Test Id : CRBF
Creatinine, Body Fluid
Useful For
Suggests clinical disorders or settings where the test may be helpful
Identifying the presence of urine as a cause for accumulation of fluid in a body compartment
Measuring the ultrafiltration capacity of the peritoneal membrane in patients receiving peritoneal dialysis
Method Name
A short description of the method used to perform the test
Enzymatic
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Specimen Type
Describes the specimen type validated for testing
Body Fluid
Necessary Information
1. Date and time of collection are required.
2. Specimen source is required.
ORDER QUESTIONS AND ANSWERS
| Question ID | Description | Answers |
|---|---|---|
| FLD13 | Fluid Type, Creatinine |
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Specimen Type: Body fluid
Preferred Source:
-Peritoneal fluid (peritoneal, abdominal, ascites, paracentesis)
-Pleural fluid (pleural, chest, thoracentesis)
-Drain fluid (drainage, JP drain)
-Peritoneal dialysate (dialysis fluid)
-Pericardial
Acceptable Source: Write in source name with source location (if appropriate)
Collection Container/Tube: Sterile container
Submission Container/Tube: Plastic vial
Specimen Volume: 1 mL
Collection Instructions:
1. Centrifuge to remove any cellular material and transfer into a plastic vial.
2. Indicate the specimen source and source location on label.
Forms
If not ordering electronically, complete, print, and send a Renal Diagnostics Test Request (T830) with the specimen.
Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.
0.5 mL
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
| Gross hemolysis | Reject |
| Gross lipemia | Reject |
| Gross icterus | Reject |
| Anticoagulant or additive Breast milk Nasal secretions Gastric secretions Bronchoalveolar lavage (BAL) or bronchial washings Colostomy/ostomy Feces Urine Saliva Sputum Vitreous fluid | Reject |
Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Body Fluid | Refrigerated (preferred) | 7 days | |
| Ambient | 24 hours | ||
| Frozen | 30 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
Identifying the presence of urine as a cause for accumulation of fluid in a body compartment
Measuring the ultrafiltration capacity of the peritoneal membrane in patients receiving peritoneal dialysis
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Byproducts of nitrogen metabolism are present in high concentration in urine compared to blood and serve as a surrogate marker for the identification of urine leakage into a body compartment. Concentrations of creatinine or urea nitrogen that exceed the concentration found in a concurrent sample of blood are suggestive of the presence of urine.(1)
Peritoneal, abdominal, pelvic drain fluid:
Trauma as well as abdominal or pelvic surgery can lead to bladder perforation or formation of urinary fistula with excessive accumulation of peritoneal fluid or increased surgical drain output caused by intraperitoneal urinary leakage.(1,2)
Pleural fluid:
Urinoma describes the accumulation of urine in the perirenal and retroperitoneal spaces caused by genitourinary tract injury due to trauma or blockage of the urinary tract due to stones, strictures, tumors, benign prostate hypertrophy, etc.(3) Rarely, this fluid can translocate to the pleural cavity causing pleural effusion via movement of urine through the diaphragm or via lymphatic communication between retroperitoneal and pleural spaces caused by increased pressure due to urinoma. Urinothorax is the term used to describe an accumulation of urine in the pleural space. Patients often develop symptoms of dyspnea, chest pain, abdominal pain, and reduced diuresis.(4) The condition is reversed when treatment is directed to correct the primary cause (trauma in 75% and obstruction in 24% of cases). The pleural fluid to serum creatinine ratio is above 1 in 97.9% of cases (n=48; median ratio=2.9, range=0.95-16).
Peritoneal dialysis fluid:
Peritoneal dialysis (PD) is a type of ambulatory dialysis in which hyperosmotic fluid is infused into the patient's peritoneal cavity, with the peritoneum employed as the dialysis membrane promoting the diffusion of small molecules and free water from circulation.(5) The peritoneal equilibration test estimates the rate of small solute transport across the peritoneal membrane and the ultrafiltration capacity. Several analytes may be measured in order to perform this test. Creatinine is measured in PD fluid as well as in plasma or serum in samples taken 2 and/or 4 hours after the dialysate is instilled. The dialysate fluid to serum or plasma creatinine ratio is calculated with larger ratios (approaching 1.0) observed in patients exhibiting faster transport rates.
Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
An interpretive report will be provided.
Interpretation
Provides information to assist in interpretation of the test results
Peritoneal, pleural, and drain fluid concentrations should be compared to serum or plasma. Fluid to serum ratios above 1.0 suggest the specimen may be contaminated with urine.(1-4)
Peritoneal dialysate fluid to serum creatinine ratios can be calculated from timed collections to determine peritoneal membrane transport rates.(5)
All other fluids: results should be interpreted in conjunction with serum creatinine and other clinical findings.
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
The manufacturer lists the following interfering substances that affect creatinine results for serum testing and are expected to impact body fluid results in a similar manner, when present:
-Rifampicin, levodopa, and calcium dobesilate (eg, Dexium) cause artificially low creatinine results.
-As tested according to CLSI recommendation methyldopa causes artificially low creatinine results.
-Dicynone (Etamsylate) at therapeutic concentrations may lead to falsely low results.
-N-ethylglycine at therapeutic concentrations and DL-proline at concentrations of 1 mmol/L or greater (> or =115 mg/L) give falsely high results.
-2-Phenyl-1,3-indandion (Phenindion) at therapeutic concentrations interferes with the assay.
-In patients receiving catecholamines (dopamine, dobutamine, epinephrine, and norepinephrine) falsely low results might be observed.
Results can be falsely decreased in patients with elevated levels of N-acetyl-p-benzoquinone imine (NAPQI, a metabolite of acetaminophen), N-acetylcysteine, and metamizole.
In very rare cases, gammopathy, in particular type IgM (Waldenstrom macroglobulinemia), may cause unreliable results.
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. Manahan KJ, Fanning J. Peritoneal fluid urea nitrogen and creatinine reference values. Obstet Gynecol. 1999;93:780-782
2. Wong MH, Lim SK, Ng KL, Ng KP. Pseudo-acute kidney injury with recurrent ascites due to intraperitoneal urine leakage. Intern Med J. 2012;42(7):848-849
3. Austin A, Jogani SN, Brasher PB, Argula RG, Huggins JT, Chopra A. The urinothorax: A comprehensive review with case series. Am J Med Sci. 2017;354(1):44-53
4. Toubes ME, Lama A, Ferreiro L, et al. Urinothorax: a systematic review. J Thorac Dis. 2017;9(5):1209-1218
5. Block DR, Florkowski CM. Body fluids. In: Rafai N, Horvath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018: chap 43
6. Saenger AK, Lockwood C, Snozek CL, et al. Catecholamine interference in enzymatic creatinine assays. Clin Chem. 2009;55(9):1732-1736
Method Description
Describes how the test is performed and provides a method-specific reference
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 2,4,6-triiodo-3-hydroxybenzoic acid 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 plus ver 2. Roche Diagnostics; V16.0, 02/2022)
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.
Monday through Sunday
Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.
Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location
Indicates the location of the laboratory that performs the test
Fees :
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.
- Authorized users can sign in to Test Prices for detailed fee information.
- Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
- Prospective clients should contact their account representative. For assistance, contact Customer Service.
Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.
This test has been modified from the manufacturer's instructions. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.
CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
CPT codes are provided by the performing laboratory.
CPT codes are provided by the performing laboratory.
82570
LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.
| Test Id | Test Order Name | Order LOINC Value |
|---|---|---|
| CRBF | Creatinine, BF | 12190-5 |
| 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.
|
|---|---|---|
| CR_BF | Creatinine, BF | 12190-5 |
| FLD13 | Fluid Type, Creatinine | 14725-6 |