Sign in →

Test Code GDCU Gadolinium/Creatinine Ratio, Urine

Additional Codes

Epic# -

LAB000 (enter test name into comments)

 

Cerner name(s):

  • Miscellaneous Sendout


Specimen Required


Only orderable as part of a profile. For more information see GDUCR / Gadolinium/Creatinine Ratio, Random, Urine.


Secondary ID

615339

Useful For

Measurement of gadolinium concentration for assessing chronic exposure and monitoring effectiveness of dialysis using a random urine collection

Method Name

Only orderable as part of a profile. For more information see GDUCR / Gadolinium/Creatinine Ratio, Random, Urine.

 

Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)

Reporting Name

Gadolinium/Creat Ratio, U

Specimen Type

Urine

Specimen Minimum Volume

1.5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Urine Refrigerated (preferred) 28 days
  Ambient  28 days
  Frozen  28 days

Reject Due To

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

Clinical Information

Gadolinium is a member of the lanthanide series of the periodic table of elements and is considered a nonessential element. Due to its paramagnetic properties, chelated gadolinium is commonly employed as contrast media (gadolinium-based contrast agents: GBCA) for magnetic resonance imaging and computer tomography scanning.

 

Gadolinium is primarily eliminated via the kidneys, so exposure can be prolonged in patients with renal insufficiency. In healthy subjects with normal kidney function, the plasma half-life of gadolinium is approximately 90 minutes (1.5 hours). Patients with reduced kidney function and some patients with normal kidney function may exhibit a prolonged gadolinium elimination half-life.

 

To date, the only known adverse health effect related to gadolinium retention is a rare condition called nephrogenic systemic fibrosis (NSF). NSF is a relatively uncommon condition in which fibrous plaques develop in the dermis and, often, in deeper connective tissues. Reported cases have occurred almost exclusively in patients with severe kidney disease, and almost all have been associated with prior use of GBCA. NSF is a painful skin disease characterized by thickening of the skin, which can involve the joints and cause significant limitation of motion within weeks to months. Over the past decade, changes in clinical practice guidelines have almost completely eliminated the incidence of NSF. However, the association of NSF and observed elevated gadolinium concentrations is still not fully understood.

Reference Values

Only orderable as part of a profile. For more information see GDUCR / Gadolinium/Creatinine Ratio, Random, Urine.

 

0-17 years: Not established

≥18 years: <0.8 mcg/g creatinine

Cautions

Urine gadolinium concentration will be elevated if the specimen is collected less than 96 hours after administration of gadolinium-based contrast agents. This elevation is due to the residual gadolinium present from contrast media infusion. An elevated gadolinium in a specimen collected more than 96 hours after contrast media infusion does not definitively indicate risk of nephrogenic systemic fibrosis or gadolinium toxicity. Ultimately, individuals should consult with their healthcare providers to interpret any test results.

 

Gadolinium may also be present in the effluent of metropolitan sewage treatment plants and in the rivers near metropolitan areas. Sewage treatment does not remove gadolinium. Anthropogenic sources of gadolinium could contribute to low concentrations of gadolinium excreted in the urine.

Clinical Reference

1. Othersen JB, Maize JC, Woolson RF, Budisavljevic MN. Nephrogenic systemic fibrosis after exposure to gadolinium in patients with renal failure. Nephrol Dial Transplant 2007;22(11):3179-3185

2. Christensen KN, Lee CU, Hanley MM, et al. Quantification of gadolinium in fresh skin and serum samples from patients with nephrogenic systemic fibrosis. J Am Acad Dermatol. 2011;64(1):91-96

3. Girardi M, Kay J, Elston DM, et al. Nephrogenic systemic fibrosis: Clinicopathological definition and workup recommendations. J Am Acad Dermatol. 2011;65(6):1095-1106

4. Telgmann L, Sperling M, Karst U. Determination of gadolinium-based MRI contrast agents in biological and environmental samples: A review. Analytica Chimica Acta. 2013;764:1-16

5. Daftari Besheli L, Aran S, Shaqdan K, et al. Current status of nephrogenic systemic fibrosis. Clin Radiol. 2014;69(7):661-668

6. Aime S, Caravan P. Biodistribution of gadolinium-based contrast agents, including gadolinium deposition. J. Magn Reson Imaging 2009;30(6):1259-1267

7. McDonald RJ, McDonald JS, Kallmes DF, et al. Intracranial gadolinium deposition after contrast-enhanced MR imaging. Radiology. 2015;275:772-782

8. Bornhorst J, Wegwerth P, Day P, et al. Urinary reference intervals for gadolinium in individuals without recent exposure to gadolinium-based contrast agents. Clin Chem Lab Med. 2020;58(3):e87-e90. doi: 10.1515/cclm-2019-0607

9. Alwasiyah D, Murphy C, Jannetto P, Hogg M, Beuhler MC. Urinary Gadolinium Levels After Contrast-Enhanced MRI in Individuals with Normal Renal Function: a Pilot Study. J Med Toxicol. 2019;15(2):121-127

Method Description

The metal of interest is analyzed by inductively coupled plasma mass spectrometry.(Unpublished Mayo method)

Day(s) Performed

Thursday

Report Available

2 to 8 days

Specimen Retention Time

14 days

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Test Classification

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

83018

LOINC Code Information

Test ID Test Order Name Order LOINC Value
GDCU Gadolinium/Creat Ratio, U 93854-8

 

Result ID Test Result Name Result LOINC Value
615339 Gadolinium/Creat Ratio, U 93854-8