Test Id : RFAMA

Patient's age and sex are required.

Collection Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 0.6 mL

Collection Instructions:

1. Serum gel tubes should be centrifuged within 2 hours of collection.

2. Red-top tubes should be centrifuged and the serum aliquoted into a plastic vial within 2 hours of collection.

If not ordering electronically, complete, print, and send a Renal Diagnostics Test Request (T830) with the specimen.

0.5 mL

Aiding in diagnosis and management of conditions affecting kidney function

General health screening

Screening patients at risk of developing kidney disease

Management of patients with known kidney disease

This panel could be ordered when a patient has risk factors for kidney dysfunction such as high blood pressure (hypertension), diabetes, cardiovascular disease, obesity, elevated cholesterol, or a family history of kidney disease. This panel may also be ordered when someone has signs and symptoms of kidney disease, though early kidney disease often does not cause any noticeable symptoms. It may be initially detected through routine blood or urine testing.

SODIUM

<1 year: Not established

> or =1 year: 135-145 mmol/L

POTASSIUM

<1 year: Not established

> or =1 year: 3.6-5.2 mmol/L

CHLORIDE

<1 year: Not established

1-17 years: 102-112 mmol/L

> or =18 years: 98-107 mmol/L

BICARBONATE

Males

<1 year: Not established

1-2 years: 17-25 mmol/L

3 years: 18-26 mmol/L

4-5 years: 19-27 mmol/L

6-7 years: 20-28 mmol/L

8-17 years: 21-29 mmol/L

> or =18 years: 22-29 mmol/L

Females

<1 year: Not established

1-3 years: 18-25 mmol/L

4-5 years: 19-26 mmol/L

6-7 years: 20-27 mmol/L

8-9 years: 21-28 mmol/L

> or =10 years: 22-29 mmol/L

ANION GAP

<7 years: Not established

> or =7 years: 7-15

BLOOD UREA NITROGEN (BUN)

Males

<12 months: Not established

1-17 years: 7-20 mg/dL

> or =18 years: 8-24 mg/dL

Females

<12 months: Not established

1-17 years: 7-20 mg/dL

> or =18 years: 6-21 mg/dL

CREATININE

Males

0-11 months: 0.17-0.42 mg/dL

1-5 years: 0.19-0.49 mg/dL

6-10 years: 0.26-0.61 mg/dL

11-14 years: 0.35-0.86 mg/dL

> or =15 years: 0.74-1.35 mg/dL

Females

0-11 months: 0.17-0.42 mg/dL

1-5 years: 0.19-0.49 mg/dL

6-10 years: 0.26-0.61 mg/dL

11-15 years: 0.35-0.86 mg/dL

> or =16 years: 0.59-1.04 mg/dL

ESTIMATED GLOMERULAR FILTRATION RATE (eGFR)

>= 18 years old: > or =60 mL/min/BSA (body surface area)

Estimated GFR calculated using the 2021 CKD-EPI creatinine equation.

Note: eGFR results will not be calculated for patients younger than 18 years old.

CALCIUM

<1 year: 8.7-11.0 mg/dL

1-17 years: 9.3-10.6 mg/dL

18-59 years: 8.6-10.0 mg/dL

60-90 years: 8.8-10.2 mg/dL

>90 years: 8.2-9.6 mg/dL

GLUCOSE

0-11 months: Not established

> or =1 year: 70-140 mg/dL

Total Protein

> or =1 year: 6.3-7.9 g/dL

Reference values have not been established for patients who are younger than 12 months of age.

ALBUMIN

> or =12 months: 3.5-5.0 g/dL

Reference values have not been established for patients who are younger than 12 months of age.

PHOSPHORUS

Males

1-4 years: 4.3-5.4 mg/dL

5-13 years: 3.7-5.4 mg/dL

14-15 years: 3.5-5.3 mg/dL

16-17 years: 3.1-4.7 mg/dL

> or =18 years: 2.5-4.5 mg/dL

Reference values have not been established for patients that are younger than 12 months of age.

Females

1-7 years: 4.3-5.4 mg/dL

8-13 years: 4.0-5.2 mg/dL

14-15 years: 3.5-4.9 mg/dL

16-17 years: 3.1-4.7 mg/dL

> or =18 years: 2.5-4.5 mg/dL

Reference values have not been established for patients that are younger than 12 months of age.

Panel results are not diagnostic but rather indicate that there may be a problem with the kidneys and that further testing is required to make a diagnosis and determine the cause. Results of the panel are usually considered together, rather than separately. Individual test results can be abnormal due to causes other than kidney disease but taken together with risks and signs and symptoms, they may give an indication of whether kidney disease is present.

No significant cautionary statements.

1. Oh MS: Evaluation of renal function, water, electrolytes, and acid-base balance. In: McPherson RA, Pincus MR, eds.  Henry's Clinical Diagnosis and Management by Laboratory Methods. 22nd ed. Elsevier Saunders; 2011:chap 14

2. Renal Panel. Testing.com; Updated November 9, 2021. Accessed July 14, 2022. Available at www.testing.com/tests/renal-panel/

Potassium, Sodium, Chloride:

Ion-selective electrode (ISE) (indirect potentiometry). The ion selective electron (ISE) module indirectly measures the electromotive force (EMF) difference between an ISE and a reference electrode. The EMF of the ISE is dependent on the ion concentration of the sample. The EMF of the reference electrode is constant. An electronic calculation circuit converts EMF of the sample to the ion concentration of the sample.(Package insert: ISE Indirect Na, K, CL for Gen2. Roche Diagnostics; 12/2020)

Bicarbonate:

This is a photometric rate reaction. Bicarbonate (HCO3-) reacts with phosphoenolpyruvate in the presence of phosphoenolpyruvate carboxylase to produce oxaloacetate and phosphate. The oxaloacetate produced is coupled with nicotinamide adenine dinucleotide (NADH) in the presence of malate dehydrogenase to produce malate and NAD+. The consumption of NADH causes a decrease in absorbance and is monitored in the UV range of 320 nm to 400 nm. The rate of change is directly proportional to the concentration of bicarbonate.(Package insert: Bicarbonate reagent. Roche Diagnostics; 04/2019)

Anion Gap:

This is a calculated result. The following equation is used to calculate the anion gap (A gap):

A gap = Na - (Cl + HCO3-)

Blood Urea Nitrogen (BUN):

This is a kinetic UV assay where urease cleaves urea to form ammonia and carbon dioxide. The ammonia formed then reacts with alpha-ketoglutarate and NADH in the presence of urease/glutamate dehydrogenase to yield glutamate and NAD+. The decrease in absorbance, due to the consumption of NADH, is measured kinetically and is proportional to the amount of urea in the sample.(Package insert: Urea/BUN reagent. Roche Diagnostics; 12/2019)

Creatinine:

This enzymatic method is based on the conversion of creatinine with the aid of creatininase, creatinase, and sarcosine oxidase to glycine, formaldehyde, and hydrogen peroxide. Catalyzed by peroxidase, the liberated hydrogen peroxide reacts with 4-aminophenazone and HTIB (hydroxy[tosyloxy]iodobenzene) to form a quinone imine chromogen. The color intensity of the quinone imine chromogen formed is directly proportional to the creatinine concentration in the reaction mixture.(Package insert: Creatinine. Roche Diagnostics; 02/2019)

Estimated Glomerular Filtration Rate:

Estimated GFR (eGFR) is calculated using the 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation:

Females:

If creatinine < or =0.7 mg/dL: 142 x (Scr/0.7)(-0.241) x 0.9938age x 1.012

If creatinine >0.7 mg/dL: 142 x (Scr/0.7)(-1.200) x 0.9938age x 1.012

Males:

If creatinine < or =0.9 mg/dL: 142 x (Scr/0.9)(-0.302) x 0.9938age

If creatinine >0.9 mg/dL: 142 x (Scr/0.9)(-1.200) x 0.9938age

Values are reported for calculated glomerular filtration rate (GFR) estimates between 15-90 mL/min/1.73 m(4). Estimated GFR values outside of this range are reported as "<15 mL/min/1.73 m(2)" or ">90 mL/min/1.73 m(4)" and not as an exact number.

Calcium:

Calcium ions react with NM-BAPTA (5-nitro-5'-methyl-1,2-bis(o-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid)under alkaline conditions to form a complex. This complex reacts in the second step with EDTA. The change in absorbance is directly proportional to the calcium concentration and is measured photometrically.(Package insert: Calcium Gen.2 reagent. Roche Diagnostics; 07/2019)

Glucose:

Glucose in the serum, in the presence of hexokinase, is converted to glucose-6-phosphate (G6P). In the presence of nicotinamide adenine dinucleotide phosphate (NADP+), glucose-6-phosphate dehydrogenase oxidizes G6P to gluconate-6-phosphate and NADPH. The rate of NADPH formation is directly proportional to glucose concentration in the serum and is measured photometrically.(Package insert: Glucose HK Gen.3 Reagent. Roche Diagnostics; 11/2021)

Albumin:

The dye, bromcresol green (BCG), is added to serum in an acid buffer. The color intensity of the blue-green albumin-BCG complex is directly proportional to the albumin concentration and is determined photometrically.(Package insert: Albumin Gen.2 reagent. Roche Diagnostics; 02/2022)

Phosphorus (Inorganic):

Inorganic phosphate forms an ammonium phosphomolybdate complex with ammonium molybdate in the presence of sulfuric acid. The concentration of phosphomolybdate formed is directly proportional to the inorganic phosphate concentration and is measures photometrically.(Package insert: Phosphate (Inorganic) ver 2. Roche Diagnostics; V11.0, 07/2019)

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This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

KS: 84132

NAS: 84295

CL: 82435

HCO3: 82374

BUN: 84520

CRTS1: 82565

CA: 82310

GLURA: 82947

ALB: 82040

PHOS: 84100