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Blood Chemistry Panel

A blood chemistry panel is another common test used to evaluate a variety of components. Usually, it
consists of about 7-25 tests. The information below is meant to provide an overview of these tests. Your
doctor will counsel you regarding the results of your personal blood work and laboratory tests.

Kidney Function Tests

The creatinine blood test and blood urea nitrogen (BUN) test are used to assess kidney function in
people with lupus kidney disease (nephritis).

Creatinine: Creatinine is produced by your muscles as they breakdown creatine, a substance

involved in muscle contraction. Creatinine is formed at a constant rate in the body and excreted by
the kidneys, so by evaluating the amount of creatinine in your blood, your doctor can determine
how efciently your kidneys are working. Creatinine levels are measured by taking a sample of
blood from your vein; then, the concentration of creatinine in your blood is compared to a standard
amount for your age and sex. Increased blood creatinine levels may indicate an increase in lupus
involvement of the kidney. Other conditions, such as high blood pressure or diabetes, can also
cause elevated creatinine levels.

Sometimes individuals are asked to provide a 24-hour urine sample for further assessment. The
combination of blood and urine samples can be used to evaluate a creatine clearancehow
effectively your kidneys lter small molecules, such as creatinine, from your blood. In addition,
since creatinine is usually removed from the blood at a constant rate, blood creatinine levels can be
used as a standard by which doctors can compare other urine or blood tests. Your serum (blood)
creatinine level can also be combined with your age, weight, and gender to evaluate your
estimated glomerular ltration rate (eGFR). Glomeruli are tiny ball-shaped structures in your
kidneys that help lter blood and prevent the loss of valuable substances, such as blood cells and
proteins. The eGFR is an educated estimate of the amount of blood that is ltered per minute by
your glomeruli and is often used to detect kidney damage.

Blood urea nitrogen (BUN): The BUN test measures the amount of urea nitrogen in your blood. The
 liver produces nitrogen in the form of ammonia (NH3) as it breaks down proteins into their
constituent amino acids. From the liver, urea travels in your blood to the kidneys, which lter the
urea and ush it from your body in the form of urine. To evaluate an individuals BUN level, blood is
drawn from the vein, and the concentration of urea nitrogen in the blood is evaluated and
compared to a standard value for that persons age range. Even though increased protein levels in a
persons diet can cause their blood urea nitrogen levels to increase, elevated BUN may suggest
kidney involvement due to lupus or another condition such as dehydration that causes decreased
blood ow to the kidneys. Low BUN levels are uncommon and are usually not as important; they
can suggest certain conditions, such as malnutrition, over-hydration, or liver disease, but doctors
usually use other tests to monitor these conditions.

Blood Glucose (Sugar) Test

Tests of blood glucose levels are performed to determine if an individuals blood glucose is in normal
range. This test helps to detect hyperglycemia (high blood sugar), hypoglycemia (low blood sugar), and
diabetes (which can occur after long-term steroid therapy). Glucose is a simple sugar that your body gets
from the food you eat. The cells of your body need glucose to obtain energy, and they cannot function
without it. When we think of providing our bodies with energy, we usually think about movement and
physical activity. However, glucose is also vital to the cells of your brain and central nervous system.

The amount of glucose in your blood is controlled by a feedback mechanism involving two hormones,
insulin and glucagon. These hormones work to ensure that your blood contains the right amount of
glucose so that your cellsincluding those in your brain and central nervous systemcan function
correctly. When your body takes in glucose after a meal, insulin is secreted by cells in your pancreas
(beta cells) in order to lower your blood glucose to the appropriate level. When your blood sugar gets too
low, glucagon is secreted by alpha cells of the pancreas in order to raise glucose levels. Disruptions in this
feedback mechanism can be harmful to your body. In people with diabetes, the body either does not
make enough insulin or does not use it properly. High or low blood sugar levels caused by diabetes or
other conditions can be serious if not kept in check.
Blood glucose levels are usually evaluated when the patient is fasting, but they can also be taken at
random, after a meal, or in a challenge test in which a person consumes a certain amount of glucose to
challenge their system and track the way his/her body deals with glucose over time. Diabetics usually
monitor their own blood glucose levels at home.

Fasting Lipid Prole

A lipid prole is a group of tests that includes measurements of total cholesterol, HDL-cholesterol (good
cholesterol), LDL-cholesterol (bad cholesterol), and triglycerides (fats), all of which are risk factors for
cardiovascular disease. It is important that your doctors perform fasting lipid proles if your cholesterol
has been elevated, because people with lupus are at an increased risk for heart disease. In fact,
cardiovascular diseasenot lupus itselfis the number one cause of death in people with lupus.
Furthermore, medications used in lupus treatment, especially corticosteroids such as prednisone, can
raise blood pressure, blood glucose, cholesterol, and triglyceride levels, exacerbating the risk factors for
cardiovascular disease in people with lupus.

A fasting lipid prole is performed only when a patient is fasting (i.e., has not eaten since midnight of the
previous night). Fasting ensures an accurate reading of your baseline total cholesterol, HDL, LDL, and
triglyceride levels. However, please understand that it is alright to take your medications with water
upon the day you are fastingwater does not affect the fasting lipid prole.

Total Cholesterol: Cholesterol is a fatty substance made in the body and absorbed from certain
foods that is essential in your bodys normal processes. It plays an important role in the membranes
 of your cells, is used to make hormones, and helps form the bile acids needed for your body to
obtain nutrients from food. Your total cholesterol is a measurement of both types of
cholesterolLDL and HDLand should be below 200 mg/dL. Total cholesterol levels above 240
mg/dL are considered dangerously high, especially in people with additional risk factors for
cardiovascular disease, such as smoking, obesity, or family history. If your total cholesterol level is
above 200 mg/dL, your doctor will most likely recommend that you follow a diet low in saturated
fats and cholesterol and begin a moderate exercise regimen. If diet and exercise alone are not
enough to control your cholesterol, she/he may prescribe a medication called a statin to help lower
your cholesterol levels.

Low Density Lipoproteins (LDL): Cholesterol circulates in the body in complex molecules called
lipoproteins. Low density lipoproteins (LDL) are sometimes known as bad cholesterol, because
they can deposit excess cholesterol in your arterial walls, restricting blood ow and causing a
condition known as atherosclerosis. If arteries become blocked, a person can suffer heart attack,
stroke, or other complications. LDL levels above 100 mg/dL are considered to be above the optimal
range. If you have other risk factors for heart disease, such as a history of smoking, low HDL levels,
high blood pressure, diabetes, or a personal or family history of cardiovascular disease, you should
aim for lower LDL levels.

High Density Lipoproteins (HDL): High density lipoproteins (HDL) are known as good cholesterol
because they help to move cholesterol out of the body by carrying it to the liver where it is
processed for excretion. HDL levels less than 40mg/dL are associated with an increased risk of
heart disease, but a good HDL level is above 60mg/dL.

Protein
A comprehensive metabolic panel will also check the levels of certain proteins in your blood. Specically,
the test checks for albumin levels and total protein levels.

Albumin: Albumin is a small protein made in the liver that constitutes the major protein in blood
serum. Albumin performs many functions in your body, including nourishing tissues, transporting
various substances through the body (hormones, vitamins, drugs, and ions), and preventing uid
from leaking out of your blood vessels. Albumin concentration will drop if a person suffers from
liver damage, kidney disease, malnourishment, serious inammation, or shock. Abumin levels allow
your doctor to assess for or monitor liver or kidney disease due to lupus and other factors.

Total Protein: In addition to albumin, your blood serum also contains a protein called globulin. In
fact, globulin is actually a class of proteins that includes enzymes, antibodies, and hundreds of
other proteins. A total protein test measures the combined amount of these proteins in your blood.
An albumin to globulin (A/G) ratio is also computed. A persons total protein level gives information
about kidney damage, liver damage, and nutritional health. If your total protein falls outside of the
normal level, your doctor will most likely order other tests to assess for liver or kidney function.

Electrolytes
Electrolytes are ions (electrically charged chemicals) in the blood and other body uids. The
concentration of electrolytes in your body depends on adequate intake of nutrients, proper absorption
of nutrients by the intestines, and proper kidney and lung function. Abnormal electrolyte concentrations
can indicate abnormalities in certain organs and bodily processes. For example, retention of sodium,
bicarbonate, or calcium can indicate problems with kidney function. Hormones also help to control
electrolyte concentrations, so abnormal electrolyte levels can also reveal certain hormone deciencies
or problems with certain hormone-regulating glands or organs. Some of the electrolytes measured in a
comprehensive metabolic panel are explained below.

Sodium (Na+): Sodium helps to regulate your bodys water balance and plays an important role in
proper heart rhythm, blood pressure, blood volume, and brain and nerve function. Hypernatremia
refers to having too much sodium in the blood; this can occur, for example, due to a high-salt diet.
Too much sodium in your blood can cause high blood pressure, among other things. Hyponatremia
refers to having too little sodium in the blood. Hyponatremia can cause confusion, restlessness,
anxiety, weakness, and muscle cramps. Sodium levels in the blood are regulated by a hormone
called aldosterone that is secreted by the adrenal glands. Aldosterone works to regulate sodium
levels by increasing your kidneys reabsorption of sodium ions.

Potassium (K+): Potassium plays a role in regulating the acid-base chemistry and water balance in
your blood and body tissues. It also helps your body to synthesize proteins and make use of
carbohydrates for fuel. Potassium is essential for normal muscle growth and helps sodium and
calcium to maintain normal hearth rhythm and regulate the bodys water balance. Potassium also
helps your muscles to contract and your nerves to send impulses. Potassium levels may be low if an
individual is on a diuretic (uid pill) such as hydrochlorothiazide (HCTC) or furosemide (Lasix).
Blood potassium levels that are too high or low may lead to muscle weakness and cramping; very
low levels may cause irregularities in heartbeat. Like sodium levels, potassium levels in the blood
are regulated by aldosterone, which promotes potassium loss from your kidneys.

Calcium (Ca2+): Most people recognize calcium as a part of bones and teeth, but calcium plays
many other roles in the body, such as regulating heartbeat, transmitting nerve impulses,
contracting muscles, and helping blood to clot properly. Blood calcium levels are regulated by
parathyroid hormone, which is secreted by the parathyroid gland, and calcitonin, which is secreted
by the thyroid gland. Since lupus causes an increased risk of osteoporosis and corticosteroid (e.g.,
prednisone) use can elevate this risk, most people with lupus should take calcium and vitamin D
supplements to help maintain adequate bone density. Medications called bisphosponates may be
added to help with bone integrity if osteoporosis is detected. However, it is important that you
realize that a blood calcium test measures the amount of calcium in the blood, not the bones. For
an adequate measurement of bone health, you will need to obtain a DEXA scan every 2 years.

Chloride (Cl-): Chloride ions help your body in maintaining proper pH and uid balance. It also
secreted by the stomach during digestion. Excessive sweating, vomiting, or diarrhea can cause
chloride levels to drop. Low chloride levels may alter the pH of your blood, cause dehydration; they
may also cause you to lose potassium.

Carbon dioxide (CO2): This test measures the amount of carbon dioxide (CO2) in the blood, which
is present in the form of CO2, bicarbonate (HCO3-), and carbonic acid (H2CO3). These three forms
are involved in the equilibrium that maintains the pH of your blood (7.35-7.45). Bicarbonate also
works with other electrolytes to maintain a certain charge balance in your cells. The concentration
of carbon dioxide in your blood is maintained by your lungs and kidneys. High or low levels of CO2
may prompt your doctor to order other tests to check your kidney and lung function, blood gases,
or uid retention.

Liver Tests
Lupus and some of the medications used to treat lupus can affect the liver. In addition, factors such as
excessive alcohol intake or viral hepatitis can affect the liver in people with lupus, just as they can in the
normal population. Certain tests can be performed as part of a comprehensive metabolic panel to give
insight into the function of your liver. In addition, your doctor may order a test called a liver panel if
she/he suspects that you have symptoms of a liver disorder. Usually these tests measure certain liver
enzymes, namely alkaline phosphatase (ALP), alanine amino transferase (ALT), and aspartate amino
transferase (AST). Bilirubin, a waste product of the liver that is stored in the gall bladder, is also
measured. These values can be used by your doctor as a screening or monitoring tool for liver
involvement. About 30-60% of lupus patients experience abnormal liver function tests; some have no
symptoms of liver disorder. Generally, increased levels correlate with increased activity, but other
factors can contribute to elevated levels of liver enzymes in the blood. For example, NSAIDs,
acetaminophen (Tylenol), and aspirin can cause liver enzyme values to increase, especially in people with
lupus. If your doctor notices abnormal liver enzyme levels, she/he may ask you to undergo additional
tests for hepatitis.

The liver enzymes and substances detected in a comprehensive metabolic panel are explained in more
detail below.

Alkaline phosphatase (ALP): Alkaline phosphatase (ALP) is an enzymea protein that helps to
bring about chemical reactions in your bodyfound mainly in your liver and bones. High levels of
ALP in the blood may indicate bone or liver abnormalities. If high ALP values are accompanied by
high values of other liver enzymes and bilirubin, then the test suggests liver involvement. Certain
ratios of liver enzymes can also indicate more specic conditions. Children usually have higher ALP
levels than adults because their bones are still growing.

Alanine amino transferase (ALT): Alanine amino transferase (ALT) is another enzyme found mainly
in the liver. Smaller quantities can also be found in your kidneys, heart, and muscles. Levels of this
enzyme are usually assessed in conjunction with readings for other liver enzymes to determine or
monitor liver involvement. Very high levels of ALT may indicate acute hepatitis.

Aspartate amino transferase (AST): Aspartame amino transferase (AST) is an enzyme found mainly
in the liver, heart, and muscles. AST is released into the blood by injured liver or muscle cells but is
used primarily to detect liver damage. [Another enzyme called creatine kinase (CK or CPK) is a
better indicator of heart or muscle damage.] Levels of AST are usually viewed alongside other liver
enzymes to assess for liver damage. Like ALT, very high levels of AST may suggest acute hepatitis.

Bilirubin: Bilirubin is a yellow-brown substance formed when the liver breaks down old red blood
cells. Too much bilirubin can be a sign that the liver cannot adequately remove bilirubin from the
system due to blockage (e.g., gallstones, tumors), cirrhosis, or acute hepatitis. Elevated bilirubin
can also indicate hemolytic anemia, a reduction in red blood cells due to abnormal breakdown of
red blood cells (hemolysis). Hemolytic anemia can be inherited or acquired; about 10-15% of
people with lupus develop autoimmune hemolytic anemia. Hemolytic anemia causes red blood
cells to have a shortened lifespan in the blood, and since bilirubin is a product of old red blood cells,
it accumulates in the body faster than it can be eliminated. [Other tests called the Coombs test,
haptoglobin count, and reticulocyte count are better diagnostic tests for hemolytic anemia.]
Several inherited conditions, such as Gilberts syndrome, can also cause a person to have too much
bilirubin. These conditions may be serious or benign. Often a buildup of bilirbubin is accompanied
by a yellowing of the skin called jaundice.

Thyroid Tests
The thyroid is a gland in your neck associated with your metabolismthe processes by which your body
makes use of energy. Autoimmune thyroid disease can occur in people with lupus, as can other thyroid
conditions. Usually, thyroid conditions cause the gland to release too much or too little hormone. Your
doctor may order tests to detect the level of thyroid hormones in the blood, especially if you experience
signicant weight loss or gain, sweating, acute sensitivity to hot or cold, fatigue, or other symptoms.
These tests can also help your doctor monitor the effectiveness of thyroid treatment. Tests for thyroid
hormones are explained below in greater detail. Your doctor may request additional tests, such as tests
for thyroid antibodies, to learn more about your condition.

Thyroid stimulating hormone (TSH): Thyroid stimulating hormone (TSH) is a hormone released by
the pituitary gland that signals the thyroid to release its hormones (T3 and T4) when levels in the
blood get low. Together, TSH, T3, and T4 are part of a negative feedback loop that keeps levels of
thyroid hormones constant in the blood. Abnormal levels of TSH in the blood can suggest a
problem with the pituitary gland, such as a tumor, but this is unlikely. More often, high or low TSH
levels indicate problems with the thyroid gland. The thyroid may not be responding to stimulation
by TSH, or it may be releasing too much T3 and T4. Underactive thyroid (hypothyroidism) is more
common in lupus, but overactive thyroid (hyperthyroidism) can also occur. Both of these conditions
can be dangerous if not properly treated.

T4 and T3: Thyroid hormone contains thyroxine (T4, 90%) and triidothyronine (T3, 10%). The
primary role of these substances is to regulate your bodys metabolism. Abnormal levels of thyroid
hormone can indicate hypo- or hyperthyroidism.

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