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Serum enzymes in patients with renal failure

Neil S Sanghani, MD
Ramesh Soundararajan, MD, FACP
Thomas A Golper, MD
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD


The serum enzymes of patients with end-stage renal disease (ESRD) are commonly abnormal. This is due in part to the absence of renal excretion and to the frequent presence of multiple comorbid conditions. Since the diagnosis of many diseases is based upon the detection of elevated levels of these enzymes, the accurate clinical assessment of the patient with ESRD is hampered by a paucity of knowledge concerning the serum concentrations of different enzymes in various disease states.

The use and significance of variations in the concentrations of serum enzymes in dialysis patients will be reviewed here. A discussion of serum cardiac enzymes in patients with renal failure is presented separately. (See "Serum cardiac biomarkers in patients with renal failure".)


The serum enzymes most commonly used to help assess the diagnosis of hepatobiliary disease include the aminotransferases, alkaline phosphatase, and gammaglutamyl transpeptidase (GGT).

Aminotransferases — Serum concentrations of aspartate and alanine aminotransferase (AST [SGOT] and ALT [SGPT]) are routinely measured to assess liver function in patients with and without renal failure. The aminotransferases are normally present in the circulation in low concentrations, usually <40 int. units/L. (See "Approach to the patient with abnormal liver biochemical and function tests", section on 'Liver enzymes'.)

The concentrations of serum aminotransferases in both chronic dialysis and chronic renal failure patients most commonly fall within the lower end of the range of normal values [1-4]. Although the exact cause is unknown, possible underlying reasons may be related to pyridoxine deficiency (pyridoxal phosphate is a necessary coenzyme for ALT and AST) [5-7] and/or the presence of an inhibitory substance in the uremic milieu [1].

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Literature review current through: Oct 2017. | This topic last updated: Jan 15, 2016.
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