Clinical Biochemistry

741 Pages·2011·16.39 MB·English

by  Nessar Ahmed

Clinical Biochemistry

Clinical Biochemistry
Edited by
Dr Nessar Ahmed
PhD, CSci, FIBMS
Reader in Clinical Biochemistry
School of Healthcare Science
Manchester Metropolitan University
1
1
Great Clarendon Street, Oxford ox2 6dp
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Typeset by MPS Limited, a Macmillan Company
Printed in Italy on acid-free paper by
L.E.G.O. S.p.A. – Lavis TN
ISBN 978–0–19–953393–0
1 3 5 7 9 10 8 6 4 2
This book is dedicated to the one I love the most,
my daughter Neha Ahmed.
Dr Nessar Ahmed
24 July 2010
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CCoonntteennttss
Preface xi 3.4 Kidney disease 82
An introduction to the Fundamentals of
3.5 Specific kidney disease 87
Biomedical Science series xii
Online learning materials xiv Summary 95
Contributors xvi Further reading 96
Abbreviations xviii
Questions 97
Reference ranges xxiv
4 Hyperuricaemia and gout 99
1 Biochemical investigations
and quality control 1 Joanne Marsden
David Cameron
4.1 Sources of purines 102
1.1 Historical background 3 4.2 Purine catabolism and excretion 104
1.2 Modern clinical biochemistry laboratories 4 4.3 Hypouricaemia 106
1.3 Point of care testing 15 4.4 Hyperuricaemia 106
1.4 Evaluation of a clinical method 16 4.5 Clinical features of gout 108
1.5 Quality control 23 4.6 Diagnosis of gout 109
1.6 Audit 29 4.7 Treatment and management of gout 111
Summary 31 Summary 113
Further reading 31
Further reading 113
Questions 32
Questions 114
2 Automation 35 5 Fluid and electrolyte disorders 115
Tim James Tim James and Walter Reid
2.1 Historical context 36 5.1 Water homeostasis 116
2.2 General automated chemistry systems 38 5.2 Assessing fluid and electrolyte status 119
2.3 Automated immunochemistry analysers 48 5.3 Disturbances of plasma sodium 122
2.4 Integration of processes and robotics 51 5.4 Disturbances of plasma potassium 126
2.5 Automation in specialized areas of clinical 5.5 Plasma and urine osmolality 133
biochemistry 56
5.6 Chloride and bicarbonate 135
Summary 56
Summary 136
Further reading 57
Further reading 136
Questions 58
Questions 137
3 Kidney disease 59 6 Acid-base disorders 139
Edmund Lamb David Tierney
3.1 Renal anatomy 60 6.1 Hydrogen ion (H+) and pH 139
3.2 Renal physiology 64 6.2 Acids, bases, and buffers 142
3.3 Kidney function tests 70 6.3 Physiological role of H+ 144
viii CONTENTS
6.4 Production of surplus H+ 145 9 Abnormalities of lipid
6.5 Hydrogen ion homeostasis 145 metabolism 213
Mike France
6.6 Classification and investigation of
acid-base disorders 152
9.1 Types of lipids 214
6.7 Metabolic acid-base disorders 155
9.2 Lipoproteins 218
6.8 Respiratory acid-base disorders 162
9.3 Lipoprotein (a) 228
6.9 Mixed acid-base disorders 166
9.4 Classification of lipid disorders 228
6.10 Interpretation of acid-base data 169 9.5 Hypercholesterolaemia 231
Summary 172 9.6 Hypocholesterolaemia 234
Further reading 173
9.7 Hypertriglyceridaemia 237
Questions 173
9.8 Lipids, atheroma, and heart disease 239
9.9 Measurement of lipids in clinical samples 242
7 Clinical enzymology and
9.10 Assessment of cardiovascular risk 246
biomarkers 175
9.11 Management of hyperlipidaemias 246
Paul Collinson and Amy Lloyd
Summary 251
7.1 Enzymes and enzyme activities 176 Further reading 252
7.2 Isoenzymes 178 Questions 253
7.3 Biomarkers 179
10 Disorders of calcium, phosphate,
7.4 Cardiac disease 180
and magnesium homeostasis 255
7.5 Cardiac disease, electrocardiogram,
Nessar Ahmed and Farhad Behzad
and biomarkers 181
7.6 Development of heart disease 182 10.1 Distribution, function, and regulation
7.7 Cardiac biomarkers in clinical practice 184 of calcium 256
7.8 Biomarkers of muscle damage for the 10.2 Disorders of calcium homeostasis 263
diagnosis of AMI 188 10.3 Distribution, function, and regulation
7.9 Natriuretic peptides 190 of phosphate 272
7.10 Possible future biomarkers in 10.4 Disorders of phosphate homeostasis 274
cardiac disease 191 10.5 Distribution, function, and regulation
Summary 191 of magnesium 280
Further reading 192 10.6 Disorders of magnesium homeostasis 282
Questions 192 10.7 Bone metabolism 288
10.8 Markers of bone disease 289
8 Liver function tests 194 10.9 Metabolic bone disease 290
Roy Sherwood Summary 294
Further reading 295
8.1 Liver 194
Questions 296
8.2 Diseases of the liver 199
8.3 Liver function tests 203
11 Abnormal pituitary function 297
8.4 The current liver function tests: pros
Garry McDowell
and cons 211
Summary 211 11.1 Endocrine system 298
Further reading 211 11.2 Structure of the hypothalamus and
Questions 212 pituitary gland 300
CONTENTS ix
11.3 Anterior pituitary hormones 303 13.12 Monitoring and management of diabetes 368
11.4 Posterior pituitary hormones 306 13.13 Hypoglycaemia 371
11.5 Disorders of pituitary function 306 Summary 373
11.6 Anterior pituitary hyperfunction 306 Further reading 374
11.7 Anterior pituitary hypofunction 313 Questions 375
11.8 Posterior pituitary dysfunction 315
Summary 317 14 Adrenal disease 377
Further reading 318 John Honour
Questions 318
14.1 Adrenal glands 378
12 Thyroid disease 320 14.2 Disorders of adrenal glands 390
Garry McDowell 14.3 Investigation of adrenal disorders 401
14.4 Management of adrenal disorders 411
12.1 Structure of the thyroid gland 320
Summary 412
12.2 Thyroid hormones 322
Further reading 412
12.3 Function of thyroid hormones 325
Questions 413
12.4 Control of thyroid hormone secretion 325
12.5 Disorders of thyroid function 326
15 Reproductive endocrinology 415
12.6 Hyperthyroidism 326
Ian Laing and Julie Thornton
12.7 Hypothyroidism 329
12.8 Laboratory tests to determine the cause 15.1 Reproductive endocrinology in the female 416
of thyroid dysfunction 333
15.2 Hormonal changes in the menstrual cycle 421
12.9 Interpretation of thyroid function tests 334
15.3 Menopause 423
Summary 335
15.4 Causes of anovulatory infertility 425
Further reading 335
15.5 Polycystic ovary syndrome 429
Questions 336
15.6 Investigations in female reproductive
endocrinology 435
13 Diabetes mellitus and
15.7 Management of anovulatory infertility 437
hypoglycaemia 338
15.8 Reproductive endocrinology in the male 440
Allen Yates and Ian Laing
15.9 Limitations in assays for steroid
13.1 The islets of Langerhans 340 and polypeptide hormones 445
13.2 Glucose-induced insulin secretion 340 Summary 446
13.3 Glucagon secretion 343 Further reading 447
Questions 448
13.4 Insulin, glucagon, and the
counter-regulatory hormones 345
13.5 Incretin hormones 347 16 Biochemical nutrition 450
13.6 Impaired glucose and lipid handling 348 Pat Twomey and William Simpson
13.7 Diagnosis, classification, and aetiology
16.1 Types of nutrients 450
of diabetes 355
16.2 Specific nutrients: macronutrients 452
13.8 Acute complications of diabetes 360
16.3 Specific nutrients: organic micronutrients 455
13.9 Long-term complications of diabetes 363
16.4 Specific nutrients: inorganic micronutrients 463
13.10 Evidence-based medicine and
diabetes treatment 365 16.5 Assessment of nutritional status 467
13.11 Treatments for diabetes 365 16.6 Disordered eating patterns 474