Renal Panel Components
A renal panel for patients with risk factors such as diabetes, hypertension, or family history of kidney disease must include two essential tests: serum creatinine to calculate estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) on a spot urine sample. 1, 2
Core Components
Essential Tests for CKD Detection
- Serum creatinine is measured to calculate eGFR using validated equations (CKD-EPI 2021), which estimates kidney filtration function 1, 2
- Urine albumin-to-creatinine ratio (UACR) on a random spot urine collection detects kidney damage through albuminuria, with values ≥30 mg/g indicating abnormality 1, 2
- These two tests together can detect the majority of CKD cases, as CKD is diagnosed when either eGFR <60 mL/min/1.73 m² OR UACR ≥30 mg/g persists for at least 3 months 1, 2
Additional Electrolyte and Metabolic Parameters
- Blood urea nitrogen (BUN) reflects glomerular function and helps assess the extent of renal dysfunction 3
- Serum electrolytes including sodium, potassium, chloride, and bicarbonate screen for metabolic acidosis, hyperkalemia, and other electrolyte abnormalities that develop as kidney function declines 2
Risk-Specific Testing Approach
For Diabetic Patients
- Annual screening with both eGFR and UACR is mandatory starting immediately at diagnosis of type 2 diabetes, as 6.5% already have elevated urinary albumin and 28% have hypertension at diagnosis 2
- Glucose control markers should be assessed, as optimal glycemic control reduces progression risk 2
For Hypertensive Patients
- Blood pressure measurement is critical, as uncontrolled systolic hypertension accelerates GFR deterioration at rates of 4-8 mL/min per year 2
- Approximately 70% of individuals with elevated serum creatinine have hypertension, making it the dominant risk factor 2
For Patients with Family History
- Both eGFR and UACR should be measured, as individuals with family history of kidney failure have increased prevalence of hypertension, diabetes, and earlier stages of CKD 1, 2
Common Pitfalls to Avoid
- Never rely on serum creatinine alone without calculating eGFR using validated equations, as raw creatinine values are misleading 2
- Never skip albuminuria testing, as eGFR and UACR provide independent prognostic information for cardiovascular events, CKD progression, and mortality 2
- Do not use urine dipstick for protein detection; always use quantitative UACR measurement for accurate assessment 2
- Avoid ordering 24-hour urine collections routinely, as spot UACR is the preferred and more practical method 4
Interpretation Framework
- CKD is confirmed when abnormalities persist for at least 3 months, distinguishing it from acute kidney injury 1, 2
- GFR estimates >60 mL/min/1.73 m² are not reported as numeric values by laboratories due to lesser accuracy at higher levels, so interpretation depends on UACR results and clinical context 1
- Restricting testing to high-risk patients (diabetes, hypertension, age >60 years, family history) reduces false-positive results and enables efficient resource use 1, 2