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Clinical chemistry 1:
what comes from where
Clinical chemistry, or biochemistry, is the cornerstone
of any laboratory. It is the most common automated
laboratory modality utilised by veterinary nurses,
usually on a daily basis. But what do the numbers
mean? And where in the body do the measurands
come from? The aim of this two­part series is to give
you a whistle­stop tour of the common measurands
found on the feline biochemical profile.
A s with any laboratory-based
methodology, the results you achieve
are only as good as the sample you use. In
essence, if the sample is compromised for any
reason (most commonly haemolysed samples
with feline patients but also consider lipaemic
and icteric samples), then the results will also
be compromised. Always make a note of the
sample quality when processing samples as it
is directly reflected in the interpretation. The
full range of the artefactual changes are
beyond the scope of this article, but
references to the most important changes as
we move through the body systems and
analytical groups will be made.
Figure 1: Example of an in-house instrument
A closer look at...
Matthew Garland
BSc RSciTech SAC DIP Cert Nat Sci Vn MRSB
Matthew Garland is a veterinary nurse and
registered science technician with a degree
in chemistry and molecular biology, and over
20 years’ experience in the veterinary field.
He is currently a deputy director and
veterinary laboratory manager, and teaches
student veterinary nurses key laboratory
skills. Matthew has contributed to several
published research projects, has had several
articles on veterinary haematology and
clinical biochemistry published and delivers
regular CPD. Being passionate about team
development and the development of others,
Matthew sits on the registers assessors
board of the Royal Society of Biology (RSB)
and is also a judge for the RSB Apprentice
of the Year award.
This article is the first in a two-
part series. The second part will
discuss the common measurands
connected with hepatic and
metabolic laboratory testing and
their use for our feline patients.
Routine biochemistry can be
processed on serum gel, plain serum
(clot activator tubes) or lithium
heparin tubes, with most ‘in-house’
instruments using the latter sample1,2
(Figure 1). Ideally, patients should be
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starved before sampling, but water
should always be offered. Serum
samples should be spun down after
30 mins of standing or once the clot
has formed. If you are using lithium
heparin tubes these can be spun
once adequate mixing is achieved.
Once separated, the serum/plasma
should be kept in the fridge if not
being processed in the next hour or
frozen if prolonged storage is
required.1

Interpretation is very much the

remit of the clinical pathologist
Figure 2: Example feline biochemistry profile report
or veterinary surgeon in charge of
the case, but having a sound
knowledge of how to interpret will
allow nurses to aid the veterinary
surgeons as well as spot any
erroneous results (Figure 2). Listed
below are some basic considerations
when interpreting biochemical
results:
• Interpret results in conjunction
with the clinical signs. If the
results do not fit the case then
reassess the blood work.
• Interpret the measurands in
conjunction with those from
the same organ or group.
• Develop an understanding of the
magnitude of change expected in
the results for the condition you
are testing for.
• Develop a keen understanding
of the artefactual changes due to
poor sample handing (see above)
or poor analytical technique.
Common biochemical measurands
can be grouped in to four categories
(Table 1), which aids us in
interpretation; however, measurands
can cross categories depending on
certain conditions so it is patterns
that we use to determine a
diagnosis. It is important to look at
the whole clinical picture and utilise
multiple diagnostic techniques while
formulating a diagnosis.3
Renal
Without doubt, the most assessed
parameters for older feline patients
are those for renal function. The

Table 1: Common groupings of clinical biochemistry measurands

Renal Hepatic Metabolic Other common
measurands

Urea Alanine aminotransferase Proteins (total Lipase

Creatinine (ALT) protein and albumin) Creatine kinase (CK)

Inorganic Alkaline phosphatase Calcium Amylase

phosphate (ALP, ALKP) Glucose
Gamma Cholesterol
glutamyltransferase (GGT)
Sodium
Bilirubin
Potassium
Bile acids
Chloride

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Table 2: Common conditions that lead to azotaemia

Prerenal Renal Postrenal

Hypovolaemia Lymphoma and other Urinary tract obstruction
Dehydration cancerous lesions (after the nephron)

Shock Trauma
Toxicity

Table 3: Other causes of urea and creatinine abnormalities

Urea Creatinine Both

Gastrointestinal bleeding Muscle wastage Dehydration
Liver failure Shock
Heart disease

‘gold standard’ method to assess and creatinine can become elevated

renal function is to directly measure
glomerular filtration rate (GFR) but
this is rarely utilised in veterinary
medicine.2,3 Instead, we utilise a
simpler, less accurate indirect
method by monitoring urea and
creatinine. Abnormalities in urea and
creatinine are only observed after an
estimated 75% of the renal nephrons
are damaged.1 Damage can be
caused for a variety of reasons,
including inflammation, old age,
trauma, etc. Elevations in both
measurands are termed azotaemia
and can be classified as pre-renal,
renal and post renal (Table 2).1–3
for other non-renal-related
conditions (Table 3).
Inorganic phosphate
Phosphorus has multiple functions
within the body, being responsible
for structure in the phospholipids
and phosphoproteins.2,3 It is also
utilised in cell signalling, metabolism
and nucleic acid formation.
Phosphate is usually absorbed

Urea and creatinine

The most important function of the
urinary system is to excrete urea and
creatinine.1,2 These are both waste
products generated by the
metabolism of nitrogenous products.
Urea is the main metabolite from the
metabolism of dietary protein
formed in the liver from ammonium
and bicarbonate.2,3 Creatinine is
derived from the catabolism of
muscle creatine and creatine
phosphate.1,2 Both waste products
are filtered by the kidneys and, as
such, can be used as an indication of Figure 3: An older feline patient with chronic
kidney function. However, both urea kidney disease

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Table 4: Common reasons for
hypophosphataemia and hyperphosphataemia
Hypophosphataemia Hyperphosphataemia
Hyperglycaemia Kidney dysfunction
Insulin therapy High phosphate diet
Hypercalcaemia Tissue damage
Osteolytic lesion
into the bloodstream from the
gastrointestinal (GI) tract and is
usually stored in bones and teeth,
with excess being excreted through
the kidneys. Hyperphosphataemia
usually occurs when GI absorption
or cellular release exceeds excretion
and/or tissue requirements.1,2
Chronic kidney disease is a common
reason for the presence of a
hyperphosphataemia on a feline
profile, though there are other
possible causes (Figure 3).
Hypophosphatemia is also observed
in feline patients though is unlikely
to be related to renal problems
(Table 4).
Hyperphosphatemia can also
be caused by incorrect sample
handling. As mentioned previously,
a haemolysed sample will cause
elevations in phosphate as well as a
sample that has not been separated
from the red blood cells in the
correct time. If adult reference
ranges are used in young animals,
then there will be a perceived
Table 5: Common causes of creatine kinase elevations
Skeletal muscle Cardiac muscle
Road traffic accident Endocarditis
Seizures Thrombus
Inflammation
Parasitic disease
Intramuscular injections
Anorexia
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hyperphosphataemia when, in fact,
the level is normal for their age.
This is largely due to bone growth.2,3
Assessing renal function should
always be completed with a full
urine analysis with a bare minimum
of a urine specific gravity. Renal
insufficiency can cause other blood
panel abnormalities such as
electrolyte disturbances and
elevations in lipase.
Other common measurands
The brand of your point of care
analysers will dictate which tests
are commonly available to you in
practice. Listed below are two
commonly asked about measurands
and their relevance to feline patients.
Serum amylase and lipase
A commonly asked question
is regarding the diagnosis of
pancreatitis in feline patients and
the use of serum amylase and lipase.
Serum amylase and lipase activity
are measured by a variety of
methods, and all detect amylase
from a variety of tissue sources
other than the pancreas. Indeed,
elevated amylase and lipase are
not specific for pancreatic injury
and in some cases and species they
can be related to renal disease.1,2
Amylase and lipase are not
considered specific for pancreatitis
in cats as cats with spontaneous
pancreatitis have normal to slightly
Smooth muscle
Endometritis
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elevated amylase levels. It has also
been observed that cats with
pancreatitis have low levels of
serum amylase.

Both serum amylase and lipase are

much more sensitive and specific in
canine patients and can be utilised
with a great deal of success. If
pancreatitis is a concern in a feline
patient, then the feline pancreatic
lipase immunoreactivity (fPLI) test
should be considered along with
diagnostic imaging.1,2,3

Creatine kinase (CK)

Creatine kinase (CK) is an enzyme
found in high concentrations in
theskeletal, cardiac and smooth
muscles. CK is a component
(isoenzyme) of the cytoplasm of
muscle cells and is released when
these cells are damaged. CK is
considered specific for muscle
damage, and activity can peak
6-12 h post-trauma but will also
decrease rapidly due to a short half-
life (studies suggest 2 h).2,3

Please see Table 5 for a list of the

common causes of CK elevations.

Erroneous CK can also be caused by

poor sample handling. Haemolysed
samples can cause artificially
elevated results, so great care must
be taken when interpreting these
results.1

References
1 Stockham SL, Scott MA. Fundamentals of
veterinary clinical pathology. 2nd ed. Hoboken,
NJ: Wiley-Blackwell.
2 Villers E and Ristic J. BSAVA manual of canine
and feline clinical pathology. 3rd ed. Gloucester:
BSAVA, 2016.
3 Latimer KS. Duncan and Prasse’s veterinary
laboratory medicine. 5th ed. Hoboken, NJ:
Wiley-Blackwell, 2011.

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