Differentiation of acute uric acid nephropathy from other causes of acute kidney failure
For patients who cannot collect a 24-hour specimen, typically small children, a uric acid to creatinine ratio can be used to approximate 24-hour excretion
Test Id | Reporting Name | Available Separately | Always Performed |
---|---|---|---|
RTIO1 | Uric Acid/Creat Ratio, Random, U | No | Yes |
URCO3 | Uric Acid, Random, U | No | Yes |
CRETR | Creatinine, Random, U | No | Yes |
URCO3: Uricase
CRETR: Enzymatic Colorimetric Assay
RTIO1: Calculation
Uric Acid, Random, U
Urine
X-ray dyes and contrast media will affect test results.
-If a kidney X-ray with dye or computerized tomography (CT) scan with contrast has been performed, patient should wait a minimum of 1 day before starting collection.
-If a cholangiography (bile duct X-ray) has performed, patient should wait 7 days before starting collection.
-Urine must be collected before tablets have been taken for gallbladder X-ray, otherwise patient should wait 7 days before starting collection.
Supplies: Sarstedt Aliquot Tube 5 mL (T914)
Collection Container/Tube: Plastic urine container
Submission Container/Tube: Plastic, 5-mL tube or a clean, plastic aliquot container with no metal cap or glued insert
Specimen Volume: 4 mL
Collection Instructions:
1. Collect a random urine specimen.
2. No preservative.
If not ordering electronically, complete, print, and send a Renal Diagnostics Test Request (T830) with the specimen.
1 mL
All specimens will be evaluated at Mayo Clinic Laboratories for test suitability. |
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Urine | Refrigerated (preferred) | 14 days | |
Frozen | 30 days | ||
Ambient | 7 days |
Differentiation of acute uric acid nephropathy from other causes of acute kidney failure
For patients who cannot collect a 24-hour specimen, typically small children, a uric acid to creatinine ratio can be used to approximate 24-hour excretion
Uric acid is the end-product of purine metabolism. It is freely filtered by the glomeruli and most is reabsorbed by the tubules. There is also active tubular secretion.
Increased levels of uric acid in the urine usually accompany increased plasma uric acid levels unless there is a decreased excretion of uric acid by the kidneys. Urine uric acid levels reflect the amount of dietary purines and endogenous nucleic acid breakdown.
Acute uric acid nephropathy can cause acute renal failure due to uric acid precipitation within tubules. This is most commonly seen in patients with hematologic malignancies (eg, lymphoma, leukemia), often after acute lysis of cells by chemotherapy. Less commonly this may be seen with seizures, treatment of solid tumors, overproduction of uric acid in metabolic disorders such as Lesch-Nyhan syndrome or decreased uric acid reabsorption in the proximal nephron due to tubular disorder (Fanconi syndrome).
> or =18 years: <0.60 mg/mg creatinine
Reference values have not been established for patients who are younger than 18 years.
Uric acid excretion can be either decreased or increased in response to a variety of pharmacologic agents.
Urine uric acid levels are elevated in states of uric acid overproduction such as in leukemia and polycythemia and after intake of food rich in nucleoproteins.
A uric acid to creatinine ratio (mg/mg) greater than 1.0 is consistent with acute uric acid nephropathy, whereas values less than 0.75 are consistent with other causes of acute renal failure.(1)
A timed 24-hour collection is usually the preferred method for measuring and interpreting this urinary analyte. Random collections normalized to urinary creatinine may be of clinical use in 2 scenarios, however:
-When acute renal failure secondary to uric acid is suspected, a uric acid to creatinine ratio (mg/mg) greater than 1.0 is consistent with acute uric acid nephropathy, whereas values less than 0.75 are consistent with other causes of acute renal failure.(1)
-In patients who cannot collect a 24-hour specimen, typically small children, a uric acid creatinine ratio can be used to approximate 24-hour excretion.
Pediatric Reference Ranges of Uric Acid/Creatinine (mg/mg)(2) | ||
Age (year) | 5th Percentile | 95th Percentile |
0-0.5 | >1.189 | <2.378 |
0.5-1 | >1.040 | <2.229 |
1-2 | >0.743 | <2.080 |
2-3 | >0.698 | <1.932 |
3-5 | >0.594 | <1.635 |
5-7 | >0.446 | <1.189 |
7-10 | >0.386 | <0.832 |
10-14 | >0.297 | <0.654 |
14-17 | >0.297 | <0.594 |
High levels of bilirubin and ascorbic acid may interfere with measurement.
1. Lamb EJ, Jones GRD. Kidney function tests. In: Rifai N, Horvath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018:500-503
2. Kelton J, Kelley WN, Holmes EW. A rapid method for the diagnosis of acute uric acid nephropathy. Arch Intern Med. 1978;138(4):612-615
3. Matos V, Van Melle G, Werner D et al. Urinary oxalate and urate to creatinine ratios in a healthy pediatric population. Am J Kidney Dis. 1999; Aug;34(2):e1
4. Newman DJ, Price CP. Renal function and nitrogen metabolites. In: Tietz NW, ed. Textbook of Clinical Chemistry. WB Saunders Company, 1999:1245-1250
Uric acid is oxidized by the specific enzyme uricase to form allantoin and peroxide. Peroxide reacts in the presence of peroxidase and a color reagent to form a red color, the intensity of which is proportional to the uric acid concentration.(Package insert: Roche Uric Acid Plus. Roche Diagnostics; V12.0 02/2022)
Creatinine Method: The enzymatic method is based on the determination of sarcosine from creatinine with the aid of creatininase, creatinase, and sarcosine oxidase. The liberated hydrogen peroxide is measured via a modified Trinder reaction using a colorimetric indicator. Optimization of the buffer system and the colorimetric indicator enables the creatinine concentration to be quantified both precisely and specifically.(Package insert: Creatinine plus v2. Roche Diagnostics; V2.0 03/2023)
Monday through Sunday
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.
84560
82570
Test Id | Test Order Name | Order LOINC Value |
---|---|---|
RURC1 | Uric Acid/Creat Ratio, Random, U | 3089-0 |
Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
---|---|---|
CRETR | Creatinine, Random, U | 2161-8 |
RTIO1 | Uric Acid/Creat Ratio, Random, U | 3089-0 |
URCO3 | Uric Acid, Random, U | 3086-6 |