The utility of uric acid assay in dogs as an indicator of functional hepatic mass

Abstract

Laboratory serum biochemical tests are regarded by the Liver Study Group (LSG) of the WSAVA as an essential component of any liver investigation. The LSG categorised liver disease into four groups: vascular disorders, biliary disorders; parenchymal disorders and neoplasia. The laboratory tests that evaluate the liver have three categories. The cytosolic enzymes assess hepatocellular integrity; the cholestatic or inducible enzymes assess the biliary tree, liver excretory pathways and possible enzyme induction. The third category is the liver function tests which assess overall hepatic functional mass and portovascular integrity. The liver function tests commonly used include plasma ammonia concentration, serum bile acid concentrations and various tests that evaluate the uptake and conjugation of metabolites by the liver. Uric acid was once used as a liver test in the late 1950’s early 1960’s. Physiologically, uric acid is an attractive candidate for a liver function test. In most mammalian species serum uric acid levels only increase to the levels encountered in humans when there is hepatic dysfunction. Uric acid fell out of favour as a liver function test following the publication of two studies and one case report in the late 1950’s. The differences between hepatocellular integrity tests, cholestatic tests and tests of liver function were not fully understood at that time. The authors unfairly compared uric acid, essentially a liver function test, to a test of cholestasis. In addition the authors had very vague inclusion criteria for their liver disease cases. Despite the short-comings in these studies several prominent reference texts have since perpetuated their findings and uric acid fell out of the reckoning as a test of liver function. Many tests of liver function have been used over the years. Dynamic function tests have gained popularity again. Plasma ammonia concentration is a very reliable test of liver function but has very stringent sample-handling requirements which often make its application in the average clinic setting impractical. Serum bile acid concentrations, while not as sensitive or specific for portovascular shunting as ammonia, are widely regarded as the best test of overall liver function, especially with respect to non vascular-associated liver disease. However bile acid assays are not widely available in South Africa resulting in delays in turn-around times. In today’s climate of ever increasing costs, and demand for rapid turn around times, it would be very useful to veterinarians if a simple, rapid, cheap and robust assay could be found for evaluating functional hepatic mass. Uric acid would seem to have this potential and it is performed by most medical laboratories. In this study the serum uric acid concentrations and concentration of bile acids of a control group of normal dogs was used to compare to those in three other groups of dogs. Two of these groups had liver disease, and the third was a renal disease group. The one group of liver disease was comprised of dogs with congenital vascular anomalies while the second liver disease group was made up of dogs with various parenchymal liver diseases. Serum bile acid concentrations in the four groups were compared to the serum uric acid levels to assess the utility of uric acid as a test of liver function; and to measure the affects of diminished renal function on serum uric acid concentrations. There were significant differences in the serum bile acid concentrations between the two liver disease groups and the non-liver disease groups. Uric acid concentrations between all four groups did not differ significantly however. Serum uric acid was elevated in dogs with renal impairment. Therefore the findings in this study indicate that uric acid cannot be used as a test of liver function and is not comparable to serum bile acids in this regard. Copyright