Alt levels normal range: Alanine Aminotransferase (ALT) Test and Results (aka SGPT Test)
Alanine Aminotransferase (ALT) Test and Results (aka SGPT Test)
The alanine aminotransferase (ALT) test is a blood test that checks for liver damage. Your doctor can use this test to find out if a disease, drug, or injury has damaged your liver.
Your liver does a lot of important things for you:
- It makes a fluid called bile that helps your body digest food.
- It removes waste products and other toxins from your blood.
- It produces proteins and cholesterol.
Diseases such as hepatitis and cirrhosis can damage your liver and prevent it from doing its many jobs.
Why Is ALT Important?
This enzyme is found mainly in your liver. Smaller amounts of ALT are in your kidneys and other organs, too.
Your body uses ALT to break down food into energy. Normally, ALT levels in the blood are low. If your liver is damaged, it will release more ALT into your blood and levels will rise. (ALT used to be called serum glutamic-pyruvic transaminase, or SGPT).
Doctors often give the ALT test along with other liver tests.
Why Would My Doctor Order This Test?
Your doctor might recommend ALT if you have symptoms of liver disease or damage, such as:
Here are some reasons you might get this test:
- You’ve been exposed to the hepatitis virus.
- You drink a lot of alcohol.
- You have a family history of liver disease.
- You take medicine that’s known to cause liver damage.
The ALT test can be done as part of a blood panel during a regular exam. If you’ve already been diagnosed with liver disease, your doctor can use the ALT test to see how well your treatment is working.
How Do I Prepare?
You don’t need any special preparation for the ALT test. Your doctor might ask you to stop eating or drinking a few hours before the test.
Tell your doctor what prescription drugs or supplements you take. Some medicines can affect the results of this test.
What Happens During the Test?
A nurse or lab tech will take a sample of your blood, usually from a vein in your arm. They will first tie a band around the upper part of your arm to make your vein fill with blood and swell up. Then they will clean the area with an antiseptic and place a needle into your vein. Your blood will collect into a vial or tube.
The blood test should take only a couple of minutes. After your blood is taken, the lab tech will remove the needle and band, then put a piece of gauze and a bandage over the spot the needle went in to stop the bleeding.
What Are the Risks?
The ALT blood test is safe. Risks are usually minor, and can include:
- Slight pain when the needle is inserted
- Fainting or feeling dizzy
What Do the Results Mean?
You should get your results in about a day. A normal ALT test result can range from 7 to 55 units per liter (U/L). Levels are normally higher in men.
Slightly high ALT levels may be caused by:
Moderately high ALT levels may be because of:
Very high ALT levels can be caused by:
What Other Tests Will I Take?
ALT usually is done as part of a group of liver function tests called a liver panel.
This panel also includes an aspartate aminotransferase (AST) test. AST is another liver enzyme. As with ALT, the levels of AST in your blood rise if your liver is damaged.
Comparing ALT with AST levels gives your doctor more information about the health of your liver. The ALT-to-AST ratio can help your doctor figure out how severe the liver damage is and what might have caused it.
To find out what type of liver disease you have, your doctor might also test the levels of other enzymes and proteins found in your liver, including:
Talk to your doctor to make sure you understand all of your liver test results. Also find out how these results might affect your treatment.
Liver function tests – Mayo Clinic
Liver function tests are blood tests used to help diagnose and monitor liver disease or damage. The tests measure the levels of certain enzymes and proteins in your blood.
Some of these tests measure how well the liver is performing its normal functions of producing protein and clearing bilirubin, a blood waste product. Other liver function tests measure enzymes that liver cells release in response to damage or disease.
Abnormal liver function test results don’t always indicate liver disease. Your doctor will explain your results and what they mean.
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Why it’s done
Liver function tests can be used to:
- Screen for liver infections, such as hepatitis
- Monitor the progression of a disease, such as viral or alcoholic hepatitis, and determine how well a treatment is working
- Measure the severity of a disease, particularly scarring of the liver (cirrhosis)
- Monitor possible side effects of medications
Liver function tests check the levels of certain enzymes and proteins in your blood. Levels that are higher or lower than normal can indicate liver problems. Some common liver function tests include:
- Alanine transaminase (ALT). ALT is an enzyme found in the liver that helps convert proteins into energy for the liver cells. When the liver is damaged, ALT is released into the bloodstream and levels increase.
- Aspartate transaminase (AST). AST is an enzyme that helps metabolize amino acids. Like ALT, AST is normally present in blood at low levels. An increase in AST levels may indicate liver damage, disease or muscle damage.
- Alkaline phosphatase (ALP). ALP is an enzyme found in the liver and bone and is important for breaking down proteins. Higher-than-normal levels of ALP may indicate liver damage or disease, such as a blocked bile duct, or certain bone diseases.
- Albumin and total protein. Albumin is one of several proteins made in the liver. Your body needs these proteins to fight infections and to perform other functions. Lower-than-normal levels of albumin and total protein may indicate liver damage or disease.
- Bilirubin. Bilirubin is a substance produced during the normal breakdown of red blood cells. Bilirubin passes through the liver and is excreted in stool. Elevated levels of bilirubin (jaundice) might indicate liver damage or disease or certain types of anemia.
- Gamma-glutamyltransferase (GGT). GGT is an enzyme in the blood. Higher-than-normal levels may indicate liver or bile duct damage.
- L-lactate dehydrogenase (LD). LD is an enzyme found in the liver. Elevated levels may indicate liver damage but can be elevated in many other disorders.
- Prothrombin time (PT). PT is the time it takes your blood to clot. Increased PT may indicate liver damage but can also be elevated if you’re taking certain blood-thinning drugs, such as warfarin.
Show more related information
The blood sample for liver function tests is usually taken from a vein in your arm. The main risk associated with blood tests is soreness or bruising at the site of the blood draw. Most people don’t have serious reactions to having blood drawn.
How you prepare
Certain foods and medications can affect the results of your liver function tests. Your doctor will probably ask you to avoid eating food and taking some medications before your blood is drawn.
What you can expect
During the test
The blood sample for liver function tests is usually drawn through a small needle inserted into a vein in the bend of your arm. The needle is attached to a small tube, to collect your blood. You may feel a quick pain as the needle is inserted into your arm and experience some short-term discomfort at the site after the needle is removed.
After the test
Your blood will be sent to a laboratory for analysis. If the lab analysis is done on-site, you could have your test results within hours. If your doctor sends your blood to an off-site laboratory, you may receive the results within several days.
Normal blood test results for typical liver function tests include:
- ALT. 7 to 55 units per liter (U/L)
- AST. 8 to 48 U/L
- ALP. 40 to 129 U/L
- Albumin. 3.5 to 5.0 grams per deciliter (g/dL)
- Total protein. 6.3 to 7.9 g/dL
- Bilirubin. 0.1 to 1.2 milligrams per deciliter (mg/dL)
- GGT. 8 to 61 U/L
- LD. 122 to 222 U/L
- PT. 9.4 to 12.5 seconds
These results are typical for adult men. Normal results vary from laboratory to laboratory and might be slightly different for women and children.
Your doctor will use these results to help diagnose your condition or determine treatment you might need. If you already have liver disease, liver function tests can help determine how your disease is progressing and if you’re responding to treatment.
Overview of ALT and AST Liver Enzymes
Liver enzymes are substances produced by the liver that can be measured with a blood test. Any elevation in an enzyme level may be a sign of a liver problem, and aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are two of the enzymes central to such an investigation. When used comparatively, AST and ALT can help identify liver toxicity, liver disease, or liver damage.
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Roles of AST and ALT
Aminotransferases are chemicals that the liver uses to make glycogen. Glycogen is the stored form of glucose, a sugar that the body uses for energy. Any glucose not immediately used will be converted into glycogen and stored in cells for future use. Most will be stored in the liver, while the remainder will be warehoused in skeletal muscles, glial cells of the brain, and other organs.
Aspartate aminotransferase (AST) is found in a variety of tissues, including the liver, brain, pancreas, heart, kidneys, lungs, and skeletal muscles. If any of these tissues are damaged, AST will be released into the bloodstream. While increased AST levels are indicative of a tissue injury, it is not specific to the liver per se.
By contrast, alanine aminotransferase (ALT) is found primarily in the liver. Any elevation of the ALT is a direct indication of a liver injury, whether minor or severe. Occasional increases may occur in association with a short-term infection or illness. Sustained increases are more problematic as they suggest an underlying disease and a greater likelihood of liver damage.
Normal Lab Values
AST and ALT are measured in international units per liter (IU/L). The normal levels vary based on a person’s body mass index (BMI) as well as the individual lab’s reference value. Generally speaking, the normal reference value for adults is:
- AST: 8 to 48 IU/L
- ALT: 7 to 55 IU/L
The high end of the reference range is referred to as the upper limit of normal (ULN). This number is used to establish how elevated your liver enzymes are.
Mild elevations are generally considered to be two to three times the ULN. With some liver diseases, the level can exceed 50 times the ULN. Levels this high are described as deranged.
While it may seem that a high ALT is all that is needed to diagnose liver disease, its relationship to AST can provide valuable clues as to what exactly is going on and whether the issue is acute (occurring suddenly and progressing rapidly) or chronic (long-standing or persistent).
If the liver sustains an acute injury, you can expect to see a sudden spike in the ALT. On the other hand, if a liver disease is slowly progressing, the damage incurred by the liver will gradually affect other organs as well. As these organs are damaged, the AST will begin to rise.
This occurs with diseases like hepatitis C in which long-term liver damage will trigger an ever-expanding array of symptoms involving the kidneys, brain, eyes, skin, and joints (referred to as extra-hepatic symptoms).
This enzyme relationship can be described diagnostically with the AST/ALT ratio. This is a calculation that compares the levels of AST and ALT in your blood. Depending on which value is elevated and the extent of that elevation, doctors can often get a pretty strong indication as to what disease is involved.
What the AST/ALT Ratio Reveals
The AST/ALT ratio is important insofar as the pattern of elevation can tell a lot about the condition involved. Among the general guidelines used to diagnose liver disease:
- An AST/ALT ratio of less than one (where the ALT is significantly higher than the AST) is suggestive of non-alcoholic fatty liver disease.
- An AST/ALT ratio equal to one (where the ALT is equal to the AST) is suggestive of acute viral hepatitis or drug-related liver toxicity.
- An AST/ALT ratio higher than one (where the AST is higher than ALT) is suggestive of cirrhosis.
- An AST/ALT ratio higher than 2:1 (where the AST is more than twice as high as the ALT) is suggestive of alcoholic liver disease.
However, a disease cannot be diagnosed by the pattern of elevation alone. The magnitude of elevation described in multiples of the ULN also needs to be evaluated. It is only when the magnitude is above a certain threshold that the ratio can be considered diagnostic.
When Testing Is Recommended
AST and AST are part of a comprehensive testing panel known as the liver function test (LFT). An LFT may be ordered:
- If you have symptoms of liver disease, including jaundice, dark urine, nausea, vomiting, and fatigue
- To monitor the progression of a liver disease
- To determine when certain drug treatments should be started
- To assess your response to a liver treatment
Even beyond the scope of liver disease, an LFT can assess whether a drug (prescription or over-the-counter) or an herbal remedy is causing liver injury.
If the lab test is processed on-site, the results can be returned within hours. Otherwise, your doctor will usually receive the results in anywhere from one to three days.
Are You Drinking Too Much? How Alcohol Consumption Can Affect Your Health
Many people enjoy a drink now and then. But how is that alcohol affecting your body? The liver is where a lot of your metabolism lives. It filters out harmful substances, like alcohol and toxins, from your blood. But its duties don’t end there. It processes what you eat and drink into energy and nutrients for your body, produces bile to help you digest those nutrients, stores blood sugar in the form of glycogen, and performs many other essential functions. So a healthy liver is critical to your overall well-being and performance. But how can you find out whether your liver is healthy, or whether you may have pushed it too far? Well, the best way to monitor your liver health is through a blood test for liver damage biomarkers, such as ALT.
Found primarily in your liver cells, ALT is an enzyme that plays a role in converting stored glucose into usable energy. When liver cells are damaged, ALT can leak out into your bloodstream. Normally, there is only a small amount of ALT in your blood; higher levels of ALT typically indicate liver injury or inflammation
The normal range for ALT is 10-40 units per liter (U/L) of blood for men and 7-35 U/L for women. Blood tests from InsideTracker will tell you your optimal range for ALT based on your age, gender, ethnicity, athletic activity, alcohol consumption, BMI, and smoking history. And if your levels of ALT are elevated, InsideTracker will recommend diet, lifestyle, and supplement changes that can help to reduce your ALT levels. Since high levels of ALT indicate liver damage or disease, it’s important to consult your physician if you have elevated ALT.
Many lifestyle factors can influence your ALT levels, including:
One of the more frequent causes of high ALT levels is a condition commonly referred to as a fatty liver, which is a reversible condition that occurs when large amounts of triglycerides (the type of fat typically found in food) accumulate in liver cells. In the United States, alcohol abuse is one of the largest contributors to fatty liver, but other causes include elevated blood glucose and excess body weight. Disease and certain medications can also increase ALT.
The good news is that many people can lower their elevated ALT with changes in their lifestyle and exercise:
InsideTracker will recommend personalized lifestyle changes to help you decrease your ALT.
What you eat also has an effect on ALT. Limiting high-fat foods, especially ones that are derived from animal sources, may help decrease elevated ALT levels. High-fat foods increase fat levels in your blood, which may end up being deposited in the liver.
Helpful changes can include:
- Choosing lean proteins, such as chicken breast, fish, or beans, and low-fat dairy products.
- Reducing the refined carbohydrates and sugars in your diet. Instead, eat whole foods like beans, whole grains, berries, oatmeal, and vegetables, which provide fiber, vitamins and antioxidants.
- Eating foods high in folate, which studies have shown can help to reduce ALT and improve liver health. Foods include black-eyed peas, fortified breakfast cereals, Brussels sprouts, and avocado.
With an InsideTracker Ultimate test you can easily check whether you have elevated ALT, and learn how to improve your liver health using simple interventions such as food, supplement, exercise, and lifestyle changes.
Some other blog posts we think you’ll love:
Alanine Aminotransferase (ALT) | Lab Tests Online
Sources Used in Current Review
2019 Review completed by H.L.Chong, MD, FRSPH, IPFPH, Clinical Scholar, Faculty of Public Health of the Royal Society of Physicians of United Kingdom.
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(Updated June 13, 2019) Sood, G MD. Acute Liver Failure Workup. Medscape Reference. Available online at https://emedicine.medscape.com/article/177354-workup#c2. Accessed August 2019.
McPherson RA, Matthew R, Pincus MR. Henry’s Clinical Diagnosis and Management by Laboratory Methods. 22nd ed. Philadelphia: Elsevier Saunders; 2011.
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Clarke, W. and Dufour, D. R., Editors (2006). Contemporary Practice in Clinical Chemistry, AACC Press, Washington, DC, Pp 270-271.
Carey, W (January 1, 2009) Approach to the Patient with Liver Disease: A Guide to Commonly Used Liver Tests, Cleveland Clinic. Available online at http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/hepatology/guide-to-common-liver-tests/. Accessed February 2010.
Henry’s Clinical Diagnosis and Management by Laboratory Methods. 21st ed. McPherson RA and Pincus MR, eds. Philadelphia: 2007, Pp 268-269.
(2000) Dufour, DR et al. National Academy of Clinical Biochemistry Standards of Laboratory Practice: Laboratory Guidelines for Screening, Diagnosis and Monitoring of Hepatic Injury http://www.aacc.org/SiteCollectionDocuments/NACB/LMPG/hepatic/hepatic_combined.pdf#page=3. Accessed February 2010.
(March 15, 2005) Giboney, P. Mildly Elevated Liver Transaminases in the Asymptomatic Patient. Am Fam Physician 2005; 71:1105–10. Available online at http://www.aafp.org/afp/2005/0315/p1105.html. Accessed February 2010.
(Feb 22, 2009) MedlinePlus Medical Encyclopedia: ALT. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003473.htm. Accessed February 2010.
Alanine Aminotransferase (ALT) (GPT), Serum. Mayo Clinic. Available online at http://www.mayomedicallaboratories.com/test-info/hematology/catalog/Overview/8362. Accessed September 2013.
Orlewicz, M. S. (Update April 20, 2012.) Alanine Aminotransferase. Medscape. Available online at http://emedicine.medscape.com/article/2087247. Accessed September 2013.
Nyblom, H. et. al. (July 2004.) High AST/ALT Ratio May Indicated Advanced Alcoholic Liver Disease Rather Than Heavy Drinking. National Center for Biotechnology Information PubMed. Available online at http://www.ncbi.nlm.nih.gov/pubmed/15208167. Accessed September 2013.
2016 review performed by Alan F. Weir, PhD, DABCC, Instructor, Fox Valley Technical College.
(September 9, 2014) Thompson, E. Gregory, MD. Alanine Aminotransferase (ALT). WebMD. Available online at http://www.webmd.com/digestive-disorders/alanine-aminotransferase-alt. Accessed on 4/05/16.
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(April 30, 2015) Davis, Charles Patrick, MD, PhD. Liver Blood Tests. MedicineNet. Available online at http://www.medicinenet.com/liver_blood_tests/page4.htm. Accessed on 4/05/16.
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Alanine aminotransferase (ALT) test: Uses and results
The liver makes several enzymes, including alanine aminotransferase, or ALT. These enzymes help break down proteins so that the body can digest them.
Besides helping the liver break down proteins, ALT helps the liver perform its basic functions. Some of these include:
- filtering toxins from the blood
- storing nutrients and iron
- producing bile, which aids digestion
Most ALT that the liver produces stays within the organ. However, when the liver is damaged or inflamed, it may release ALT into the bloodstream.
When this happens, the level of ALT in the blood rises. Therefore, doctors use an ALT blood test to screen for liver disease or damage. Learn more about the test in this article.
A doctor orders an ALT test to look for problems with liver function. Many people have this test as part of a comprehensive metabolic panel.
The comprehensive metabolic panel is a routine blood test that checks a person’s glucose level, kidney function, and liver function. It is often part of a routine checkup that gives a doctor insight into an individual’s overall health.
Other times, a doctor orders the ALT blood test as part of a series of blood tests called liver panels if they suspect that a person’s liver is damaged or diseased.
Doctors may order liver panels if a person has symptoms of liver disease or damage. Symptoms of liver problems include:
- yellowing of the eyes and skin (jaundice)
- pain in the upper right quadrant of the abdomen
- referred pain in the right shoulder
- easy bleeding or bruising
- intense itching
- pale stools
- swelling in legs or abdomen
These symptoms can indicate liver disease, injury, or another problem that may be affecting the liver.
Medical problems that can cause elevated ALT levels include:
Certain medications can also cause ALT levels in the blood to be high.
Often, these levels are elevated before symptoms of liver damage occur, making the test useful for people at risk of liver damage.
When a doctor can detect liver damage early, they may be better able to treat it and prevent further injury.
People at risk of liver damage or disease include:
- people with a family history of liver disease
- people who have diabetes
- people who are overweight
- people who consume a lot of alcoholic beverages
- people taking certain medications
Doctors routinely order liver panels to monitor diagnosed liver disease or injury. The results of these tests can show how well the treatment plan is working.
A person with a healthy liver will have an ALT level in the normal range. The normal range can vary from laboratory to laboratory.
According to the Mayo Clinic, the normal range for adult males is 7–55 units per liter. Females may have a lower upper limit normal than males.
Age can also affect results. A person should speak with their doctor about what their results mean.
If a person has results above the normal range, this may indicate liver damage.
Causes of elevated ALT levels include:
- the destruction of liver cells
- a lack of blood flow to the liver
- cirrhosis, or severe scarring of the liver
- hemochromatosis, or iron buildup
- mononucleosis, an infection usually caused by the Epstein-Barr virus
- a tumor in the liver
A person should discuss their results with their doctor, who can say if the numbers returned are within a normal range.
If a person’s results are too low or high, a doctor can help determine the appropriate course of treatment.
People with higher ALT levels often need additional tests to discover the underlying cause of the liver damage and treat it.
An ALT blood test helps determine if a person has liver damage. Uncovering the cause of the problem often requires further testing.
The normal range for results tends to vary among facilities, and a doctor can discuss what the results mean on an individual basis.
Once they know the underlying cause of the liver damage, based on symptoms and test results, the doctor will discuss appropriate treatment options.
What is Alanine Aminotransferase (ALT)? Test & Normal Range
Alanine aminotransferase (ALT) is an important marker of liver health. Keep reading to find out why this marker is often part of liver function tests – and when you should be concerned about your levels.
What is ALT?
Alanine aminotransferase or ALT (also known as SGPT) is an enzyme your body needs to break down proteins into energy [1, 2].
Healthy liver cells store most of ALT, but small amounts are also found in the kidneys, heart, muscles, fat tissue, intestines, and pancreas .
Normally, blood ALT levels are low. However, when liver cells are damaged due to illness, injury, or medication, they release ALT, increasing its blood levels .
Therefore, ALT blood levels are a marker of liver health: low levels typically indicate a healthy liver, while high levels suggest liver damage .
Most of ALT is safely stored in the liver. When there is liver damage, ALT leaks into the bloodstream.
Before we talk about the ALT blood test, let’s take a look at what ALT normally does in the body.
ALT helps turn L-alanine and alpha-ketoglutarate into glucose that can be used for energy (via pyruvate) and L-glutamate which can be eliminated as waste or used to build new proteins [6, 7, 8, 9].
ALT Blood Test
An ALT blood test may be ordered to [10, 11, 12, 13]:
- Assess liver health
- Investigate symptoms of liver disease, such as abnormally yellow skin or eyes (jaundice), or pain in the upper-right section of the abdomen
- Monitor progression of a liver disease
- Evaluate the effectiveness of a treatment for liver disease
- Determine if the liver is involved in or damaged by a health condition, such as diabetes or heart disease
Since ALT is an enzyme, its levels are typically determined by measuring its activity (the rate at which ALT transforms L-alanine and α-ketoglutarate into pyruvate and L-glutamate) .
ALT levels are often measured together with the liver enzyme aspartate transaminase (AST). The ratio of AST/ALT is also sometimes used as a marker of liver health.
While ALT levels can signal the presence of liver damage, they cannot determine the type of damage, such as scarring, infection, or inflammation .
Your doctor will typically order an ALT test along with AST to assess your liver function. High levels can signal liver damage, but they don’t reveal its type or cause.
ALT is measured in units per liter of blood or U/L.
The normal range is around 7-35 U/L in women and 7-40 U/L in men. There may be some lab-to-lab variability in ranges due to differences in equipment, techniques, and chemicals used.
ALT levels typically do not change much during pregnancy. They may slightly increase during the final trimester, but generally still remain below 40 U/L [16, 17, 18, 19].
Low ALT levels are expected and normal – they are just uncommon in the general population. This is because reference ranges are based on where 95% of a healthy population falls into, which means that there are 5% of the people who are healthy and not within the reference range!
There are some factors that can decrease ALT, but they are not common. These include:
- Vitamin B6 deficiency [20, 21]
- Smoking 
- Regular exercise 
- Oral contraceptives or hormone replacement therapy [22, 24]
- Chronic kidney disease [25, 26]
Find out more about low ALT levels and associated conditions here.
High ALT levels often signal a problem with the liver. However, a result that’s higher than normal, doesn’t necessarily mean that you have a health condition that needs treatment. Your doctor will interpret your ALT result, taking into account your medical history, symptoms, and other test results.
ALT can increase due to various underlying issues. Causes shown below are commonly associated with high ALT levels. Work with your doctor or another health care professional to get an accurate diagnosis. Aforementioned conditions include:
- Liver diseases, such as fatty liver, viral hepatitis, other infections that affect the liver (mononucleosis), or liver cancer [27, 28]
- Liver damage due to toxins such as lead, mercury, or pesticides [11, 29, 30]
- Liver damage due to prescription and over-the-counter drugs and supplements [11, 31, 32, 33]
- Alcohol abuse 
- Anorexia 
- Obesity [36, 34, 37]
- Gallstones and gallstone-induced inflammation of the pancreas (pancreatitis) [38, 39]
- Muscle damage due to strenuous exercise, injury, or muscle disease [40, 41, 42]
- Tissue damage due to surgery or burns [43, 44]
- Heart attack or heart failure [45, 31]
- Underactive thyroid gland (hypothyroidism) 
- Abnormal red blood cell destruction (hemolysis) [46, 47]
Read through this post to learn more about the causes of high ALT and what you can do to decrease high ALT levels.
While one elevated ALT test doesn’t necessarily mean that you have a health condition that needs treatment, several high ALT tests or a high ALT test in conjunction with symptoms of liver damage or disease are a reason for concern. Your doctor should work on finding the underlying cause and treatment options .
Tests of other liver enzymes such as AST, ALP, bilirubin, and GGT can help create a more complete picture of liver health .
ALT is an enzyme your body needs to turn proteins into energy. Most of it is stored in your liver. Your levels will usually remain stable and relatively low if your liver is healthy, while liver damage causes ALT to leak into the bloodstream in higher amounts. Thus, doctors typically order ALT to check liver function. However, various other conditions beyond liver health can also affect your levels. That’s why doctors will analyze ALT alongside other markers of liver health like AST, ALP, bilirubin, and GGT.
90,000 decoding, the norm, which means an increase in the level of AsAT
A biochemical blood test for AST is widespread in clinical practice and is used to diagnose a variety of diseases. This study is used by a wide variety of specialists, including cardiologists, therapists and gastroenterologists. The reason for this demand is its informativeness and versatility regarding pathological changes in tissues and organs. The AST test is specific for damage to the heart muscle, hepatitis of all types, malignant lesions of the bone tissue, etc.e. As a rule, it is used in conjunction with blood tests for ALAT *. AlAt is a biochemical blood test that accompanies the diagnosis of liver diseases. It is used as an independent study and in combination with AST.
AST and ALT
Tests for AST and ALT are two studies, often prescribed by a doctor in combination. Why is the level of these two enzymes so important to determine simultaneously? For the first time, the idea of the informativeness of their ratio was put forward by the scientist Fernando De Ritis from Italy.He used the method for the differential diagnosis of various types of hepatitis. Since then, his name has become a household name. The Ritis coefficient shows the ratio of the activity of AST and ALT. In healthy people, the coefficient is 0.91-1.75. The indicator is informative only if the values of these enzymes exceed the reference values. If in a double test only AST values are exceeded, this means that the myocardium is damaged. With damage to the heart muscle, the level of AST increases 8-10 times, ALT – only 1.5-2 times.If the patient has a liver problem, on the contrary, the ALT level increases 8-10 times, and the AST values - only 2-4 times.
What is the enzyme
AST or AST – a protein synthesized inside the cells of the human body. Its highest concentrations are found in the tissues of the myocardium, muscles and liver. To a lesser extent, the enzyme is present in the kidneys, pancreas, cells of the central nervous system and the brain. It is encoded by the genes GOT 1 and GOT 2. In a healthy person, the level of the enzyme is quite low.Its active release into the blood begins with a rupture of the heart muscle, as well as destruction of the liver as a result of hepatitis, cirrhosis or cancer. The enzyme is important because it contains vitamin B 6, which is involved in amino acid metabolism and, accordingly, insulin synthesis. In analyzes, the indicator is measured in units per liter of blood.
Spectrum of application of the analysis for AST
- In cardiology as a marker of myocardial infarction. In the heart muscle, the enzyme is more than 10,000 times active than in the blood.With a heart attack, an intense release of the enzyme occurs.
- For liver pathologies. Diseases such as hepatitis and cirrhosis are certainly accompanied by the destruction of liver tissue and a sharp jump in AST values.
- For chronic alcoholism.
- In obstetrics and gynecology. During pregnancy, a woman may experience a slight increase in AST values. This is due to the effects of the growing fetus on the mother’s liver. In the first trimester, its values should not exceed 31 U / L, in the second and third – 30 U / L.
- In endocrinology for diabetes mellitus and / or overweight.
Symptoms for which an AST test is recommended
- Jaundice of the skin
- Jaundice of the eye sclera
- Pain in the right and left hypochondrium
- Dyspeptic disorders (vomiting, nausea, heartburn)
- General loss of appetite and appetite and
- Abnormalities in urine and stool results
How to Prepare for Analysis
There are some rules and restrictions to follow to improve the reliability of your analysis.So on the eve of the study, one should refrain from eating fatty and smoked foods, as well as confectionery. It is best if the test is performed on an empty stomach in the morning. When taking medications, you need to consult with your doctor about their possible cancellation. The fact is that with a biochemical blood test, many medicines can affect the results of the study. When treated with antidepressants, antibiotics, diuretics and other drugs, the test readings may be distorted. In addition, it is forbidden to perform ultrasound, X-ray examination and physiotherapy procedures immediately before a visit to the procedural room.
Interpretation of the AST test
Norm in women
The AST test values differ depending on age and gender. So in women, the norm of the enzyme in the blood is 31 U / l. The older a person is, the lower his activity in the body. This is due to a slowdown in metabolism in general. A natural physiological condition such as pregnancy also affects enzyme levels.During this period, its small jumps can be observed both in one direction and in the other direction.
Norm in men
The concentration of the enzyme in men begins to exceed its amount in women from 12-17 years of age. Its higher concentrations are due to the large volume of muscle tissue. At puberty, the norm of AST in boys is about 29 U / l. This is about four units higher than that of girls of the same age. In an adult male, the enzyme level can reach 37 U / L.
Deviations from the norms
An excess of AST in the blood can occur for the following reasons:
Rupture of the heart muscle (myocardial infarction)
Malignant liver damage Metastases of malignant tumors in the liver Alcohol abuse Autoimmune muscle tissue diseases Poisoning, including alcohol, drugs and poisonous fungi Injuries, fractures Malignant damage to bone tissue Heat or sunstroke
If high AST values persist for several days, this means that the patient is in serious condition.An increase in the growth of values indicates that the tissues in the focus of pathology have become necrotic and additional rehabilitation measures need to be urgently taken.
A decrease in the AST level is observed at:
- Manipulation with blood (hemodialysis)
- Vitamin B deficiency
- Liver necrosis
Do not forget that only the attending physician can interpret the values. The reason for deviations in the readings of the blood test for AST can be not only diseases, but also other factors, for example, the use of dietary supplements and treatment with medications. Results may be unsatisfactory due to heart, liver, or other organ problems. Additional studies, including a test for bilirubin, total protein, and ALT, will help determine the true cause of the excess enzyme level. The specialist will compare all the data with the results, after which he will draw the appropriate conclusions.
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How to Interpret ALT, AST, Bilirubin, Alkaline Phosphatase Tests
The American College of Gastroenterology (ACG) has issued updated guidelines for biochemical blood tests used to assess liver health
New guidance is targeted at both professionals and primary care physicians.
Specific values for normal range of alanine aminotransferase (ALT) levels are provided, as well as stepwise screening algorithms for elevated ALT, aspartic aminotransferase (AST), alkaline phosphatase and bilirubin. In comparison with the documents of the previous editions, the new recommendations contain reduced limits of the norm. Those. In the previous recommendations, the upper bounds of indicators (ULN) were considered as the norm, which can vary significantly between laboratories with in the range of 30-40 international units (IU) per liter in some institutions and up to 70-80 IU / L in others.According to the new guidelines, the normal range for ALT would be 19-25 IU / L for women and 29-33 IU / L for men.
Cirrhosis of the liver. Questions and Answers
The authors noted that they are aware that due to the lowering of the normal limits, many patients will fall into the category with increased indicators and that this will create certain difficulties for doctors.
However, the authors consider lower starting points to be justified, pointing out that sometimes even the smallest elevation in ALT significantly increases the risk of death due to liver disease.
The authors point out that elevated ALT levels help identify people with chronic liver disease, such as non-alcoholic fatty liver disease, and chronic hepatitis C and B.
Therefore, it is very important to realize that even a slight increase in ALT requires additional testing if over time, its level does not return to normal. The authors hope that over time, practitioners will become accustomed to these new levels, leading to improved liver health for all, as well as overall health.
- Before evaluating liver abnormalities, repeat the laboratory panel and / or perform an explanatory test (for example, perform a GGT test if serum alkaline phosphatase levels are elevated) to confirm that the blood biochemical livers are not actually normal. (Strong recommendation, very low level of evidence).
- Testing for chronic hepatitis C is done with anti-HCV and confirmation is done with HCV-RNA by nucleic acid testing.Risk factors for hepatitis C include a history of intranasal or intravenous drug use, tattoos, body piercings, blood transfusions, and high-risk sexual behavior. Also at risk are people born between 1945 and 1965. Testing for acute hepatitis C is done with anti-HCV and HCV RNA by nucleic acid testing. (Strong recommendation, very low level of evidence).
- Testing for chronic hepatitis B is done with HBsAg testing.Acute hepatitis B testing is associated with HBsAg and anti-HBc IgM.
The following groups are at greatest risk: people born in endemic or hyperendemic areas (HBsAg prevalence> 2%), men who have sex with men, people who have ever injected drugs, dialysis patients, HIV-infected individuals, pregnant women and family members, family members and sexual contacts of HBV-infected individuals. (Strong recommendation, very low level of evidence).
- Testing for acute hepatitis A (IgM HAV) should be performed in patients with acute hepatitis and suspected fecal-oral exposure. Acute hepatitis E (IgM HEV) testing should also be done in those returning from endemic areas who are negative for acute hepatitis A, B, and C. (Strong recommendation, very low level of evidence).
- Patients with an elevated BMI and other features of metabolic syndrome, including diabetes mellitus, overweight or obesity, hyperlipidemia, or hypertension with mildly elevated ALT levels should undergo an ultrasound screening for non-alcoholic fatty liver disease (NAFLD). (Strong recommendation, very low level of evidence).
- Women who consume more than 140 grams of alcohol per week or men who consume more than 210 grams per week who have AST> ALT should be considered at risk for alcoholic liver disease and should be advised to stop drinking. (Strong recommendation, very low level of evidence).
- All patients with abnormal liver function tests in the absence of acute hepatitis should be tested for hereditary hemochromatosis with iron, transferrin, and serum ferritin levels.HFE gene mutation analysis should be performed in patients with a transferrin score ≥45% and / or elevated serum ferritin. (Strong recommendation, very low level of evidence).
- Patients with abnormal AST and ALT levels, especially those with other autoimmune conditions, should be tested for autoimmune liver disease including ANA, ASMA, and globulin levels. (Strong recommendation, very low level of evidence).
- Patients with persistently elevated AST and ALT levels, especially those under the age of 55, should be screened for Wilson’s disease with serum ceruloplasmin testing. When ceruloplasmin is low, confirmatory testing by 24-hour urine copper testing and slit-lamp eye examination to detect abnormalities (Kaiser-Fleischer mosaic rings) is recommended. (Strong recommendation, very low level of evidence).
- Patients with persistently elevated AST or ALT should be screened for alpha-1 antitrypsin deficiency (A1AT) with an alpha-1 antitrypsin phenotype (Strong recommendation, very low level of evidence).
- Physicians should ask patients with abnormal kidney tests about the drugs and medicines they are taking, including those that they take on their own, without a doctor’s recommendation. It is also worth considering dietary or herbal supplements that may be associated with DILI. (Strong recommendation, very low level of evidence).
- Liver biopsy may be considered when serologic testing and imaging are unable to identify a diagnosis, interpret a condition, or when multiple diagnoses are possible.(Strong recommendation, very low level of evidence).
- An increase in alkaline phosphatase should be confirmed by an increase in GGT. Given the lack of specificity for liver disease, GGT should not be used as a screening test for underlying liver disease in the absence of other abnormal liver findings. (Strong recommendation, very low level of evidence).
- Patients with elevated alkaline phosphatase with or without elevated bilirubin should be tested for PBC (formerly called primary biliary cirrhosis) with antimitochondrial antibody testing.(Strong recommendation, very low level of evidence).
- Patients with elevated alkaline phosphatase with or without elevated bilirubin should be tested for PSC by MR cholangiography or ERCP with IgG4. (Strong recommendation, very low level of evidence).
- In patients with ALT and / or AST levels <5X ULN, laboratory tests should evaluate the possibility of viral hepatitis B and C, alcoholic and NAFLD, hemochromatosis, Wilson's disease, alpha-1-antitrypsin deficiency, autoimmune hepatitis and consider the possibility of drug poisoning and associated liver damage. (Strong recommendation, very low level of evidence).
- In individuals with ALT and / or AST 5-15X ULN, acute hepatitis A, B, and C should be considered in addition to all eiologies (Strong recommendation, very low level of evidence).
- In individuals with ALT and / or AST> 15X ULN or a massive increase in ALT> 10,000 IU / L, acetaminophen toxicity and ischemic hepatopathy (shock liver) should be considered. (Strong recommendation, very low level of evidence).
- A patient with acute hepatitis with increased prothrombin time and / or encephalopathy requires immediate referral to a specialist hepaologist. specialist in the liver. (Strong recommendation, very low level of evidence).
ALT, alanine aminotransferase; ANA, anti-nuclear antibodies; ASMA, anti-smooth antibody; AST, aspartate aminotransferase; BMI, body mass index; DILI, drug-induced liver damage; GGT, gamma glutamyl transferase; HAV, hepatitis A virus; HBc, the main antigen of hepatitis B; HBsAg, hepatitis B surface antigen; HCV, hepatitis C virus; HEV, hepatitis E virus; HFE, hereditary hemochromatosis; IgM, immunoglobulin M; MR, magnetic resonance; NAFLD, non-alcoholic fatty liver disease; PBC, primary biliary cholangitis; PSC, primary sclerosing cholangitis; ULN, upper limit of normal
The following contributors were involved in the preparation of the recommendations:
Division of Gastroenterology / Hepatology, Department of Medicine, Stanford University School of Medicine Palo Alto, California, USA; Digestive Health Institute, University Hospitals Cleveland Medical Center and Division of Gastroenterology and Liver Disease, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Yale Viral Hepatitis Program, Yale University School of Medicine. New Haven, Connecticut, USA. Correspondence: Paul Y. Kwo, MD, FACG, Division of Gastroenterology / Hepatology, Stanford University School of Medicine, 750 Welch Road, Suite 210, Palo Alto, California 94304, USA
What is Alanine Aminotransferase?
Alanine aminotransferase (ALT) is an enzyme found primarily in the liver. It is also found in smaller amounts in other organs such as the kidneys, heart, muscles, and pancreas.Formerly referred to as serum glutamate pyruvic transaminase, ALT is now sometimes interchangeably referred to as alanine transaminase. ALT is usually monitored by doctors on blood chemistry panels, and is especially useful in liver function tests.
The enzyme alanine aminotransferase is involved in the alanine cycle in cells. As an enzyme, it is a protein made by the body to speed up a chemical reaction. The specific function of ALT is to catalyze a reversible reaction that transfers an amino group from alanine to alpha-ketoglutarate, forming pyruvate and glutamate.ALT activity is highest in hepatocytes, or liver cells, and striated cells of skeletal and cardiac muscles. Due to its role in the glucose-alanine cycle, ALT promotes effective muscle contraction by using muscle protein to produce glucose and waste waste through the liver.
Both humans and veterinarians routinely measure ALT on blood chemistry panels. Elevated levels of ALT in the blood are a sign of hepatocellular damage or damage to liver cells.When liver cells are damaged, ALT effectively leaks out of these cells, causing it to appear in higher concentrations on blood panels. Thus, ALT is known as a leakage enzyme. It is often measured in combination with aspartate transaminase (AST), alkaline phosphatase, and bilirubin to evaluate liver disease.
Some common causes of elevated alanine aminotransferase include liver disease such as cirrhosis of the liver, viral hepatitis, liver tumors and ischemia, or lack of blood flow to the liver.Additional causes of elevated ALT levels include drugs that affect the liver, such as statins, certain antibiotics, chemotherapy, aspirin, drugs, and barbituates.
ALT may also be elevated in other conditions such as pancreatitis, mononucleosis, or celiac disease. Sometimes ALT levels rise due to recent cardiac catheterization or surgery. Individuals on long-term medications, or those with risk factors for liver disease, are often monitored regularly for high ALT levels.
The normal ALT range for an adult alanine aminotransferase test is 0-40 units / liter. However, ranges can vary based on gender and even animal species. Test results can also vary from one testing laboratory to another.
Alanine aminotransferase test results can also be distorted by cigarette smoking, medication, or pregnancy. Sometimes exercising just before the test can skew the results.Certain herbs, such as echinacea or valerian, can also raise blood ALT levels.
Liver function tests-ALT | Sağlam Aile
The most common tests used to check for liver damage are ALT (alanine aminotransferase) and AST (aspartate aminotransferase).
What is ALT?
Alanine aminotransferase (ALT) is an enzyme found primarily in the liver and to a lesser extent in the kidneys and other organs.It plays a role in converting digested nutrients into energy. It is usually found in liver cells and can be found in very small amounts in the blood due to dead liver cells. An excess of ALT in the blood is a major indicator of liver damage. Liver damage can be caused by many diseases. Other tests should be done after treatment planning and analysis of elevated ALT and other liver enzymes before liver failure develops. The higher the level of the enzyme in the blood, the more the liver is damaged.A slight increase can also occur in conditions such as unbalanced and excessively fatty foods, fatty liver.
When should an ALT test be performed?
ALT testing, along with other liver enzymes, can be tested at regular clinic visits if liver disease is suspected. An ALT test is one of the most important reasons to suspect liver disease or damage in the following situations:
- Swelling and pain in the abdomen and stomach
- Nausea, vomiting
- Fast weight loss
- Constant fatigue
- Unexplained itching of the skin
- Darkening of the color of urine
- Light color of feces
In addition to the reasons stated above, those who continue to drink alcohol should have more frequent ALT tests for liver damage.In addition, people with a family history of liver disease, hepatitis, or drug use that can cause liver damage should be tested regularly for ALT.
ALT above and below the norm
Normal ALT levels should be in the range of 7-35 U / L in healthy women and 10-50 U / L in men. There is no medical significance or danger of getting results below these standards. That is, if your test results are below normal, there is nothing to worry about.However, if the ALT level is higher than normal, it is necessary to find out the cause. The following are the most common conditions that can lead to elevated ALT levels, meaning liver damage:
- Liver obesity
- Constantly used drugs
- Excessive alcohol consumption
- Excess weight
- Diabetes mellitus
- Medicines for cholesterol
- Heart problems
- Hepatitis A, B and C infections
- In addition to the reasons listed above, people with a family history of liver disease are more likely to develop liver disease than others.To do this, these people need to regularly take liver tests.
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Alanine aminotransferase, ALT, ALAT, Transaminase in Moscow inexpensively
Alanine aminotransferase is produced by cells of the human body to catalyze metabolic processes. The largest amount of the enzyme is formed in the liver and is normally almost completely involved in reactions.With various pathologies, the level of ALT in the blood rises. As a result, the study of alanine aminotransferase is used to diagnose acute and chronic diseases: hepatitis, diseases of the cardiovascular system, gastrointestinal tract, skeletal muscles – and to evaluate the effectiveness of the stages of their therapy.
Analysis of the transaminase index and identification of the size of the deviation from normal values is carried out in conjunction with ultrasound data, studies of markers of viral hepatitis, other indicators of biochemistry: total bilirubin, G-GTP, AST, ALP.Indications for testing are symptoms of lesion or situations of increased risk of liver damage, chronic alcoholism, previous contacts with patients with viral hepatitis, hereditary diseases, diabetes.
Determination of alanine aminotransferase
Transferases, which include alanine aminotransferase, or glutamate pyruvate transaminase, are involved in protein-carbohydrate metabolism – in cyclic reactions of conversion of amino acids into keto acids, transamination.The enzyme ALT is highly active in the tissues of the kidneys and liver, comparatively less in the tissues of the spleen, myocardium, lungs, skeletal muscles, and pancreas. An increase in the amount of the enzyme in the bloodstream occurs when the cells of these organs are damaged: nephorones, hepatocytes, cardiomyocytes, myocytes.
Indications for analysis ALAT
Study of the ALT indicator is prescribed in the presence of symptoms of liver dysfunction: loss of appetite, nausea, vomiting, fatigue and weakness, pain in the right hypochondrium, yellowness of the whites of the eyes or skin, staining of feces in a light color, darkening of urine.
Analysis of blood biochemistry for ALT is carried out to confirm the diagnosis of the following liver diseases:
- hepatitis of a viral, autoimmune, toxic nature;
- malignant neoplasms.
Overweight patients taking drugs toxic to the liver, alcohol abuse, diabetes or a history of hereditary liver pathologies are also prescribed blood biochemistry with ALT determination.
In addition, testing of alanine aminotransferase parameters is performed in the following situations:
- diagnostics of pathologies of skeletal muscles, pancreas, kidneys, gall bladder, spleen;
- examination of contacts for viral hepatitis;
- examination of blood donors;
- monitoring of medication intake;
- inflammation, soft tissue damage: trauma, burns;
- in the presence of a shock state.
ALT study is prescribed as part of a comprehensive examination for the detection of viral infections, malignant tumors, diseases: myocardial infarction, pericarditis, myocarditis, hypothyroidism, hemolytic anemia, myopathy
The analysis for the level of alanine aminotransferase is carried out in patients with chronic diseases before starting drug therapy. Further in the course of treatment, testing is carried out in order to control the dynamics, the tolerance of drugs, the state of the liver are checked.
Identification of pathologies and their features by the value of transaminase
To a large extent, the activity of the enzyme increases with medicinal and viral hepatitis. There is a proportional relationship between its amount in the bloodstream and the severity of the disease. For the diagnosis of pathologies, it is important that the ALT level exceeds the norm even before the onset of the jaundice stage. Alanine aminotransferase also increases already in the early stages of infectious and toxic hepatitis and, with favorable development, gradually decreases over several weeks.In case of liver damage due to alcohol exposure, the excess from the reference intervals is not so significant.
Natural causes also affect the amount of transaminase in the blood. The enzyme level increases due to factors affecting the condition of the muscles, such as multiple intramuscular injections, intense exercise. Enzyme production is affected by liver-depressing drugs, dietary supplements, excessive consumption of alcoholic beverages, and food intake containing many food additives.
Causes of deviations in the level of alanine aminotransferase from the norm
A significant increase in the level of alanine aminotransferase can be observed in case of poisoning with potent drugs, lead, carbon tetrachloride, while taking narcotic analgesics, as well as in diseases:
- infectious mononucleosis;
- hepatitis, cirrhosis, cholestasis, liver cancer;
- fatty hepatosis;
- acute myocardial infarction;
- renal, heart failure;
- destructive pancreatitis;
- acute cholecystitis;
- gallstone disease;
- extensive soft tissue lesions.
An increase in the number of ALT in most cases indicates the defeat of hepatocytes and disruption of their normal functioning. Metabolic pathologies cause liver infections, autoimmune processes, neoplasms, diseases that provoke ischemia, circulatory disorders, the use of substances toxic to the liver.
Hepatotoxic drugs: alcohol, food additives, psychotropics, anabolic steroids, COCs, immunosuppressants, antibiotics, anesthetics.
Reasons for a decrease in the level of alanine aminotransferase:
- liver necrosis;
- decompensated cirrhosis;
- vitamin B₆ deficiency in the body.
Extensive liver damage leads to a decrease in the number of hepatocytes and, as a consequence, to a decrease in the level of ALT in the tissues of biological fluids of the body. Vitamin B₆, along with ALAT, is involved in transamination, therefore, for the normal activity of the enzyme, its intake with food should be sufficient.
Treatment of pathologies causing abnormal ALT levels
Deciphering the result of the analysis of biochemistry for ALT is carried out in conjunction with the results of complex biochemistry, data on aspartate aminotransferase.The following specialists are involved in the therapy of diseases that cause an increase or decrease in the level of transaminase in the blood: hepatologists, cardiologists, gastroenterologists, endocrinologists, nephrologists, infectious disease specialists, therapists.
Treatment is aimed at eliminating the causes of pathological processes. Medicines are combined with dietary food. For liver diseases, drugs are prescribed that improve digestion, choleretic, hepatoprotectors. Most of the prescriptions are plant foods rich in vitamins, especially vitamins B and D.The amount of salt and animal fats is limited. It is important to exclude nicotine, alcohol, hepatotoxic substances, the intake of which is not agreed with the doctor.
Symptoms of heart muscle damage associated with an increase in alanine aminotransferase require consultation with a cardiologist. In this case, the doctor additionally prescribes echocardiography, electrocardiography (ECG), blood tests for troponin I, MV-CPK. Clarification of the diagnosis of damage to the musculature of the skeleton is carried out by a rheumatologist. In addition to ALT, the level of the enzyme creatine kinase is studied.
Preparation for analysis
There are no contraindications to the study of ALT, but taking a biomaterial is not recommended without performing a set of preparatory measures. Blood is drawn from a vein in the morning on an empty stomach. The last meal with limited fat and no alcohol should be 8-14 hours before manipulation. During the period of abstinence, it is allowed to drink non-carbonated water. In the hour interval preceding the procedure, smoking, emotional and physical stress are excluded.Data on the intake of medications relevant for testing are reported to the doctor. Biochemistry is not performed after massage, physiotherapy, X-ray and ultrasound studies. It is allowed to take the analysis in the daytime if the previous meal was lightweight.
Donate blood biochemistry for alanine aminotransferase
We invite you to take a biochemical blood test for ALT in one of our medical centers within walking distance from the metro ring stations. Our clinics are equipped with high-tech equipment and professional staff.We offer accurate blood sampling, accurate testing, low prices. Contact us!
GENERAL RULES FOR PREPARATION FOR BLOOD TESTS
Blood is taken from a vein. General recommendations must be followed:
- blood is donated in the morning on an empty stomach or not earlier than 2–4 hours after a meal;
- it is allowed to use water without gas;
- on the eve of the analysis, you should give up alcohol, exclude physical and emotional stress;
- quit smoking 30 minutes before the study;
- it is not necessary to donate blood during the period of taking medication, unless the doctor has prescribed otherwise.
- desire to change the tension force of standard strings when it is impossible to have strings of different types of tension;
- the naive belief of poorly educated Lutiers that by changing the length of the scale it is possible to radically improve the sound of the instrument;
- manufacture of instrument / scale at the customer’s hand, regardless of official standards.
- to abandon unison strings on the viola, changing its tuning from the current LYA-MI-MI (hereinafter, the notes of the scale are indicated from the upper, thinnest string) to the fourth RE-LA-MI like the domra alto; 
- to mercilessly remove a second from the orchestra, which was not particularly needed before, but with the emergence of the fourth alto, combining the RE-LA-LA seconds and the LA-MI-MI viola into one instrument, and even more so;
- as a fourth alto, use modern ones: a second, short-scale alto or even accept (instruments with scales in the range of 450-490 mm), installing smooth (polished) strings on a synthetic base  on them.
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For some reason, no one has to prove that the violin viola is the same full-fledged instrument as the violin – it is a full-fledged member of the classical quartet, concerts and sonatas are written for it, and wonderful musicians, of whom Yuri Bashmet first comes to mind, perform them.And what, tell me, comes to mind when you mention the balalaika alto or second, what and by whom are they glorified? That’s it. For 120 years (!) From the moment they were born, they have not managed to advance in their development by a single millimeter. No one stutters about any solo parts, and even more so about concerts and sonatas for them, unlike, for example, the alto domra, which, having appeared in the orchestra of V.V. Andreev ten years later, the viola balalaika, in recent years more and more successfully breaks through a solo career and is already acquiring its own unique repertoire.The progress of the second and the viola is also not conducive to the fact that they use stiff steel strings with a rather strong tension (50-100% higher than that of a primo), as well as huge, by the standards of other instruments, fluctuations in the scales (see the figure below).
Not only do each of the scales of the orchestral balalaikas “dance” in a huge range, but they also intersect  ! But we are not talking about amateur instruments, but about the most real professional ones.On the one hand, it is funny, on the other, it is a shame for the low level of Russian Lutiers  , who still do not receive special education, and on the third, the picture is too egregious to be explained by such well-known reasons as:
Obviously, the same reasons apply to the domra family, but there the scatter is noticeably smaller, and the scales of neighboring instruments do not intersect. For a long time this mystery haunted me until I found out that there is another reason for the confusion with orchestral balalaikas – a historical one. Finding it helped the articles of the famous Moscow luther Valery Grebennikov on the history of balalaika revival by V.V.Personally, I no longer doubt that the flawed state of the balalaika seconds and viola, leading to their degradation, lies in the history of the appearance of these instruments at the end of the 19th century. And it was like this.
In 1883 (1884), a very young, talented and ambitious Vasily Andreev set himself an ambitious goal – to make a professional musical instrument out of a simple village “strummer” that could take its rightful place not only in Russian, but also in world culture. At that time, he could hardly think about seconds, violas and other instruments of the future orchestra – in order to “bring to mind” one prima, he had to do a lot – to carry out research work and among the numerous instrument variants existing among the people to determine the optimal shape, the number of strings, their structure, scale, make a lot of improvements in the design, abandon traditional knitted frets, start using higher quality materials in production, apply technologies for the manufacture of bowed instruments, guitars and mandolins … Only after a few years of research and work, a new, more perfect instrument, finally, was created, largely thanks to collaboration with the violin luttier V.Ivanov and the owner of the workshop for the production of stringed musical instruments F.S. Passerbsky. The latter, being interested in receiving new orders for the workshop, helped Andreyev in the period from spring 1887 to spring 1888 to develop and manufacture: prima balalaika (Andreyev’s first instrument with 12 metal frets), piccolo, alto, bass (later treble, tenor , and in 1898 a double bass). It is not difficult to guess what the quality of the new products was and the thoughtfulness of their design, tunings and lengths of the scales – it’s surprising how it was possible to make so many different instruments in such a short time, and even have time to master the game on them.But the enthusiasm of Andreev and his fellow followers was so great that a miracle happened, and the early “Circle of fans of playing the balalaikas” not only took place, but even became famous, although, in addition to problems with the quality of instruments, the level of skill of the amateur circles was not high – learning plays went “by hand” and “by ear”.
A completely different, truly professional approach appeared a few years later at a new stage in the development of the circle with the appearance in it, at the invitation of Andreev, of a talented musician, a student of A.K. Lyadov and N.A. Rimsky-Korsakov Nikolai Petrovich Fomin  . The services of this humble man to Russian music are often unfairly attributed to V.V. Andreev himself – it is a shame that his role in the creation of the Great Russian Orchestra is still poorly covered by music historians and is still awaiting serious research.
In his “Life”  Nikolai Petrovich recalls: “In October 1889, V.V. Andreev was talented, sensitively musical, but absolutely musically uneducated, realizing all his inconsistency in the development of his circle, having heard about me as an educated musician and connoisseur of Russian music, he turned to me with a request for cooperation and taking over the musical development and leadership of the circle. “It is Fomin, not Andreev, who step by step transforms the circle of amateurs into a professional orchestra, calculates the scale and scales of the new domra family, and gradually introduces the harp and wind instruments into the orchestra. “In 1896, I finally established the nomenclature of instruments, the role of each instrument in the orchestral performance, the form of writing scores.” How simple, one mean phrase (the genre of autobiography does not allow the author to go into details), behind which undoubtedly months of hard work are hidden.But nevertheless, it is one thing to create a new group of domras, relying on the laws of building a symphony orchestra, and another to try to fit into the orchestra that is being created, an already existing bulky group of balalaikas,  made by talented, but still amateurs, and besides hastily on a wave of enthusiasm without considering many factors. I think Fomin wondered for a long time over how to solve the problems of unnecessary balalaikas in the least painful way, but, as time has shown, even he did not succeed in everything.  He abolished the balalaikas treble, tenor, a little later piccolo,  changed the scale of the alto and added a new instrument – the second. 
Just say – “I changed the tuning of the viola”, but this automatically entailed a change in the scale of the instrument. And if in the orchestra with the help of the ingenious S.I. Nalimov it was relatively easy to make new ones or to rework old violas, then what could be done with hundreds, if not thousands of instruments already released “to the people” by factories and workshops, for example, the same Paserbsky?  Who would have carried them for repairs of their own free will, or, moreover, threw them away and began to buy new ones with corrected scales? They rebuilt it in a new way – the strings did not break, that’s wonderful, we will continue to play.Here it is – the main reason that the balalaikas alto and second, which are already not the most perfect musical instruments, still have an incredible range of scale fluctuations up to crossings. What a pity that Andreev, who possesses many positive qualities, but did not have special knowledge, did not get to know Fomin even before the creation of the “circle”. This would allow avoiding many mistakes and unnecessary costs when solving such a complex and responsible task as designing new musical instruments, and today with scales and tunings, orchestral balalaikas would have the same order as in domras.
The first part of the reform
I propose the following way of correcting the situation to bring the orchestral balalaikas out of age-old stagnation and degradation:
As practice shows, the alto balalaika with soft sensitive strings, not only sounds much better, but also allows you to use all the playing techniques in the right hand as an example, refusing to use the pick. If the proposed reform in the viola arouses interest and support among the musicians, then conditions will arise that allow the instrument to begin to develop normally. And there it will soon come to the balalaika Bashmetov. As a developer of the Sintal® technology, we are ready to send synthetic strings for the fourth alto free of charge to everyone (see the address for applications).in the CONTACTS section).
Second part of the reform
For faint-hearted balalaika players, please do not read!
However, the reform cannot end on the viola, and here’s why. Some readers may have guessed that, if the fourth viola is successful, there will be only one instrument in the RNI orchestra that does not have the RE-LA-MI scale.  This “black sheep” will turn out to be the prima balalaika, as a result of which its transition to a unified orchestra structure will be only a matter of time – most likely more than a decade.To make this transition less painful is the task of the second part of the reform. There will be a lot of work for both musicians and Lutiers, since strings alone cannot be done here. We’ll have to create a new instrument with a shorter scale.  However, this and other technical issues should not cause serious problems (by the way, similar instruments called “quarters” were created at one time, however, without much success, it is possible that due to the use of steel strings), but when mastering a new prima, due to the lack of a teaching methodology on such an instrument, problems will surely arise.Here one can no longer do without the assistance of higher school teachers and balalaika soloists, to whom I and my followers have yet to prove the advantages of the new instrument over the traditional one. I foresee that it will not do without hot battles.
Finishing the article, I would like to touch upon the history of the question of choosing the balalaika tuning. There is no doubt that whichever of the existing in the eighties of the nineteenth century in Russia options for the system Andreev chose, and there were many,  that would become academic.So why, at the dawn of his career, young Vasily Andreev, who dreamed of the idea of reviving the balalaika, stopped at the unison version? Accidentally? Of course not – it was this system, as the easiest to learn, that best contributed to the solution of the task set by Andreev to introduce the instrument to the masses. Let us recall his words, which today many have forgotten or do not want to remember, like much of what this outstanding person spoke about:
“An uncomplicated instrument, a melodious motive and ease of playing, which does not require lengthy and difficult preparation, make it accessible to the masses.In three minutes I can teach to play the balalaika “Barynya”. … I regard the success (balalaikas) in an intelligent society as something transient. The place for the balalaika is not here, but among the people, into which it will be brought in through the soldiers who have served their terms, who now have the correct training to play the balalaika ”. 
“I repeat, there is still a lot of work to be done to raise the musical and cultural level of the people. And the right way for such an increase is to widely attract the masses to active participation in art, through collective music lessons on improved musical instruments that are easily accessible and close in spirit to the people and familiarizing them with a repertoire that is accessible to their understanding. “
However, as we know, the instrument not only did not become widespread, it has long been not even popular, but existing (with rare exceptions) not even in an “intelligent society”, but in a small professional environment. And if we have already come to this historically, then is it not time to put the question this way: what is more important for professionals – in three minutes to learn to play “Lady” or to have an instrument on which you can successfully master a complex, diverse, including symphonic repertoire? If the modern doctrine of instrument development does not differ from the Andreevskaya one and consists in ensuring the mass mastering of the balalaika by the people who do not know any (including musical) reading and writing according to the so-called “digital system”, then everything is correct, unison is only to help.Only the train left long ago – the niche of the folk instrument is already occupied by the guitar, and neither the balalaika nor the domra will be able to win it back, either with or without unison.
A collection of pieces from 1898 for self-study of playing on a digital system for an ensemble consisting of small domra and viola, balalaikas: piccolo, prima, second, alto, bass and contrabass.
If, on the contrary, we want to give the professionals the most perfect instrument possible, then it was necessary to get rid of the unison that was already reducing its small range long ago and move to a more progressive quart system, thus bringing Fomin’s half-hearted reform to its logical end.And one should not be afraid to touch upon the reform I will accept, which, being the main instrument of the family, needs renewal and full-fledged development more than anyone else. In addition, as rightly noted in his article “On some problems of balalaika structure in performing practice”  first-class balalaika soloist Denis Pavlov, as far as I know, was the first to suggest abandoning unison strings for example, the quart tuning “allows you to perform with all the literature for balalaika created to date.The only exceptions are chords (…) using the third open MI string, which (…) are extremely rare ”.
In connection with the above, I think that in a professional environment it is high time to raise the question not about whether or not it is necessary to abandon unison in prima, but which of the variants of the quart system for prima is preferable – LA-MI-SI, proposed by Denis Pavlov, or the “general orchestral” RE-LA-MI, for which I am advocating. 
 The scale of the balalaika second can be either shorter than the prima or longer than the alto!
 I do not like the word “master” that has taken root in Russia, which does not describe the essence of the profession, and often sounds like a mockery.The English word “Luttier” is more suitable for this role, since it is not only accepted all over the world, but also does not carry any ambiguity.
 After the death of VVAndreev in 1918, NPFomin was appointed chief conductor of the Great Russian Orchestra.
 Narodnik. 2004. No. 2.
 By this time there were balalaikas: piccolo, treble, prima, alto, tenor, bass, contrabass (I also came across references to the soprano balalaika). It is obvious (for a professional) that even for an ensemble of amateur musicians, such a number of different types of instruments was too much.
 Proposing a more radical reform, with a change in the prima balalaika structure and a complete rejection of unison strings, Fomin could offend the ambitious Andreev, the founder of the balalaika ensemble.
 In the 1898 edition of “30 Pieces for Ensembles of Amateurs Playing on a Digital System,” the balalaika piccolo is still encountered. Prima and viola, except for the fact that unison strings, which until then only prima had, appeared on two more instruments of the family, so that musicians with skills in playing prima, it would be easier to master the second and the viola.And it is possible that it was easier for Fomin himself to make arrangements, considering these instruments in combination as one instrument of the RE-LA-MI scale, equal to the domra alto. It is possible that both.
 By the time the Great Russian Orchestra appeared in 1896, amateur balalaika ensembles, using instruments of the previous composition and structure, had long been in vogue. Their popularity grew so rapidly that, according to Andreev, in 1898, in the capital alone, over 60 thousand balalaikas and domras were produced annually.
 Thank you for the support of this idea, Professor of the Russian Academy of Music. Gnesins Viktor Semenovich Chunin.
 At the end of March 2010, GOSPODIN MUZYKANT® (www.gmstrings.ru) began work on the creation of synthetic strings for the balalaika alto system RE-LA-MI using the unique Syntal® technology. We bring to your attention a recording made on June 30, 2010 immediately after the manufacture and installation of the strings on the instrument. Playing a student of the Moscow State Institute of Music. A.G.Schnittke Ivan Vinogradov (“artisan” viola born in 1989 with a scale of 485 mm.)
 Today the Fomin RE-LA-MI quart tuning has the following orchestra instruments: small domra, alto, bass, double bass, balalaika bass and double bass.
 As shown by mathematical calculations, “quart prima” should have a scale in the region of 350-370 mm.
 According to V. Galakhov’s researches, there were the following scales of folklore balalaika: quart with unison, second and third, third minor, third major, third and fourth, quarter and third, sixth and second.
 VV Andreev’s interview to the correspondent of “Petersburg newspaper” (1898)
 Narodnik. 2005. No. 4 (52).
 In my opinion, the RE-LA-MI tuning has more advantages from orchestral considerations. At the end of November 2010, the first copy of such an instrument was born, which is waiting for its future enthusiast owner.
On November 27, 2010, an unusual instrument was tested at the firm – the prima balalaika in the RE-LA-MI system. The tool is designed and manufactured by Lutier Alexander Spustnikov, has a scale of 350 mm.The strings were calculated and made personally by the head of the company GOD MUSICANT® Dmitry Babichenko. The tests of the instrument and strings were carried out by the soloist of the Orchestra named after I. Osipova Dmitry Bazanov, who positively assessed the result of the work, albeit with minor remarks, which were accepted for correction.
Drug, remedy, medication
Oral tablet, 80 mg, once a day, 8 weeks
Arm Group label:
Febuxostat (trade name Uloric®)
Trade name Uloric®
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