NPN
clinically significant
Azotemia's
Diseases associated with NPN
Reference range and unit
The Numbers
Case Studies
100
Urea, Uric Acid, Ammonia, Creatine, Creatinine, amino acides
What are NPN's
100
Ammonium from urease reaction can measure
The color change of an pH indicator
100
Congestive Heart Failure
Shock
Hemorrhage
Dehydration with increase Albumin
Pre-Renal Azotemia
100
What is azotemia?
Elevated concentration of urea
100
Normal ratio Nitrogen / Creatinine
10:1 to 20:1
100
This is inversely related to plasma Creatinine
What is the GFR
100
A 30-year-old marathon runner collapses after a race. His labs show:
BUN: 36 mg/dL (normal: 7–20 mg/dL)
Creatinine: 1.0 mg/dL (normal)
Urine: dark and concentrated
He’s been running for hours with minimal water intake.
What is dehydration (prerenal azotemia)?
200
The one NPN is the compound present in highest concentration in the blood?
Urea
200
NH4 + 2-Oxoglutarate -----?------> Gutalmate
GLDH
Glutamate dehydragenase
200
Acute and Chronic renal failure
Renal Azotemia
200
Define Uremia and Gout
Very High plasma urea concentration and renal failure
Elevated concentration of uric acid
200
BUN
6-20mg/dl
200
90ml/min/1.73m2
What is the ref range of GFR
200
Case 2 – Creatinine: “The Slow Rise”
Case Clue:
A 62-year-old man with diabetes presents for routine labs:
BUN: 25 mg/dL
Creatinine: 2.8 mg/dL (previously 1.0 mg/dL)
GFR: decreased
He reports fatigue but no acute illness.
Question:
What chronic condition is most likely responsible for this gradual rise in creatinine?
What is chronic kidney disease?
300
NPN comes from the catabolism of: name both
protein and nucleic acids
300
This enzyme's function is to store ATP in muscle
CK
Creatine Kinase
300
BUN: [Cr]p = 10-15 with increase abdominal pain
What is post renal Azotemia
300
There is a reduced renal blood flow. It is a prerenal, renal or post renal?
Prerenal
300
Serum Creatinine
Male 0.9-1.3 mg/dl
female 0.6-1.1 mg/dl
300
GFR=30-59 mL / min
State 3 Renal Failure
300
Case Clue:
A 45-year-old man complains of sudden pain, redness, and swelling in his big toe.
Labs show:
Uric acid: 9.5 mg/dL (normal: 3.5–7.2 mg/dL)
Creatinine: normal
History: high-protein diet and frequent beer intake
What is the likely diagnosis associated with this elevated uric acid?
What is gout?
400
What is ammonia
400
? 
400
Which enzyme can be helpful to detect bone disorder?
ALP Alkaline Phosphatase
400
Test indicator of glomerular filtration (GFR)
Creatinine Clearance
400
Low Protein intake
Severe Vomiting and diarrhea
Liver Diseas
Pregnancy
Low or decreased Urea Concentration
400
BUN: [Cr]p = 27
Pre Renal Azotemia
400
A 28-year-old bodybuilder comes in for a physical.
Labs show:
Creatinine: 1.8 mg/dL (slightly elevated)
BUN: normal
He reports using creatine supplements daily and intense weight training.
He feels well otherwise.
What is the most likely reason for this elevated creatinine level?
What is increased muscle mass or creatine supplement use (non-pathologic elevation)
500
Associated with inherited deficiency of urea cycle enzymes
What is Hyperammonemia
500
The Conway method exploited the volatility of this NPN
Ammonia
500
BUN : [Cr]p = 6 with increased BUN
Uremia
500
What condition is if urea and creatinine are both elevated with back pain? Pre, renal or post?
Renal Azotemia
500
Liver Disease
Fanconi Syndrome
Over-treatment of Allopurinol
What is Decreased Concentration of Uric Acid
500
True or False
Jaffe Method is used with Diabetic patience
Reference range for Creatinine
500
A 3-year-old Labrador Retriever is being evaluated after a high-protein diet.
Labs show:
Uric acid: normal
Allantoin: elevated
Kidney function: normal
What explains the elevated allantoin in this dog?
Uricase is present in dogs