Test Id : CITRA
Citrate Excretion, Random, Urine
Useful For
Suggests clinical disorders or settings where the test may be helpful
Diagnosing risk factors for patients with calcium kidney stones using random urine specimens
Monitoring results of therapy in patients with calcium stones or renal tubular acidosis
Profile Information
A profile is a group of laboratory tests that are ordered and performed together under a single Mayo Test ID. Profile information lists the test performed, inclusive of the test fee, when a profile is ordered and includes reporting names and individual availability.
| Test Id | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| CITR2 | Citrate Concentration, Random, U | No | Yes |
| CRETR | Creatinine, Random, U | No | Yes |
| RAT10 | Citrate/Creatinine Ratio | No | Yes |
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
Aliases
Lists additional common names for a test, as an aid in searching
Citric Acid, Urine
Urinary Citrate Excretion
CITRA
Specimen Type
Describes the specimen type validated for testing
Urine
Ordering Guidance
A timed 24-hour collection is the preferred specimen for measuring and interpreting this urinary analyte. Order CITR / Citrate Excretion, 24 Hour, Urine.
Random collections normalized to urinary creatinine may be of some clinical use in patients who cannot collect a 24-hour specimen, typically small children.
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Patient Preparation: Any drug that causes alkalemia or acidemia may be expected to alter citrate excretion and should be avoided, if possible. The patient must avoid laxative use for 24 hours prior to collection.
Supplies: Sarstedt 5 mL Aliquot Tube (T914)
Container/Tube: Plastic, 5-mL tube
Specimen Volume: 4 mL
Collection Instructions:
1. Collect a random urine specimen.
2. No preservative.
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.
1 mL
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
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 |
|---|---|---|---|
| Urine | Refrigerated (preferred) | 14 days | |
| Frozen | 14 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
Diagnosing risk factors for patients with calcium kidney stones using random urine specimens
Monitoring results of therapy in patients with calcium stones or renal tubular acidosis
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Urinary citrate is a major inhibitor of kidney stone formation due in part to binding of calcium in urine. Low urine citrate levels are considered a risk for kidney stone formation. Several metabolic disorders are associated with low urine citrate. Any condition that lowers renal tubular pH or intracellular pH may decrease citrate (eg, metabolic acidosis, increased acid ingestion, hypokalemia, or hypomagnesemia).
Low urinary citrate is subject to therapy by correcting acidosis, hypokalemia, or hypomagnesemia by altering diet or using drugs such as citrate and potassium.
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.
No established reference values.
Interpretation
Provides information to assist in interpretation of the test results
A low value represents a potential risk for kidney stone formation/growth. Patients with low urinary citrate and new or growing stone formation may benefit from adjustments in therapy known to increase urinary citrate excretion.
Very low citrate levels suggest investigation for the possible diagnosis of metabolic acidosis (eg, renal tubular acidosis).
For children ages 5 to 18, a ratio of less than 0.176 mg citrate/ mg creatinine is below the 5% reference range and considered low.(1)
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Drugs that lower systemic pH, potassium, and/or magnesium also lower urine citrate and are to be avoided in patients with tendency to form calcium stones. Conversely, drugs that raise systemic pH, potassium, and/or magnesium may raise urine citrate and should be considered when treating patients or interpreting results.
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. Srivastava T, Winston MJ, Auron A, Alon US: Urine calcium/citrate ratio in children with hypercalciuric stones. Pediatr Res. 2009 Jul;66(1):85-90. doi: 10.1203/PDR.0b013e3181a2939e
2. Hosking DH, Wilson JW, Liedtke RR, Smith LH, Wilson DM: The urinary excretion of citrate in normal persons and patients with idiopathic calcium urolithiasis. J Lab Clin Med. 1985 Dec;106(6):682-689
3. Lieske JC, Wang X: Heritable traits that contribute to nephrolithiasis. Urolithiasis. 2019 Feb;47(1):5-10. doi: 10.1007/s00240-018-1095-1
4. Lieske JC, Turner ST, Edeh SN, Smith JA, Kardia SL: Heritability of urinary traits that contribute to nephrolithiasis. Clin J Am Soc Nephrol. 2014 May;9(5):943-950
Method Description
Describes how the test is performed and provides a method-specific reference
Citric acid in the presence of zinc (2+) at pH 8.2 is catalyzed to oxaloacetate by the enzyme, citrate lyase. Oxaloacetate in the presence of malate dehydrogenase and reduced nicotinamide adenine dinucleotide (NADH) is reduced to malate (II). The citric acid concentration in the reaction mixture can be determined by measuring the disappearance of the light-absorbing NADH(Delaney MP, Lamb EJ: Kidney disease. In: Rifai N, Horvath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018:1309-1310)
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 Saturday
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 was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It 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.
82507
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 |
|---|---|---|
| CITRA | Citrate Excretion, Random, U | 13722-4 |
| 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 |
| CITR2 | Citrate Concentration, Random, U | 2128-7 |
| RAT10 | Citrate/Creatinine Ratio | 13722-4 |