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HelpTest ID GDU Gadolinium, 24 Hour, Urine
Reporting Name
Gadolinium, 24 Hr, UUseful For
Assessing chronic exposure and monitoring effectiveness of dialysis in a 24-hour urine collection
Specimen Type
UrineAdvisory Information
Necessary Information
24-Hour volume is required.
Specimen Required
Patient Preparation: High concentrations of gadolinium and iodine are known to interfere with most metals tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for 96 hours.
Supplies: Urine Tubes, 10 mL (T068)
Container/Tube: Plastic, 10-mL urine tube or clean, plastic aliquot container with no metal cap or glued insert
Specimen Volume: 3 mL
Collection Instructions:
1. Collect urine for 24 hours.
2. Refrigerate specimen within 4 hours of completion of 24-hour collection.
3. See Trace Metals Analysis Specimen Collection and Transport in Special Instructions for complete instructions.
Additional Information: See Urine Preservatives-Collection and Transportation for 24-Hour Urine Specimens in Special Instructions for multiple collections.
Specimen Minimum Volume
0.3 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Urine | Refrigerated (preferred) | 28 days | |
| Ambient | 28 days | ||
| Frozen | 28 days |
Special Instructions
Reference Values
0-17 years: not established
≥18 years: <1.1 mcg/24 hours
Day(s) and Time(s) Performed
Thursday; 8 a.m.
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.CPT Code Information
83018
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| GDU | Gadolinium, 24 Hr, U | 8201-6 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 29252 | Gadolinium, 24 Hr, U | 8201-6 |
| TM101 | Collection Duration | 13362-9 |
| VL82 | Urine Volume | 3167-4 |
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. Patients with reduced renal function and some patients with normal renal 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 renal disease, and almost all have been associated with prior use of GBCAs. 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.
Interpretation
Elevated urine gadolinium results from a specimen collected more than 96 hours after administration of a gadolinium-based contrast agent confirms past exposure, or continued exposure through anthropogenic sources and prolonged elimination of gadolinium. Gadolinium also has been shown to be present in some municipal water sources, which may contribute to the observation of low concentrations of gadolinium in patients who never have been exposed to gadolinium-based contrast agents (GBCA).
Elevated gadolinium in a specimen collected more than 96 hours after contrast media infusion does not indicate risk of nephrogenic systemic fibrosis (NSF).
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;22:3179-3185
2. Perazella MA: Nephrogenic systemic fibrosis, kidney disease, and gadolinium: is there a link? Clin J Am Soc Nephrol. 2007;2:200-202
3. 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
4. Girardi M, Kay J, Elston DM, et al: Nephrogenic systemic fibrosis: Clinicopathological definition and workup recommendations. J Am Acad Dermatol. 2011;65:1095-1106
5. 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 Jul;69(7):661-668
7. Aime S, Caravan P: Biodistribution of gadolinium-based contrast agents, including gadolinium deposition. J Magn Reson Imaging. 2009;30(6):1259-1267
8. McDonald RJ, McDonald JS, Kallmes DF, et al: Intracranial gadolinium deposition after contrast-enhanced MR imaging. Radiology. 2015;275:772-782
Analytic Time
1 dayMethod Name
Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)
Forms
If not ordering electronically, complete, print, and send a Renal Diagnostics Test Request (T830) with the specimen.