Test Catalog

Test Id : AMMO

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Ammonium, 24 Hour, Urine

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Overview

Test Catalog

Useful For
Suggests clinical disorders or settings where the test may be helpful

Diagnosis of the cause of acidosis

 

Diagnosis and treatment of kidney stones

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.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Ammonium, 24 Hr, U

Aliases
Lists additional common names for a test, as an aid in searching

Urine Ammonia

Ammonia, Urine

Specimen Type
Describes the specimen type validated for testing

Urine

Necessary Information

24-Hour volume (in milliliters) is required.

ORDER QUESTIONS AND ANSWERS

Question ID Description Answers
VL91 Urine Volume
TM25 Collection Duration

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Supplies:

-Sarstedt 5 mL Aliquot Tube (T914)

-Diazolidinyl Urea (Germall) 5.0 mL (T822)

Container/Tube: Plastic vial

Specimen Volume: 4 mL

Collection Instructions:

1. Add 5 mL of diazolidinyl urea (Germall) as preservative at start of collection or refrigerate specimen during and after collection.

2. Collect urine for 24 hours.

3. Aliquot urine into plastic vial.

4. Specimens with pH >8 may indicate bacterial contamination and testing will be cancelled. Do not attempt to adjust pH as it will adversely affect results.

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

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Forms

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

Urine Preservative Collection Options

Note: The addition of preservative must occur at the start of collection or application of temperature controls must occur during and after collection.

Ambient

No

Refrigerate

OK

Frozen

OK

50% Acetic Acid

OK

Boric Acid

OK

Diazolidinyl Urea

Preferred

6M Hydrochloric Acid

OK

6M Nitric Acid

No

Sodium Carbonate

No

Thymol

OK

Toluene

No

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

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

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
Ambient 72 hours

Useful For
Suggests clinical disorders or settings where the test may be helpful

Diagnosis of the cause of acidosis

 

Diagnosis and treatment of kidney stones

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

The kidney regulates acid excretion and systemic acid base balance. Changing the amount of ammonium in the urine is one important way the kidneys accomplish this task. Thus, measuring the urine ammonium level can provide understanding of the cause of an acid base disturbance in individual patients.(1-3)

 

The urine ammonium level can also provide a lot of information about the daily acid production in a given patient. Since most of an individual's acid load comes from ingested protein, the urine ammonium is a good indicator of dietary protein intake.

 

Urine ammonium measurements can be particularly helpful for the diagnosis and treatment of kidney stone patients:

-High urine ammonium and low urinary pH suggest ongoing gastrointestinal losses. Such patients are at risk of uric acid and calcium oxalate stones.

-Low urine ammonium and high urine pH suggest renal tubular acidosis. Such patients are at risk of calcium phosphate stones.

-Patients with calcium oxalate and calcium phosphate stones are often treated with citrate to raise the urine citrate (a natural inhibitor of calcium oxalate and calcium phosphate crystal growth). However, citrate is metabolized to bicarbonate (a base), which can increase the urine pH. If the urine pH gets too high, the risk of calcium phosphate stones may have unintentionally been increased. Monitoring the urine ammonium concentration is one way to titrate the citrate dose and avoid this problem. A good starting citrate dose is about one-half of the urine ammonium excretion (in mEq of each). One can monitor the effect of this dose on urine ammonium, citrate, and pH values, and adjust the citrate dose based upon the response. A fall in urine ammonium should indicate whether the current citrate is enough to partially (but not completely) counteract the daily acid load of that given patient.(4)

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.

15-56 mmol/24 hour

Reference values have not been established for patients <18 years and >77 years of age.

Reference values apply to 24 hour collections.

Interpretation
Provides information to assist in interpretation of the test results

If a patient has acidosis and the amount of ammonium in the urine is low, this is suggestive of a renal tubular acidosis.

 

If the amount of ammonium is high, this suggests that the kidneys are working normally and that there are other losses of bicarbonate in the body. Typically this implies gastrointestinal losses.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

The presence of sulfasalazine, sulfapyridine, or temozolomide may lead to false results.

 

Ammonium concentrations may be falsely low in samples with a pH above8.0. Consider contamination and/or a urinary tract infection with a urease positive organism (including Ureaplasma urealyticum).

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Peonides A, Levin B, Young W: The renal excretion of hydrogen ions in infants and children. Arch Dis Child. 1965 Feb;40(209):33-39

2. Kamel KS, Briceno LF, Sanchez MI, et al: A new classification for renal defects in net acid excretion. Am J Kidney Dis. 1997 Jan;29(1):136-146

3. Madison LL, Seldin DW: Ammonia excretion and renal enzymatic adaptation in human subjects, as disclosed by administration of precursor amino acids. J Clin Invest .1958 Nov;37(11):1615-1627

4. Coe FL, Evan A, Worcester E: Pathophysiology-based treatment of idiopathic calcium kidney stones. Clin J Am Soc Nephrol. 2011 Aug;6(8):2083-2092

Method Description
Describes how the test is performed and provides a method-specific reference

Urine samples are diluted 1:100 with clinical laboratory reagent water using a liquid handler and then are analyzed on a Roche cobas.(Package insert: Roche NH3L kit. Roche Diagnostics; V10/2016)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

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 Sunday

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.

Same day/1 to 2 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

7 days

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

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 has been modified from the manufacturer's instructions. Its performance characteristics were 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
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.

82140

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
AMMO Ammonium, 24 Hr, U 25308-8
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.
AM24 Ammonium, 24 Hr, U 25308-8
TM25 Collection Duration 13362-9
VL91 Urine Volume 3167-4

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports