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Advanced - Kidney Profile
Kidney
10 parameters
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Fasting Required
Details
Comprehensive renal function panel.
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Parameters
- List of Tests
- BUN
- Calcium
- Creatinine
- Uric Acid
- eGFR
- Na
- K
- Cl
- BUN/Creatinine
- Urea
Advanced - Kidney Profile
- Why is it done?
- Comprehensive assessment of kidney function and health status through measurement of waste product clearance, electrolyte balance, and mineral metabolism
- Detection and monitoring of chronic kidney disease (CKD) at various stages through creatinine, BUN, and estimated glomerular filtration rate (eGFR)
- Evaluation of patients with diabetes, hypertension, or family history of kidney disease for early detection of renal impairment
- Assessment of electrolyte imbalances (sodium, potassium, chloride) that affect kidney function and cardiovascular health
- Diagnosis and monitoring of kidney stones through uric acid assessment and calcium-phosphate metabolism evaluation
- Pre-operative baseline assessment and medication safety evaluation before prescribing renally-cleared drugs
- Monitoring patients on ACE inhibitors, ARBs, diuretics, or NSAIDs for kidney function safety
- Evaluation of acute kidney injury (AKI) and differentiation from chronic kidney disease using BUN/creatinine ratio
- Assessment of mineral bone disorder risk through calcium and electrolyte measurement in chronic kidney disease patients
- Normal Range
- BUN (Blood Urea Nitrogen): 7-20 mg/dL or 2.5-7.1 mmol/L - Represents nitrogen in urea and indicates protein metabolism and kidney function
- Calcium: 8.5-10.5 mg/dL or 2.1-2.6 mmol/L - Normal range supports bone health and kidney mineral metabolism
- Creatinine: 0.7-1.3 mg/dL (males) or 0.6-1.1 mg/dL (females) or 60-110 µmol/L - Primary indicator of glomerular filtration rate
- Uric Acid: 3.5-7.2 mg/dL (males) or 2.6-6.0 mg/dL (females) or 210-430 µmol/L (males) or 155-357 µmol/L (females) - Normal levels indicate appropriate purine metabolism
- eGFR (Estimated Glomerular Filtration Rate): >60 mL/min/1.73m² - Indicates normal kidney function; values 60-89 suggest mild decline
- Na (Sodium): 136-145 mEq/L or 136-145 mmol/L - Maintains osmotic balance and kidney's ability to concentrate urine
- K (Potassium): 3.5-5.0 mEq/L or 3.5-5.0 mmol/L - Critical for kidney regulation and cardiac function
- Cl (Chloride): 98-107 mEq/L or 98-107 mmol/L - Works with sodium to maintain electrolyte and acid-base balance
- BUN/Creatinine Ratio: 10:1 to 20:1 (typically 10-20) - Helps differentiate between acute and chronic kidney disease
- Urea: 2.5-7.1 mmol/L or 7-20 mg/dL - Reflects nitrogen excretion and overall kidney clearance function
- Interpretation
- BUN - Elevated levels indicate reduced kidney filtration, dehydration, high protein diet, or urinary tract obstruction; low levels suggest malnutrition, liver disease, or overhydration
- Calcium - High levels (hypercalcemia) may indicate hyperparathyroidism, kidney disease, or kidney stones; low levels (hypocalcemia) suggest kidney disease, vitamin D deficiency, or hypoparathyroidism
- Creatinine - Elevated levels directly indicate reduced glomerular filtration rate and kidney dysfunction; minimal elevation requires monitoring; severely elevated suggests acute or chronic kidney disease requiring intervention
- Uric Acid - Elevated levels indicate gout risk, kidney stone formation, tumor lysis syndrome, or inadequate kidney excretion; low levels suggest rare xanthine oxidase deficiency or excessive uricosuric medication
- eGFR - Stage 1 (>90): Normal kidney function; Stage 2 (60-89): Mild loss; Stage 3a (45-59): Mild to moderate loss; Stage 3b (30-44): Moderate to severe loss; Stage 4 (15-29): Severe loss; Stage 5 (<15): Kidney failure requiring dialysis
- Na - Hyponatremia (<136) causes confusion, seizures, and can indicate kidney dysfunction or SIADH; hypernatremia (>145) suggests dehydration or kidney's inability to conserve water
- K - Hyperkalemia (>5.0) is dangerous in kidney disease causing cardiac arrhythmias; hypokalemia (<3.5) indicates excessive loss through kidney or GI tract requiring supplementation
- Cl - Hypochloremia (<98) often accompanies hyponatremia in kidney disease; hyperchloremia (>107) suggests dehydration or metabolic acidosis with kidney involvement
- BUN/Creatinine Ratio - Ratio >20 suggests prerenal azotemia, dehydration, or GI bleeding; ratio <10 indicates acute tubular necrosis or chronic kidney disease; normal 10-20 ratio with elevated both values indicates kidney disease
- Urea - Elevated levels parallel creatinine elevation indicating kidney dysfunction; provides similar information as BUN but measured in different units (mmol/L vs mg/dL)
- Associated Organs
- BUN and Urea - Primary kidney function markers reflecting glomerular filtration; abnormalities indicate acute or chronic kidney disease, kidney failure, or systemic conditions affecting kidney perfusion
- Creatinine and eGFR - Gold standard kidney function tests indicating glomerular filtration capacity; declining trends signal progressive CKD requiring intervention; used to adjust medication dosing in renal impairment
- Calcium - Kidney involvement in calcium homeostasis through vitamin D activation and phosphate regulation; abnormalities in CKD lead to secondary hyperparathyroidism and mineral bone disease
- Uric Acid - Kidney responsible for 60-90% of uric acid excretion; elevated levels in kidney disease increase gout and kidney stone risk; progression marker in CKD patients
- Na, K, Cl - Kidney tubules regulate electrolyte reabsorption and excretion; abnormalities indicate tubular dysfunction, acute kidney injury, or chronic kidney disease affecting renal tubular function
- BUN/Creatinine Ratio - Helps differentiate acute from chronic kidney problems; high ratios with normal creatinine suggest dehydration affecting kidney perfusion rather than intrinsic kidney disease
- Cardiac complications - Electrolyte abnormalities (K, Na) in kidney disease directly increase arrhythmia risk; chronic kidney disease increases cardiovascular disease risk through multiple mechanisms
- Bone health - Calcium and phosphate regulation through kidneys critical for bone strength; CKD leads to secondary hyperparathyroidism, bone loss, and increased fracture risk
- Liver interaction - Liver processes ammonia from urea metabolism; elevated kidney dysfunction can affect ammonia clearance leading to hepatic encephalopathy in advanced disease
- Follow-up Tests
- For elevated Creatinine/BUN/Urea - Urinalysis and urine microalbumin to assess proteinuria; repeat kidney function tests at 1-3 month intervals for trending progression
- For abnormal eGFR - Renal ultrasound to assess kidney size and structure; referral to nephrology if eGFR <30 mL/min/1.73m² for CKD staging and management planning
- For abnormal Calcium - Phosphorus, PTH (parathyroid hormone), and vitamin D (25-hydroxyvitamin D) testing to evaluate mineral metabolism and secondary hyperparathyroidism
- For elevated Uric Acid - Urine uric acid measurement; consider 24-hour urine collection if hyperuricemia suspected; imaging studies (ultrasound or CT) if kidney stones suspected
- For abnormal Electrolytes (Na, K, Cl) - Arterial or venous blood gas to assess acid-base status; repeat electrolytes in 1-2 weeks to monitor trend and medication response
- For elevated BUN/Creatinine Ratio >20 - Assess volume status clinically; consider imaging if obstruction suspected; renal perfusion assessment if prerenal azotemia considered
- For CKD confirmation - Complete metabolic panel, complete blood count to assess for anemia; lipid panel; blood pressure monitoring; diabetes screening if not known
- Routine monitoring frequency - Stage 1-2 CKD: annually; Stage 3a: every 6 months; Stage 3b: every 3 months; Stage 4-5: monthly or as clinically indicated
- Complementary tests - Renal biopsy if nephrotic syndrome suspected or diagnosis unclear; immunology panel if autoimmune kidney disease considered; blood cultures if infected kidney stone suspected
- Fasting Required?
- Fasting Status: No - The Advanced Kidney Profile does not require fasting; blood can be drawn at any time of day regardless of food intake
- Hydration: Maintain normal hydration status on the day of testing; avoid excessive fluid intake or dehydration as both can affect electrolyte levels and creatinine interpretation
- Medication timing: Do not withhold regular medications unless specifically instructed by physician; continue ACE inhibitors, ARBs, diuretics, and NSAIDs as baseline kidney function values are needed on current medications
- Muscle activity: Avoid strenuous exercise 24 hours before testing as intense activity elevates creatinine and alters electrolytes; light activity is acceptable
- Dietary considerations: Avoid high protein meals immediately before testing if possible; limit dietary purines (red meat, organ meats, seafood) for 24 hours before collection for accurate uric acid results
- Caffeine and tobacco: Avoid excessive caffeine intake and smoking before testing; these may temporarily affect electrolyte levels and kidney perfusion
- Timing consistency: If repeat testing for comparison, try to collect specimens at similar times of day and in similar clinical conditions for accurate trend analysis
- Medications to report: Inform laboratory of any NSAIDs, ACE inhibitors, ARBs, diuretics, supplements, or herbal products as these can affect results; temporary discontinuation may be needed for specific circumstances
- General preparation: Arrive 10-15 minutes early; ensure proper patient identification; inform phlebotomist of any special considerations or previous difficult draws
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