Quote:
Originally Posted by Ritzui
My test results shows alkaline phosphatase high. In October it was 157. The average number it should be is between 36 - 130 U/L. In March it was 210. The doctor did say it could be the bone or liver. The bone came out high but I never got the results for the liver even though I asked. I am not sure if it means if it's normal or that they can't test for it. For the bone the average number should be 7.7 - 21.3 mcg/L. It is 69.9 mcg/L. I asked the doctor several times already why I didn't get test results for the liver since she told me I was going to get tested for the liver and bone. She didn't answer this and instead said it's most likely related to the chronic kidney disease. My GI doctor also said it is probably due to chronic kidney disease. Today I saw a new kidney doctor for the first time. He said it has nothing to do with kidney disease and said my regular doctor has to test for this. What kind of test needs to be done to find out why I have alkaline phosphatase high? And why wouldn't I get test results for the liver when it comes to this if that's what I was told would be done? Does it mean it cannot be done for the liver or that it can only be the bones?
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People with chronic renal disease can cause retention of phosphates which bind calcium and reduces it's levels to the point of activating PTH and causing secondary hyperparathyroidism the end result being osteomalacia. Vitamin D also comes into play with calcium and phosphate homeostasis and so again the elevated phosphate level screws things up.
Alkaline phosphatase activity (ALK) correlates with osteoblast bone formation rather than osteoclast bone destruction activity.
As far as breaking down the alkaline phosphatase level with isoenzyme studies that is rarely done because of some technical reservations with regards to placental ALK another source of ALK. Most of the time an elevated ALK is evaluated in relation to other liver enzymes that are also membrane bound and elevated at the same time. The other enzyme that is membrane bound is GGT and so if both the GGT and ALK are elevated then it is assumed that the ALK is liver derived. The ALT and AST are cytosolic enzymes associated with cell necrosis. The ALK and GGT are outer membrane and released through washing out effects of cholestasis. That is by far the most common way to distinguish between bone or liver origins is by doing a GGT that is included in the liver panel. That's why it's included in the liver panel.
Chronic kidney disease can make certain blood level interpretations problematic because of the backup of enzymes and chemicals that are retained due to decreased glomerular filtration. That backup can cause an elevation of certain constituents. One would have to carefully take into account the creatinine value and any particular value.
Your doctors will figure it out.
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