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Test ID GDU Gadolinium, 24 Hour, Urine

Reporting Name

Gadolinium, 24 Hr, U

Useful For

Assessing chronic exposure and monitoring effectiveness of dialysis in a 24-hour urine collection

Specimen Type

Urine


Ordering Guidance


 



Necessary Information


24-Hour volume is required.



Specimen Required


Patient Preparation: High concentrations of gadolinium and iodine are known to interfere with most metal 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 for complete instructions.

Additional Information: See Urine Preservatives-Collection and Transportation for 24-Hour Urine Specimens 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

Reference Values

0-17 years: not established

≥18 years: <1.1 mcg/24 hours

Day(s) Performed

Wednesday

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 US 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 kidney insufficiency. 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.

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.

 

Elevated gadolinium in a specimen collected more than 96 hours after contrast media infusion does not indicate risk of nephrogenic systemic fibrosis.

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 Nov;22:3179-3185

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 Jan;64(1):91-96

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

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

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

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

7. Attari H, Cao Y, Elmholdt TR, Zhao Y, Prince MR: A systematic review of 639 patients with biopsy-confirmed nephrogenic systemic fibrosis. Radiology. 2019 Aug;292(2):376-386

8. Woolen SA, Shankar PR, Gagnier JJ, MacEachern MP, Singer L, Davenport MS: Risk of nephrogenic systemic fibrosis in patients with stage 4 or 5 chronic kidney disease receiving a group II gadolinium-based contrast agent: A systematic review and meta-analysis. JAMA Intern Med. 2020 Feb 1;180(2):223-230

9. 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 Feb 25;58(3):e87-e90

Report Available

2 to 8 days

Method Name

Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)

Urine Preservative Collection Options

Note: The addition of preservative or application of temperature controls must occur within 4 hours of completion of the collection.

Ambient

OK

Refrigerate

Preferred

Frozen

OK

50% Acetic Acid

No

Boric Acid

No

Diazolidinyl Urea

No

6M Hydrochloric Acid

OK

6M Nitric Acid

OK

Sodium Carbonate

No

Thymol

No

Toluene

No

Forms

If not ordering electronically, complete, print, and send a Renal Diagnostics Test Request (T830) with the specimen.