Elevated alkaline phosphatase

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Elevated alkaline phosphatase
File:Feathery degeneration high mag.jpg
Micrograph showing changes that may be associated with an elevated alkaline phosphatase (cholestasis and feathery degeneration). Liver biopsy. H&E stain.
Classification and external resources
Specialty Pathology
ICD-10 R74.8
ICD-9-CM 790.5
Patient UK Elevated alkaline phosphatase
[[[d:Lua error in Module:Wikidata at line 863: attempt to index field 'wikibase' (a nil value).|edit on Wikidata]]]

Elevated alkaline phosphatase describes the situation where the levels of alkaline phosphatasee(ALP) exceeds the reference range. These group of enzymes has a low substrate specificity that catalyze the hydrolysis of phosphate esters at in an acidic environment. Major function of alkaline phosphatase is transporting across cell membranes.[1] Alkaline phosphatases are present in many human tissues, including bone, intestine, kidney, liver, placenta and white blood cells.[2] Now damages to these very tissues in the body causes the release of ALP into the blood stream, these elevated levels which can be detected through a blood test indicates such damages are presented in the body. Elevated alkaline phosphate is associated with certain medical conditions[3] or syndromes (e.g., hyperphosphatasia with mental retardation syndrome, HPMRS). It serves as a significant indication for certain medical conditions, diseases and syndromes.

If the reason alkaline phosphatase is elevated is not known, isoenzyme studies using electrophoresis can confirm the source of the ALP. Heat stability also distinguishes bone and liver isoenzymes ("bone burns, liver lasts").

Liver

Bone/skeletal

Other unlisted musculoskeletal conditions may also cause elevated alkaline phosphatase.

Obesity

Elevated levels of the alkaline phosphatase enzyme are reported with those who have obesity. A study reported there were higher serum levels of alkaline phosphatase in obese than in the non obese. With elevated alkaline phosphatase levels there is an increase in disproportionate intracellular fat depots and thereby releasing itself into the bloodstream. The relationship between alkaline phosphatase and obesity is still being tested.[5]

Kidney

Elevated serum levels of alkaline phosphatase has been associated with Chronic Kidney Disease (CDK). Recently, studies have shown that elevated levels may predict mortality independent of bone metabolism factors and liver function tests in CDK.[6] This distinction is indicated by the markers of inflammations specifically from C-reactive protein (CRP) with elevated levels of alkaline phosphatase. Hence, elevated serum alkaline phosphatase activity maybe be a marker for inflammation because of its association with elevated levels of CRP.

Cancer

Elevated alkaline phosphatase in patients with cancer normally spans throughout the bones or livers. Metastasize that exist in the lung, breast, prostate, colon, thyroid, and further organs can penetrate in the liver or bone.[8] Yet, cancers that are already present in certain organs and tissues can produce alkaline phosphatase elevations if metastasis is not present. Isoenzymes, which are certain forms of alkaline phosphatase generated by these tumors, enlarges the total volume of alkaline phosphatase levels on experiential studies. The Regan isoenzyme[9] is one of the best studies of these isoenzymes that is linked to several human cancers. Basically, the Regan isozenzyme is an alkaline phosphatase that is located in the placenta and associated with the gonadal and urologic cancers.

Testing

An alkaline phosphatase isoenzyme test can be done to check for elevated ALP levels. Tissues that contain high levels of ALP include the liver, bile ducts, and bones. Normal levels of ALP range from 44 to 147 U/L (units per liter) and higher than normal levels indicate cancer, bone disease such as Paget disease, liver disease such as hepatitis, and other conditions of the blood.[10]

Elevated alkaline phosphatase is most commonly caused by liver disease or bone disorder. Testing for ALP primarily consists of obtaining a blood sample from a patient along with several other tests for the disorder in question that may be associated with the increase in ALP in the blood serum.[11] It is possible to distinguish between the different forms (isoenzymes) of ALP produced by different types of tissues in the body, in order to pinpoint what's causing the increase of ALP, in order to treat the patient for either liver disease or bone disorder. A more rapid way for testing ALP concentration is by using p-nitrophenyl phosphate as substrate.[12] The required volume of serum is 5 cubic mm. for each testing. The sample is first incubated for 30 min. at 38 °C, in a buffered solution in the presence of p-nitrophenyl phosphate. By the action of ALP, phosphate groups are removed from the substrate and para- nitrophenol is liberated giving off a yellow color in solution which can be measured spectrophotometrically.[13]

Other

Treatments

The following are the most common treatments of elevated alkaline phosphatase.[19]

  • Treatment of the underlying condition
    • Once doctors identifies the cause of elevated ALP and diagnose a treatment, the levels of alkaline phosphatase fluntuates back to normal
  • Removal of medication - that's associated with increased levels of alkaline phosphatase
  • Dietary changes
    • Avoid foods that are rich in zinc
      • Elimination of foods that are rich in vitamin B12 from the diet
  • Lifestyle change
    • Healthy diet in association with physical exercise
    • Exposure to sunlight which increases the production of vitamin D

References

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  11. ↑ Lua error in package.lua at line 80: module 'strict' not found.
  12. ↑ Lua error in package.lua at line 80: module 'strict' not found.
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  14. ↑ Lua error in package.lua at line 80: module 'strict' not found.
  15. ↑ Lua error in package.lua at line 80: module 'strict' not found.
  16. ↑ Pruessner, Harold T, “Detecting Celiac Disease in your Patients” American Family Physician: 57 (5), March 1, 1998 pp1023-1034.
  17. ↑ Eur J Gastroenterol Hepatol. 2012 Jan;24(1):17-24. doi: 10.1097/MEG.0b013e32834c7b71. Liver-test abnormalities in sarcoidosis. Cremers J, Drent M, Driessen A, Nieman F, Wijnen P, Baughman R, Koek G.
  18. ↑ Pareek, S. S., “Liver involvement in secondary syphilis” Digestive Diseases and Sciences: 24 (1), January 1979 pp41-43.
  19. ↑ Lua error in package.lua at line 80: module 'strict' not found.

External links

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