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Basic - Kidney Profile
Kidney
7 parameters
Report in 4Hrs
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No Fasting Required
Details
Serum urea, creatinine, electrolytes.
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Parameters
- List of Tests
- BUN
- Calcium
- Creatinine
- Uric Acid
- eGFR
- BUN/Creatinine
- Urea
Basic - Kidney Profile
- Why is it done?
- Comprehensive assessment of kidney function and metabolic waste filtration by measuring blood levels of nitrogen-containing compounds, electrolytes, and glomerular filtration markers
- BUN (Blood Urea Nitrogen) and Urea - measure the concentration of urea, a byproduct of protein metabolism that should be filtered by the kidneys and excreted in urine
- Creatinine - evaluates kidney filtration efficiency as creatinine is produced at a constant rate from muscle metabolism and is freely filtered by the glomerulus
- BUN/Creatinine Ratio - assesses the relationship between these two markers to differentiate between pre-renal, intrinsic renal, and post-renal causes of kidney dysfunction
- eGFR (Estimated Glomerular Filtration Rate) - calculates the kidney's ability to filter waste, providing the most reliable estimate of kidney function
- Calcium - evaluates mineral metabolism and bone health as kidney function affects calcium and phosphorus regulation
- Uric Acid - assesses purine metabolism and screens for hyperuricemia, as kidneys regulate uric acid excretion
- Diagnosis of acute and chronic kidney disease at various stages
- Monitoring of patients with hypertension, diabetes mellitus, or heart disease who are at risk for kidney dysfunction
- Screening before starting nephrotoxic medications or contrast dye procedures
- Detection of gout risk and monitoring of patients with history of kidney stones
- Assessment of electrolyte balance and bone metabolism abnormalities associated with renal disease
- Evaluation of dehydration, uremia, and acute illness presenting with kidney-related symptoms
- Normal Range
- BUN (Blood Urea Nitrogen): 7-20 mg/dL (2.5-7.1 mmol/L) - represents nitrogen portion of urea compound
- Urea: 15-45 mg/dL (2.5-7.5 mmol/L) - complete urea measurement; normal indicates adequate kidney filtration of nitrogen waste
- Creatinine: 0.7-1.3 mg/dL for males (62-115 μmol/L); 0.6-1.1 mg/dL for females (53-97 μmol/L) - normal range varies with age and muscle mass
- BUN/Creatinine Ratio: 10:1 to 20:1 - ratio of 10-20 indicates normal kidney function
- eGFR (Estimated Glomerular Filtration Rate): ≥60 mL/min/1.73m² - indicates normal kidney function; calculated using creatinine, age, gender, and race
- Calcium (Total): 8.5-10.5 mg/dL (2.1-2.6 mmol/L) - optimal range for bone health and neuromuscular function
- Calcium (Ionized): 4.5-5.3 mg/dL (1.1-1.3 mmol/L) - physiologically active form of calcium
- Uric Acid: 3.5-7.2 mg/dL for males (208-428 μmol/L); 2.6-6.0 mg/dL for females (155-357 μmol/L) - varies by gender due to hormonal effects
- Interpretation
- BUN Elevation (>20 mg/dL): May indicate kidney disease, dehydration, high protein diet, urinary obstruction, heart failure, or catabolic states; decreased values (<7 mg/dL) suggest liver disease, malnutrition, or overhydration
- Urea Interpretation parallels BUN since BUN represents 46.7% of urea molecule; elevated urea (>45 mg/dL) confirms impaired renal clearance; low urea (<15 mg/dL) suggests reduced nitrogen waste production
- Creatinine Elevation (>1.3 mg/dL males; >1.1 mg/dL females): Indicates reduced glomerular filtration rate and kidney dysfunction; even mild elevations suggest potential kidney disease; must consider muscle mass and age; decreased creatinine (<0.6 mg/dL) may indicate muscle wasting or liver disease
- BUN/Creatinine Ratio >20:1: Suggests pre-renal azotemia (dehydration, shock, reduced renal perfusion) or conditions causing increased BUN reabsorption; Ratio <10:1 (lower ratios) may indicate intrinsic renal disease or post-renal obstruction; interpretation requires clinical context
- eGFR 60-89 mL/min/1.73m²: Stage 2 CKD - mild decrease in kidney function with low risk of complications but requires monitoring; eGFR 45-59: Stage 3a CKD - mild to moderate decrease; 30-44: Stage 3b CKD - moderate to severe decrease; 15-29: Stage 4 CKD - severe decrease; <15: Stage 5 CKD - kidney failure requiring dialysis or transplant
- Calcium Elevation (>10.5 mg/dL): Hypercalcemia may indicate primary hyperparathyroidism, vitamin D excess, malignancy, or granulomatous diseases; can cause kidney stones and organ damage; Calcium Decrease (<8.5 mg/dL): Hypocalcemia suggests secondary hyperparathyroidism from chronic kidney disease, vitamin D deficiency, or hypoalbuminemia; causes muscle cramps and cardiac arrhythmias
- Uric Acid Elevation (>7.2 mg/dL males; >6.0 mg/dL females): Hyperuricemia indicates impaired kidney excretion, increased purine metabolism, or uric acid overproduction; risk factor for gout, kidney stones, and chronic kidney disease; may indicate metabolic syndrome
- Uric Acid Decrease (<2.6 mg/dL females; <3.5 mg/dL males): May indicate xanthine oxidase deficiency, uricosuric drugs, or severe liver disease; rarely clinically significant
- Pattern Recognition: Elevated BUN/creatinine with elevated calcium and uric acid suggests chronic kidney disease with mineral metabolism derangement; elevated creatinine with normal BUN/creatinine ratio and high eGFR may indicate acute kidney injury or pre-analytical error
- Factors affecting interpretation: Age (eGFR adjusted), gender (uric acid and creatinine vary), muscle mass (affects creatinine), medications (NSAIDs, diuretics, ACE inhibitors), dehydration status, recent contrast administration, and dietary factors (protein intake, purines)
- Associated Organs
- Kidneys (Primary): All tests measure kidney function; glomerular filtration of waste products (BUN, creatinine, uric acid); tubular reabsorption and secretion; electrolyte and mineral regulation (calcium); diagnosis of acute kidney injury (AKI), chronic kidney disease (CKD), glomerulonephritis, pyelonephritis, and nephrotic/nephritic syndromes
- Liver: Urea synthesis occurs in hepatocytes; liver disease impairs BUN/urea production causing decreased levels; elevated ammonia bypasses liver conversion to urea; severe hepatic disease presents with low BUN despite possible kidney disease
- Heart: Impaired cardiac function reduces renal perfusion leading to pre-renal azotemia with elevated BUN/creatinine ratio; congestive heart failure is major cause of elevated BUN; hypertension damages kidney vasculature causing proteinuria and progressive renal dysfunction
- Pancreas: Diabetes mellitus causes diabetic nephropathy with progressive kidney disease and elevated creatinine; diabetic patients require regular kidney function monitoring
- Parathyroid Glands: Regulate calcium and phosphorus homeostasis; kidney dysfunction impairs vitamin D conversion causing secondary hyperparathyroidism with abnormal calcium levels; long-term kidney disease causes tertiary hyperparathyroidism with hypercalcemia
- Bones: Kidney dysfunction impairs calcium and phosphorus balance; hyperparathyroidism causes renal osteodystrophy with bone loss and increased fracture risk; hypercalcemia risk increases with CKD progression
- Muscles: Provide creatinine production from muscle creatine phosphate breakdown; muscle wasting in chronic illness decreases creatinine artificially lowering it; uremia from kidney disease causes muscle pain and weakness; hyperuricemia causes gout affecting joints and muscles
- Urinary Tract: Obstruction (stones, tumors, strictures) causes post-renal azotemia with elevated BUN/creatinine ratio; kidney stones associated with hyperuricemia and hypercalcemia; chronic reflux and infection damage kidney tissue
- Brain: Uremia from kidney failure causes confusion, lethargy, and cognitive impairment; hypercalcemia and abnormal electrolytes cause neurological symptoms; altered calcium-phosphorus metabolism affects neuromuscular transmission
- Vascular System: Chronic kidney disease accelerates atherosclerosis and vascular calcification; hypertension from kidney disease damages vessels; abnormal calcium-phosphorus metabolism promotes vascular calcification
- Follow-up Tests
- Elevated BUN/Urea: Urinalysis with microscopy to assess for proteinuria, hematuria, casts, and specific gravity; 24-hour urine protein quantification for nephrotic syndrome evaluation; cystatin C level as alternative kidney function marker independent of muscle mass
- Elevated Creatinine: Renal ultrasound to assess kidney size, echogenicity, and exclude obstruction; renal biopsy if glomerulonephritis suspected; DEXA scan for bone density assessment due to secondary hyperparathyroidism risk
- Abnormal BUN/Creatinine Ratio: Pre-renal pattern (>20:1) requires fluid challenge, blood pressure assessment, and cardiac evaluation; intrinsic renal pattern requires further workup for nephritis or injury; post-renal pattern requires imaging to exclude obstruction (CT scan or renal ultrasound)
- Low eGFR (<60): Comprehensive metabolic panel including phosphorus, albumin, and potassium; hemoglobin A1c if diabetes suspected; lipid panel for cardiovascular risk assessment; PTH level to assess secondary hyperparathyroidism
- Abnormal Calcium: Albumin level to correct total calcium for hypoalbuminemia; ionized calcium if total calcium abnormal; phosphorus level; alkaline phosphatase; PTH level; vitamin D (25-OH vitamin D) level
- Elevated Uric Acid: 24-hour urine uric acid to assess excretion vs overproduction; serum phosphorus; LDH level to assess for cell breakdown; urine pH; imaging if history of kidney stones (non-contrast CT or renal ultrasound)
- Monitoring frequency for CKD: Stage 1-2 (eGFR ≥60): Annual monitoring; Stage 3a (eGFR 45-59): Every 6 months; Stage 3b (eGFR 30-44): Every 3-4 months; Stage 4 (eGFR 15-29): Monthly or more frequent; Stage 5 (eGFR <15): As clinically indicated, typically monthly or with dialysis initiation
- Kidney disease screening tests: Tissue typing (HLA) if renal transplant candidate; ferritin level in dialysis patients; parathyroid scan if tertiary hyperparathyroidism suspected
- Immunological workup if indicated: Antinuclear antibody (ANA), anti-GBM antibodies, ANCA (c-ANCA, p-ANCA), complement levels (C3, C4) for suspected glomerulonephritis
- Vascular assessment: Carotid ultrasound to evaluate atherosclerosis burden; coronary risk stratification given high cardiovascular risk in CKD; blood pressure monitoring and documentation
- Fasting Required?
- Fasting: Not Required - The Basic Kidney Profile tests do not require fasting as none of these measurements are significantly affected by recent food or beverage intake
- BUN and Creatinine: Not affected by fasting status; however, extreme dehydration should be avoided as it can artificially elevate these values through hemoconcentration
- Calcium: Fasting not required; not significantly affected by food intake
- Uric Acid: Fasting not required; however, recent purine-rich meals (red meat, organ meats, shellfish) or high-fructose beverages may transiently elevate uric acid levels
- eGFR: Not affected by fasting; calculation based on creatinine and demographic data
- BUN/Creatinine Ratio: Not affected by fasting; ratio automatically calculated from individual values
- Medications: Most medications do not require discontinuation before kidney profile testing; however, inform laboratory and physician of all current medications as some may affect results (diuretics, NSAIDs, ACE inhibitors, statins)
- Preparation requirements: Draw blood in morning if possible as there is a slight diurnal variation in some values; ensure adequate hydration 24 hours before test to avoid false elevation from dehydration
- Dietary considerations: Avoid excessive protein intake 24 hours before testing if BUN elevation is being investigated; avoid high-purine foods 24 hours before if evaluating for gout; avoid large quantities of high-calcium supplements immediately before testing
- Physical activity: Strenuous exercise 24 hours before testing can cause transient creatinine elevation from muscle breakdown; continue normal daily activities
- Specimen collection: Blood is drawn via venipuncture into appropriate collection tube (typically gel separator tube or SST); standard precautions apply; results typically available within 24 hours
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