5’-Nucleotidase is an enzyme specific to the liver. The 5’-nucleotidase level is elevated in patients with liver diseases, especially those associated with cholestasis. It provides information similar to Alkaline Phosphatase (ALP). However, ALP is not specific to the liver.


Diseases of the bone, sepsis, pregnancy, and other disease can produce ALP elevation. When there is doubt regarding the cause of an elevated ALP, a 5’-nucleotidase test is recommended. If that enzyme is elevated along with the ALP, the pathologic source is certainly the liver. If the 5’-nucleotidase is normal in the face of an elevated ALP, the pathologic source is outside the liver (bone, kidney, spleen). Gamma-glutamyl transpeptidase (GGT) is used similarly, as it is also specific to the liver.


5’-Nucleotidase test is used to support the diagnosis of hepatobiliary obstructive disease. It is especially useful in helping confirm that an elevated alkaline phosphatase (ALP) is the result of liver pathology rather than pathology of another tissue origin.




Normal 5’-Nucleotidase Levels

0.0-1.6 units at 37° C (98.6° F).




Causes of High 5’-Nucleotidase Levels

The 5’-nucleotidase test is most specific for pathologic conditions that cause intrahepatic or extrahepatic biliary obstruction which occur as a result of Bile Duct Obstruction or Cholestasis.  To a lesser degree, Hepatocellular disease is associated with elevations of this enzyme. Slightly elevated 5’-nucleotidase can be a result of:

  • Hepatitis.
  • Cirrhosis.
  • Hepatic Necrosis.
  • Hepatic Ischemia.
  • Hepatic Tumor.
  • Hepatotoxic Agents.