Liver, kidney and urinary tract examination (3in1)

What’s measured

Parameters:

ALT (alanine aminotransferase) is an enzyme present in the cytoplasm of cells of certain tissues such as liver cells. It is important for the formation and degradation of amino acids, and also plays a role in nitrogen metabolism, but also glucose.
Aspartate aminotransferase is another liver enzyme that is elevated when the liver cell - hepatocyte - is damaged. The most common causes of liver damage include ethanol (alcohol), fatty liver or viral hepatitis. Ureais the end product of nitrogen metabolism of amino acids. It is formed in the liver.
ALP activity and osteocalcin levels will provide information about your bone metabolism.
GGT is a gamma-glutamyl transferase, an enzyme bound to cell membranes with the highest concentration in the liver. It is very sensitive to changes in liver function, but also to damage to the biliary tract (for example, as a result of drug or alcohol damage).
Total protein determination is the determination of the concentration of all proteins in blood plasma. Proteins are the basic building blocks of all cells and tissues. They are important not only for body growth, but also perform a number of the following functions - transport of all substances insoluble in water, maintaining oncotic pressure in cells, maintaining proper blood pH.
Albumin is a type of protein in your blood that helps maintain fluid balance, transports substances in your body, and is produced by the liver.
Direct bilirubin has been processed by the liver and is ready to be eliminated from the body. Bilirubin is a yellowish pigment produced when red blood cells break down. It is processed by the liver and converted into direct bilirubin, which is then excreted through bile into the intestines and eventually eliminated from the body. Elevated levels of direct bilirubin can indicate liver or gallbladder problems.
Total bilirubin refers to the combined measurement of both direct bilirubin and indirect bilirubin in the blood. Bilirubin is a yellow pigment produced when red blood cells break down. Indirect bilirubin is the form of bilirubin that has not yet been processed by the liver. It travels through the bloodstream to the liver, where it is converted into direct bilirubin. It can help assess the liver or gallbladder conditions.
Globulin is a group of proteins found in your blood. It plays an essential role in various functions in your body, such as immune system support, blood clotting, and transport of hormones and vitamins. Abnormal globulin levels can indicate certain medical conditions, such as liver disease, immune disorders, or malnutrition."
The albumin/globulin ratio compares the levels of two types of proteins in your blood: albumin and globulins. Albumin is a specific protein, while globulins are a group of proteins that include antibodies and other important proteins for various functions in the body. An abnormal albumin/globulin ratio may indicate certain health conditions or imbalances in your body.
Creatinine is a protein (protein) that is produced by all cells of the human body. Creatinine excretion takes place exclusively by the kidneys and therefore allows the examination of the level of creatinine in the blood and the calculation of glomerular filtration to reveal disorders of renal function.
eGFR, or estimated Glomerular Filtration Rate, is a measurement used to estimate how well your kidneys are functioning. It provides an approximation of the amount of blood that passes through the tiny filters in the kidneys each minute. A higher eGFR indicates better kidney function, while a lower eGFR may suggest impaired kidney function and the need for further evaluation.
Urea is the end product of protein metabolism. It is formed as a result of the removal of split nitrogen from amino acids in the form of ammonia, which is toxic to the central nervous system, to the liver and kidneys. The urea cycle takes place in the liver and urea is then released into the bloodstream and transported to the kidneys, where it is filtered into the urine or reabsorbed. The production of urea is affected by the state of acid-base balance of the organism. Its concentration in the blood depends on the intake of protein in the diet and overall metabolism. The test is suitable as an indicator of renal function, the degree of hydration of the body, protein catabolism, to determine the level of nitrogen.
Water forms the basis of the internal environment. Disturbances in water metabolism and fundamental ions (Na, K Cl) are common. Sodium is the main cation and binds the most water. The determination of sodium ions in the blood is used to detect hyponatremia or hypernatremia accompanied by dehydration, swelling. In contrast, chlorides (Cl) are the main anion and their level is increasing as the level of sodium is decreasing, and vice versa. It participates in maintaining a constant internal environment, such as osmotic pressure or acid-base balance. Potassium is the main ion inside cells. It works with sodium and chlorides to regulate the amount of fluid in the body, stimulate muscle contraction and maintain acid-base balance.
Calcium is a mineral and also an essential building block of bones and teeth. It participates in the function of a number of enzymes, blood clotting, muscle function and the production and release of hormones.
Phosphate is an important mineral that helps with various functions, including bone health, teeth, energy production, and cell communication. Abnormal phosphate levels could indicate certain medical conditions or imbalances in your body.
Uric acid is a nitrogenous substance that is formed in humans as the product of purine metabolism. It is a powerful antioxidant (it captures free oxygen radicals). It is one of the parameters in metabolic syndrome. When increasing its content in the body, it can be deposited in the form of crystals in the tissues.
Urine analysis (Urine chemistry test and Urine sediment) focuses on pH and specific gravity of urine, also includes qualitative evidence of the presence of protein, sugar, ketone bodies, bilirubin, urobiliinogen, nitrites, hemoglobin and leukocytes in the urine. It provides insight into the cellular, organic and inorganic composition of urine. It is important for assessing kidney and bladder function.

Instructions before collection

We do not recommend entry of patients/clients with clinical signs of disease (temperature, cough, signs of respiratory tract infection, etc.) to undergo this test.
We recommend hand disinfection prior to entry to the clinics/collection points.

It is advised to fast for a minimum of 8 hours by refraining from eating or drinking anything expect water. Faiing to fast before the test may affect result quality. If you are currently on medications, consult your healtcare provider to determine whether you should continue taking them prior to the test.

PREPARATION FOR BLOOD COLLECTION
The recommended time to collect blood is between 7 a.m. and 9 a.m., to obtain comparable results from different blood draws. To assess the numerical test result, so-called reference intervals are used, which are based on morning fasting collections and are used for population comparison. This time interval is also recommended in light of the biological cycles that naturally take place in the body.

GENERAL PRE-SAMPLING INSTRUCTIONS
• It is necessary to come to the testing site earlier, so that you can rest in the waiting room for approximately 20 minutes to have a relatively relaxed body and mind.
• It is not advisable to draw blood before collection.
• It is necessary to arrive on an empty stomach for the collection itself, in the case of collections at a later time in the day, at least three hours on an empty stomach. At home, it is desirable to drink a sufficient amount of pure water (at least up to half a liter) - this is important for a successful blood collection. Mineral water, juice, coffee and tea are not recommended.
Herbs included in tea may contain substances affecting the blood count. Coffee and black tea increase gastric acid production and release insulin from the pancreas, thereby affecting glucose metabolism. Since everything in the body is interrelated, they can impact other tests. Another extreme is when your body is running out of fluids. In this case, the number of red blood cells, the level of protein and lipids bound to the protein increase and the level of urea in the blood can also increase. It is therefore advisable to drink pure water when you wake up.


Generally, it is recommended to:
• around 6 p.m. eat only light meals, do not eat fatty food (cheese, butter, cream, meat, smoked meat, bacon) and sweet meals,
• fast for 10-12 hours (Attention: it is not advisable to starve for more than 16 hours!), in the case of later collection (after 9:30 a.m.), a lighter breakfast is allowed, no later than 3 hours before collection,
• drink non-alcoholic beverages and drinks without sugar in the usual quantity, in the case of adult clients 24 hours before blood collection (Alcohol in the blood changes lipid levels, the level of glucose is reduced, uric acid levels increase and liver enzymes are released into the blood),
• take only prescribed medicines in the evening,
• avoid increased physical activity, and strength and endurance exercise the day before blood collection (Lipid, glucose, some enzyme levels in the blood and other parameters may change during physical activity. The recovery of normal values to maintain the accuracy of laboratory results may take a longer time, depending on the duration of the exercise, your physical fitness in general and other factors. We recommend maintaining normal daily physical activity such as light stretching, short cycling to work, gardening, etc.),
• avoid psychological stress, which raises blood glucose levels and causes the release of stress hormones in particular,
• avoid smoking for at least 6 hours prior to blood collection because it increases the level of carbonylhemoglobin produced by the reaction of the blood dye with carbon monoxide and alters the permeability and elasticity of the vessels, affecting the ratios of blood analytes,
• do not chew gum for at least 6 hours before blood collection, as this may affect glucose and enzyme levels,
• do not undergo stressful diagnostic or therapeutic interventions for at least 24 hours prior to blood collection.
If any of the tests you have selected require special preparation, you will be informed of the fact by email with the order and blood collection instructions attached. These specific instructions have priority over the general recommendations for preparation.


MEDICINES
It is recommended to have blood collected before the planned doses of medicines. If it is not possible to take the medicine later, you should inform the nurse during blood collection and specify what medication you have taken.
Take the medicines prescribed by your doctor in the morning or bring them with you to take them after blood collection (thyroid medicines, antihypertensive medicines, blood thinners, contraceptives, etc.) In the case of later collection (after 9:30 a.m.), you can take the prescribed medication in the morning.
Do not take iron, vitamin, nutritional supplements or other supplements, including homeopathics, for at least three (3) days prior to blood collection.


SPECIFIC SITUATIONS
In order to obtain the appropriate answers to your questions with regard to the laboratory tests, it is important to accurately notify the nurse at the healthcare provider about the following facts prior to your blood test:
• regularly used medicines and supplements (ideally come with a written list to the blood collection site),
• infectious diseases you suffer from (e.g., HIV, hepatitis, mononucleosis...),
• contact with an infected person or presence in an infectious environment,
• if you have received an infusion within the last 5 days, specify into which limb,
• intramuscular injections within 3 days prior to the blood collection date,
• long-term immobilisation, lost ability to move,
• activities at higher altitudes,
• allergy to common band-aids,
• if you feel unwell when looking at blood or needles, please also notify our blood collection staff of the fact.


OTHER FACTORS
Please note that prolonged use of medication or other important factors may affect the values measured by the tests you have selected. For more information, please see the description of the specific test. To obtain objective test results, take the time to properly prepare for your blood collection.

PREPARATION FOR URINALYSIS

If you have chosen a chemical analysis of urine and urine sediment based on the first morning urine sample, do not forget to obtain a collection tube, either at the pharmacy or at any of our sampling points. If urine culture is tested, this tube must be sterile.
 

INSTRUCTIONS TO FOLLOW
It is recommended to follow the standard drinking regime prior to urine collection, to avoid coffee and alcohol (in the case of adult clients) that are diuretic and could dilute the urine as a result of its increased production. 24 hours prior to urine collection, sexual intercourse is not appropriate because the number of cellular particles and protein in the urine will increase.
Girls and women undergo this test outside their menstrual cycle, it is not recommended to collect urine samples 3 days before or 3 days after the cycle, when red blood cells that are not produced in the urinary tract may be present. The results can be evaluated as false positives.
 

HYGIENE
Immediately before the urine collection, it is important to thoroughly clean the genitourinary tract so that urine is not contaminated with mucus, bacteria or soap. When urinating, women and girls will separate their labia and wash their external genital organs with lukewarm water. Men and boys will pull back their foreskin and wash their penis. Your hands must be clean when doing so.
 

PROCEDURE
The medium (released after one third of the urine has been emptied) morning urine should be collected. Allow the first part of the urine to end in the toilet to ensure that bacteria from the outer urinary tract have been removed and cells peeled from the urethral meatus have been eliminated. The second (medium) part of the urine shows the actual state of the urinary tract. Urine should be collected directly into a 10 ml collection tube. The remaining urine is drained back into the toilet. Close the tube tightly and rinse with water. Carefully close with the test tube cap. Do not touch the bottom of the cap with your hands, and do not place its inner side on washbasins or bathtubs. Hold the cap of the test tube only around its outer perimeter to prevent any contamination of the collected urine by bacteria on your hands or furniture. Do not pour the urine from other containers, as it may get contaminated by bacteria or fibres attached to such containers. Always collect urine samples directly into the tube.
 

STORAGE AND TRANSPORT
The sample should be delivered for analysis within 4 hours after its collection and should be maintained at 4-8 °C to avoid the decomposition of cellular elements in the urine or the bacterial proliferation at higher temperatures. Biochemical quantitative urine assay A sample of spontaneous urination is collected for examination. A urine collection tube should be prepared in the evening before the test date. If you do not have an original urine collection tube, a 3dcl jar is sufficient. The jar must be clean, rinsed with boiling water and left to dry. Collect all of the urine in the jar after performing morning genitourinary tract hygiene, then pour approximately 10 ml of urine into the collection tube. You will obtain a mixed representative sample needed to determine creatinine, total protein, albumin levels or urine electrophoresis.
One common, clean urine collection tube, usually with a yellow cap, is sufficient for the chemical analysis of urine and urinary sediment. For culture testing, urine should be collected in a sterile tube, usually with a red cap. The use of empty bottles and other household urine collection containers is not appropriate due to the presence of bacteria and other components. One common, clean urine collection tube, usually with a yellow cap, is required for a quantitative biochemical assay. Proper preparation prior to the urine collection is a must for a correct result. A correct result is one of the conditions to reach the correct diagnosis.
 

SPECIFIC SITUATIONS
In order to obtain relevant answers to your questions through laboratory tests, it is important to accurately inform about the following facts before your blood test:
•    regularly used medicines and supplements (ideally present a written list right before the blood test)
•    infectious diseases you suffer from (HIV, hepatitis, mononucleosis...)
•    contact with an infected person or presence in an infectious environment