of Ca in the kidney tissue causing destruction of kidney tissue.

9. Clinical Significance: Increase in blood urea nitrogen (hyperuremia) could be due to: Post-Renal Causes: 1) Prostate enlargement. 2) Stones in urethra. 3) Tumor of the bladder. cause obstruction to urine flow producing back pressure on the kidney and kidney damage.

10. Decrease in blood urea nitrogen (hypouremia) could be due to : 1) Liver failure. 2) Malnutrition. 3) Over hydration. 4) Early stages of pregnancy.

11. Determination of Serum Uric Acid Concentration Uric acid is the end product of purine metabolism. It comes from endogenous metabolism of nucleoproteins and exogenously from food.

12. Principle: uricase Uric acid + O2 + 2H2O ---------> Alantoin + CO2 + H2O2. peroxidase 2H2O2 + 4-aminoantipyrine + DCFS --------------> quinoneimine + 4H2O.

13. Procedure: standardsample 0.2 ml Serum sample 0.2 ml standard 1 ml Working reagent Incubate for at 37° C for 5 min, then read the absorbance against blank at λ= 520nm. Normal serum level: 3.5 – 7.2 mg/dl. * Incubate at 37° C for 5 min, then read the absorbance against blank at λ= 520nm. Normal serum level: 3.5 – 7.2 mg/dl.,

14. Calculation: Serum Uric acid conc. = A sample /A standard x Conc. Of St. (6 mg/dl) = mg/dl. Normal value: 3.4 – 7 mg/dl

15. Clinical Significance: Increase in uric acid Hyperuricemia could be due to: Decrease in uric acid Hypouricemia could be due to: 1. Gout. 2. Toxemia. 3. Leukemia. 4. Age: menopausal women. 5. Drugs:Thiazide diuretics. 1. Hepatitis. 2. Uricosuric drugs: salicylates, phenylbutazone. 3. Fanconi syndrome.

16. Determination of Serum Creatinine Concentration : Creatinine is the internal anhydride derived from dephosphorylation of creatine phosphate. Creatine Creatinine + H2O Creatinine has no useful function and is eliminated in urine by glomerular filtration.

17. Determination of Serum Creatinine Concentration : It is not reabsorbed by the tubules to any significant extent, Therefore glomerular damage will decrease the rate at which creatinine is excreted. Creatinine clearance test can be used as a test for kidney function as its excretion parallels the glomerular filtration rate (GFR). A serum creatinine level over 2 mg/dl indicates Renal Failure.

18. Principle: Creatinine in the sample reacts with picrate in alkaline medium forming a colored complex.

19. Procedure: standardsample 0.1 ml Serum sample 0.1 ml standard 1 ml Working reagent Incubate for at 37° C for 5 min, then read the absorbance against blank at λ= 520nm. Normal serum level: 3.5 – 7.2 mg/dl. * Mix then read the absorbance against blank at λ= 546 nm after 20 seconds (A1). * Then read after 80 seconds (A2). Normal serum level: 3.5 – 7.2 mg/dl.,

20. Calculation: Serum Creatinine conc. = (A2-A1) sample /(A2-A1) standard x Conc. Of St. (2 mg/dl) = mg/dl. Normal value: (0.6 - 1.1 mg/dl)