Abstract
Patients suffering from chronic renal dysfunction are monitored by measurement of biochemical markers such as serum total alkaline phosphatase (ALP) to detect increased bone remodeling before the development of advanced renal osteodystrophy. There are at least five different isoforms/isoenzymes of ALP: hepatic, skeletal, intestinal, placental, and tumor-associated (1). These can be separated by electrophoresis and differ in their resistance to heat inactivation, with placental and tumor-associated ALP being the most resistant. Approximately 95% of the total ALP activity in serum is derived from bone and liver sources; these isoforms occur in an ∼1:1 ratio in healthy adults (2). Bone remodeling leads to release of skeletal ALP from osteoblasts and, hence, to increased total …
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