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Epic Code LAB1230545 Kidney Stone Analysis

Additional Codes

Mayo code: KIDST

Interface Order Alias: 1230545

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Useful For

Managing patients with recurrent renal calculi

Specimen Type

Stone


Shipping Instructions


 



Necessary Information


Specimen source is required.



Specimen Required


Supplies: Stone Analysis Collection Kit (T550)

Sources: Bladder, kidney, prostatic, renal, or urinary

Specimen Volume: Entire dried calculi specimen

Collection Instructions:

1. Have patient collect specimen using the Patient Collection Instructions for Kidney Stones (see Special Instructions).

2. Prepare specimen per Guiding Proper Stone Collection information (see Special Instructions).

2. Do not place stone directly in a bag. If specimen is received in a bag, either transfer stone into a screw-capped, plastic container or place bag containing stone in a screw-capped, plastic container.


Specimen Minimum Volume

Entire stone

Forms

If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:

-General Request (T239)

-Renal Diagnostics Test Request (T830)

Specimen Stability Information

Specimen Type Temperature Time Special Container
Stone Ambient (preferred)
  Frozen  365 days
  Refrigerated  365 days

Reject Due To

  All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.

Cautions

No significant cautionary statements

Clinical Information

The composition of urinary stones may vary from a simple crystal to a complex mixture containing several different species of crystals. The composition of the nidus (center) may be entirely different from that of the peripheral layers.

 

Eighty percent of patients with kidney stones have a history of recurrent stone formation. Knowledge of stone composition can be useful to guide therapy of patients with recurrent stone formation.

 

Treatment of urinary calculi is complex.(1) In an overly simplified format, the following patterns are often treated as follows:

-Hyperuricuria and predominately uric acid stones: alkalinize urine to increase uric acid solubility.

-Hypercalciuria and predominately hydroxyapatite stones: acidify urine to increase calcium solubility. However, treatment also depends on urine pH and urine phosphate, sulfate, oxalate, and citrate concentrations.

-Hyperoxaluria and calcium oxalate stones: increase daily fluid intake and consider reduction of daily calcium. However, daily requirements for calcium to maintain good bone formation complicate the treatment.

-Magnesium ammonium phosphate stones (struvite): Investigate and treat urinary tract infection.

Method Name

Infrared Spectrum Analysis

Report Available

2 to 4 days

Reporting Name

Kidney Stone Analysis

Reference Values

The presence of a kidney stone is abnormal. A quantitative report will be provided after analysis.

Interpretation

The interpretation of stone analysis results is complex, and beyond the scope of this text. For more information see the second Clinical Reference.

 

Calcium oxalate stones:

-Production of calcium oxalate stones consisting of oxalate dihydrate indicate that the stone is newly formed and current urine constituents can be used to assess the importance of supersaturation.

-Production of calcium oxalate stones consisting of oxalate monohydrate indicate an old (>2 months since formed) stone and current urine composition may not be meaningful.

 

Magnesium ammonium phosphate stones (struvite):

-Production of magnesium ammonium phosphate stones (struvite) indicates that the cause of stone formation was infection.

-Treatment of the infection is the only way to inhibit further stone formation.

 

Ephedrine/guaifenesin stones:

-Certain herbal and over-the-counter preparations (eg, Mah Jung) contain high levels of ephedrine and guaifenesin. Excessive consumption of these products can lead to the formation of ephedrine/guaifenesin stones.

Method Description

Representative specimens are taken from all identifiable layers of the calculus. Each specimen is crushed into a fine powder. An infrared spectrum of each specimen is recorded, and the resulting spectrum compared against reference spectra of all known calculus components. This procedure allows for accurate analyses of complex crystal mixtures as well as the hydration state of each crystal type.(Hesse A, Bach D: Stone analysis by infrared spectroscopy. In: Rose GA, ed: Urinary Stones: Critical and Laboratory Aspects. University Park Press; 1982; Gambaro G. Croppi E, Coe F, Consensus Conference Group, et al. Metabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations: a consensus statement. J Nephrol 2016;29:715-734)

Day(s) Performed

Monday through Saturday

Clinical Reference

1. Mandel NS, Mandel IC, Kolbach-Mandel AM: Accurate stone analysis: the impact on disease and treatment. Urolithiasis. 2017;45(1):3-9. doi: 10.1007/s00240-016-0943-0

2. Smith LH. In: Schrier RW, Gottscholk CW, eds. Diseases of the Kidney. 4th ed. Little, Brown and Company; 1987:chap 25

3. Lieske JC, Segura JW: Evaluation and medical management of kidney stones. In: Potts JM, ed: Essential Urology: A Guide to Clinical Practice. Humana Press; 2004:117-152

4. Lieske JC: Pathophysiology and evaluation of obstructive uropathy. In: Smith AD, Gopal Badlani B, Bagley D, et al. Smith's Textbook of Endourology. 2nd ed. BC Decker Inc; 2007:101-106

Test Classification

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.

CPT Code Information

82365

LOINC Code Information

Test ID Test Order Name Order LOINC Value
KIDST Kidney Stone Analysis 74446-6

 

Result ID Test Result Name Result LOINC Value
605761 Kidney Stone Analysis 40787-4
SRC1 Source: 31208-2
605762 Interpretation 9795-6