ORGAN FUNCTION TEST

• Organ function tests are biochemical tests that

are certain tests done to assess if a particular
organ is functioning normally or not.

• Before a treatment for a condition is done, it is

important that various tests are done to
understand how the vital organs are
functioning.
LIVER FUNCTION TEST.
The main functions of liver are as follows:
• Bile production.
• Excretion of bilirubin, cholesterol and hormones
• Synthesis of plasma proteins
• Metabolism of carbohydrates, fats and proteins
• Storage of glycogen, vitamins and minerals
• Production of certain enzymes
• Production of certain blood clotting factors
• Detoxification of drugs
Indications for test
• Family history of liver disease

• Patients with symptoms and signs like abdominal pain, nausea and vomiting,

dark urine, light colored stool, fatigue

• Heavy alcohol use

• Exposure to hepatitis

• Diabetes

• Monitoring liver diseases

• Prognosis (Assessing and evaluating the treatment).

Liver function test includes
1. Estimation of serum bilirubin level
2. Albumin and total protein level in blood
3. Estimation of enzymes made by the liver - Alanine
transaminase, Aspartate transaminase, Gamma glutamyl
transferase, Lactate dehydrogenase
4. Prothrombin time
1. Serum bilirubin test

• Bilirubin is a substance produced during normal breakdown of

red blood cells.

• This test determines the level of bilirubin in the blood -

conjugated bilirubin, unconjugated bilirubin and total bilirubin.

• lt is processed in the liver, mixed with bile and excreted into

the bile duct

• An increase in the bilirubin level indicates an obstruction or

liver damage or a certain type of anaemia.
• Van den Bergh reaction is a specific test to
identify the increase in serum bilirubin. Normal
serum gives a negative van den Bergh reaction.

• The response of this reaction can differentiate

the different types of jaundice.

• Indirect positive : Haemolytic jaundice

Direct positive: Obstructive jaundice
Biphasic: Haemolytic jaundice
Normal values

Conjugated bilirubin (direct) = 0.1 - 0.3 mg/dl

Unconjugated bilirubin between = 0.2 -0.6 mg/dI.
Total conc. of normal plasma bilirubin = 0.3-1.9
mg/dl.

If total bilirubin level rises above 2-2.5 mg/dl it

indicates JAUNDICE
Causes of high bilirubin

• Liver disease like hepatitis

• Jaundice

• Cirrhosis of liver

• Gilbert syndrome (defect in processing of bilirubin)

• Haemolytic anaemia

• Biliary stricture

• Cancer of gall bladder or pancreas

• Gall stones

• Sickle cell anaemia

2. Albumin and total protein
• Total protein can be divided into albumin and globulin ratio.

• Low levels of total protein indicate liver damage.

• Albumin is a protein synthesized in the liver and it is a good marker to assess

chronic liver damage.

• It helps in transport of enzymes, hormones and other substances throughout the body.

• Normal serum level of albumin is 3.5-5 g/dl

• Low serum albumin is seen in patients with severe liver damage especially due to

cirrhosis.

• Globulin helps in liver functioning, blood clotting, and fighting infection.

• Alb:Glob = 1.1-2.5

• Cirrhosis of liver causes a reversal of albumin/globulin ratio (< 1.0)

3. Estimation of enzymes made by the
liver
Alanine transaminase (ALT)/(SGPT) test
• It is an enzyme found mostly in the liver (cytoplasmic enzyme) and
it helps in converting proteins into energy.
• ALT Is found in the liver cells and it is released into the blood when
there is a liver damage or inflammation.
• It is an initial test for screening liver disease.
Normal Values:
• Males 29-33 IU/L
• Females- 19-25 IUL
Causes of high levels of ALT: Hepatitis, Cirrhosis, Tumour or cancer
of liver, Hemochromatosis (Iron overload), Alcohol abuse, Blockage of
bile duct
Aspartate transaminase test (AST)/ (SGOT)

• AST İs an enzyme found in cytoplasm and mitochondria of liver

cells (and also muscles) that helps in the metabolism of amino acids.

• An increase in the serum AST level along with increase in ALT indicates
liver damage or liver disease.

Normal values:

• Normal serum level of AST is 0-35 IU/L

Causes of high AST

• Hepatitis

• Cirrhosis

• Pancreatitis
Alkaline phosphatase (ALP)

• ALP is an enzyme found in liver (and bones) that is needed for breakdown of proteins.

• In the liver it is found in the lining of bile canaliculi

Normal serum value:

• ALP is 20- 140 IUL

Causes of high ALP:

• Obstructive jaundice. (An increase in ALP along with increase in serum bilirubin indicates

obstructive jaundice).

• Gall stones

• Cirrhosis of liver

• Hepatitis

• Liver cancer
Gamma glutamyl transferase (GGT)

• Normal serum concentration is 10– 15 IU/ L.

• It is an enzyme that helps in the transport of molecules.

• In the liver it helps to metabolize drugs and other toxins.

• Serum GGT is highly elevated in biliary obstruction, viral

hepatitis, liver cancer, pancreatitis and alcoholism.

• GGT test along with other liver function test helps to

diagnose liver diseases.

Lactate dehydrogenase (LDH)

• LDH is found in almost all the cells.

• It helps in the metabolism of carbohydrate to

produce energy.

• Elevated levels may indicate liver damage but it

can be elevated in many other disorders.

• Normal serum concentration ranges between

140- 280 IU/L
4. Prothrombin time:

• Prothrombin is a protein made by the liver that helps in blood

clotting.

• Increased prothrombin time indicates liver damage like cirrhosis.

• Medications for blood thinning can also prolong the blood clotting time.

• Normal Prothrombin time is 10 to 13 seconds.

• A level higher than 13 seconds indicates that blood takes more time to

clot.

• Level less than 10 seconds indicates that blood clots faster than

normal.
RENAL FUNCTION TEST

• Renal function tests are tests that are done to assess the renal function.

The main functions of kidney are as follows:

• Regulation of water, electrolyte and acid base balance (maintaining

homeostasis)

• Removing toxins and waste products from the body

• Production of hormones like erythropoietin and calcitriol

• Regulation of blood pressure by releasing certain hormones

• Production of active form of vitamin D

Indications for renal function test

• High blood pressure

• Blood in urine

• Frequent urge to urinate

• Painful urination

• Difficulty during beginning of urination

• Edema
• Renal function tests include
1. Glomerular filtration rate (GFR)
2. Estimation of blood urea, serum creatinine,
protein (albumin), and electrolytes
3. Imaging test
4. Kidney biopsy
5. Urine tests
1. Glomerular filtration rate

• GFR is the rate at which substances in plasma are filtered

through the glomerulus.

• The normal GFR is 120 –125 ml/min.

• Accurate estimate of GFR is important for identifying kidney

diseases, which often does not have any symptoms until just
before kidney failure.

• This test is done for patients with higher risk of developing

kidney disease, i.e., those having diabetes, high blood
pressure, family history of kidney disease etc.
• The standard measurement of GFR was by injecting inulin
and testing its clearance by the kidneys.

• Since it is an invasive, time consuming and expensive

procedure, clearance of creatinine from blood and urine is
also used.

• The clearance rate for a given substance equals GFR when

it is neither secreted nor reabsorbed by the kidneys.

• The simplest method now used in the labs is the eGFR

(estimated glomerular filtration rate) test
• Here the blood sample is taken (fasting) and the creatinine level is
measured.

• Creatinine is a waste product of metabolism of protein and normal

breakdown of creatine is found in muscle tissue.

• Healthy kidneys remove the creatinine from blood and excretes it

through the urine.

• If there is a problem with the kidneys then the creatinine levels in

the blood starts to increase.

• The eGFR declines with age even if there is no kidney diseases.

• The table below shows an average eGFR in relation to age

eGFR in relation to age
Age (in years) Average eGFR
20-29 116
30-39 107
40-49 99
50-59 93
60-69 85
70+ 75
Knowing the GFR Score helps us to identify the stage of kidney disease.

Stage 1: GFR 90 ml/ min or greater - normal kidney function

Stage 2: GFR 60-89 ml / min- mild decline in kidney function

Stage 3a: GFR 45-59 ml / min - mild to moderate decline in kidney function

Stage 3b: GFR 30-44ml / min -moderate to severe decline in kidney function.

Stage 4: GFR 15-29 ml / min -severe decline in kidney function

Stage 5: GFR less than 15- kidney failure, usually requiring dialysis
2. Estimation of blood urea, serum creatinine, protein and electrolytes:

a. Blood urea nitrogen test (BUN test)

• BUN test measures the amount of urea nitrogen in the blood.

• Urea is a waste product of metabolism of protein which is removed by the kidneys.

• Normal serum urea nitrogen ranges between 7-20 mg/dl.

• An increase in blood urea nitrogen could be due to

• kidney problems

• certain medications as in case of large dose of aspirin or antibiotics

• heart failure

• dehydration or a diet high in protein.

• If the increase in urea nitrogen is due to kidney problems, then the serum

creatinine level will also be high.

b. Serum creatinine test:

• Creatinine is a waste product formed from breakdown of creatine

found in muscle tissue, which is normally excreted by the kidneys
in the urine.

• High levels of serum creatinine indicates kidney damage leading to

decreased glomerular filtration and decreased urine output.

• It is a late marker for acute kidney injury, hence 50% of the kidney
will be damaged before the serum creatinine increases

• Normal creatinine level ranges between 0.74- 1.35 mg/dl in men

and 0.59 – 1.1 mg/dl in women.
C. Serum electrolytes test:

• The electrolytes are charged particles that helps to transmit nerve and

muscle impulse throughout the body.

• The most common electrolytes associated with renal dysfunction are

sodium, potassium, chloride and bicarbonates.

• The minerals include calcium, phosphorous and magnesium.

• Normally kidneys helps to maintain the fluid and electrolyte balance.

• Malfunction of the kidneys can cause an imbalance in the fluid and

electrolyte balance and the impulses can be affected.

• So electrolyte test helps to monitor the body's electrolyte levels and it

shows how well the kidneys are functioning.

Potassium (K):
Normal range is 3.5 to 5.0 mmol/L
Hypokalaemia is below 3.5 mmol/L
Hyperkalaemia is above 5.0 mmol/L
Sodium (Na)
Normal range: 135 to 145 mmol/L
Hyponatraemia : below 135 mmol/L
Hypernatraemia: above 145 mmol/L
Chloride
Normal range Adults - 98 to 106 mEq/L
Children– 90 to 110 mEq/L
New born– 96 to 106 mEq/L
Higher than normal chloride level is
hyperchloremia.
Lower than normal chloride level is
hypochloremia.
Bicarbonates
• Though bicarbonates are freely filtered by the glomerulus.

• About 4320 mEq of bicarbonates are

reabsorbed every day to maintain the acid base balance.

• Normal serum bicarbonate level is 23 to 30 mEq/L

• A level of bicarbonate below 22mEq/L indicates chronic kidney

disease.

• In CKD , kidneys cannot remove the acids and metabolic

acidosis occur.
Calcium:
• Normal serum calcium level is 8.6 to 10.3 mg/dL

• Vitamin D and parathyroid hormone helps to regulate the absorption and excretion

of calcium by the kidneys.

• Healthy kidneys turn vitamin D into active hormone calcitriol, which increases

Ca2+ absorption from the intestine into the blood.

• Chronic kidney disease cause imbalance in calcium metabolism.

• Total intake of calcium for patients with renal disease should not be greater

than 2000mg/day.

• Hypocalcaemia occurs in chronic renal failure due to decreased production of

vitamin D and increased serum concentration of phosphorous.

Phosphorous
• Normal range for serum phosphorous is 2.5 to 4.5 mg/dL.
• Kidneys and parathyroid hormones helps in maintaining the phosphate levels
by controlling the amount of phosphate absorbed from the diet.
• When the kidneys fail, the phosphates are not excreted leading to an
increase in serum phosphate level.
• Kidney diseases can also lead to an increase in parathyroid hormone
production which leads to an increase in phosphate level.
• The increased phosphates binds to the calcium causing weakening of bones.
• A high phosphate level (hyper phosphatemia) is a sign of kidney damage
(chronic kidney disease end stage)
Magnesium:
• Normal range is 1.7 to 2.2 mg/dL
• Hyper magnesemia is above 2.6 mg/dL (occurs in kidney failure)
3. Imaging test: Ultra sound and CT scan can be done to get a picture of the kidneys.
Any obstructions, structural abnormalities, stones can be detected through imaging tests.

4. Kidney biopsy: Biopsy may be done to identify specific disease process, and the
amount of damage that has happened to the kidneys.

5. Urine tests
a. Urinalysis:
• It includes microscopic examination and dipstick test.
• The dipstick is a chemically treated stick that changes color when dipped in urine that
contain abnormalities like protein, blood, bladder infections and stones, pus, bacteria
and sugar.
• Urinalysis can help to diagnose kidney and urinary tract disorders, bladder infections
and stones.
Thyroid function tests (TFT)

• Thyroid function tests (TFT) are blood tests that are done
to check the functions of the thyroid.

• The test also measures the level of the hormone -

thyroid stimulating hormone- secreted by the pituitary
gland that stimulates the thyroid.

• Thyroid gland produces two thyroid hormones namely

thyroxine (T4) and triiodothyronine (T3)
which regulate the metabolic rate of the body.
• If the thyroid gland doesn't produce enough of these

hormones, person may show signs and symptoms like weight

gain, depression, lack of energy, brittle hair and finger nails and

this condition is called hypothyroidism.

• If the thyroid gland produces excess of these hormones, there

will be weight loss, high anxiety, tremors, diarrhea and this

condition is called hyperthyroidism.

• It is important to know that the TSH and Thyroxine (T4) are

always in a balance and their balance is maintained by

feedback regulation.
Thyroid function test includes
1. Thyroid stimulating hormone (TSH)
2. T4 or thyroxine test
3. T3 or Triiodothyronine test
4. Thyroglobulin test
5. Radioactive iodine uptake test (RAIU)
6. Thyroid scan
Thyroid stimulating hormone (TSH)

• TSH is a hormone secreted by the pituitary gland and it helps in

regulating the thyroid hormones.

• Normal range for an adult is 0.4 - 4.50mlU/L.

• Changes in TSH is an early warning of thyroid

dysfunction.

• A high TSH indicates that the thyroid gland is not making enough
thyroid hormone (hypothyroidism)

• A low TSH indicates that the thyroid is producing too much of thyroid
hormones (hyperthyroidism)
T4 test or thyroxine test
• T4 is the main form of thyroid hormone circulating in the blood

• It exist in two forms – free form and bound form.

• The free form enters the body tissues wherever it is needed, while the bound

form which is attached to the proteins does not enter the body tissues.

• A test that measures both free and bound T4 is called a total T4 test.

• Other test measures just the free T4.

• A free T4 test is considered more acute than a total T4 test.

• Normal range of serum total T4 is 5.0- 11.0 micrograms/

deciliter of blood and free T4 is 0.9-1.7 ng/dL

• A low TSH and a low free T4 indicates hypothyroidism

due to problem in the pituitary gland.

• A high TSH and low level of T4 indicates hypothyroidism

due to disease in thyroid gland.

• A low TSH with a high free T4 indicates hyperthyroidism.

3. Triiodothyronine test (T3)

• T3 is useful in diagnosis of hyperthyroidism and to

determine the severity of hyperthyroidism.

• T3 also exist in bound and free form.

• Normal range of total serum T3 is 100– 200ng/dl.

• Normal range of free T3 is 2.3 to 4.1 picograms / ml

• Free T3 level increases in hyperthyroidism and

decreases in hypothyroidism.
4. Thyroglobulin

• Thyroglobulin is a protein made by the follicular cells of the thyroid gland.

• It is used by the thyroid gland to produce T3 and T4.

• Thyroglobulin is measured by ELISA test. It is not a primary test to

measure the thyroid function.

• It helps to diagnose thyroid inflammation and monitor the treatment of

thyroid cancer.

• Normal level is 3-40 ng/ml.

5. Radioactive iodine (RAIU) uptake scan

• Thyroid gland takes up iodine from the blood stream to

make the thyroid hormones.

• This procedure helps to measure how much of iodine is

taken up by the thyroid gland by giving a dose of
radioactive iodine on an empty stomach.

• The amount of iodine that goes into the

thyroid gland is measured by 'thyroid uptake' and it helps
to determine if the thyroid gland is functioning properly.
• Hypothyroid patients usually take up too little iodine and
hyperthyroid patients take up too much of iodine.

• Normal 24 hour RAIU is 8 to 35 %. Normal 4 hour

RAIU is 5 to 15%.

• More than normal uptake by the thyroid gland indicates a

hyperactive thyroid and vice versa.
6. Thyroid scan: It is usually done at the same time when an
iodine uptake test is performed because the scan also requires
administration of radioisotope -radioactive iodine.

• Pregnant women should not have thyroid scans because the

iodine can cause development troubles within baby's thyroid
gland.

• Thyroid scan helps to identify the size of the thyroid and the
presence of any nodules

• The scan also reveals which part of the thyroid have taken up
the iodine during radioactive iodine uptake test.