Renal Panel

Purpose of the test

The purpose of a renal panel test is to find or rule out potential kidney impairment or disease. Depending on the circumstances, it may be used for diagnosis, screening, or monitoring.

Diagnosis is the identification of a health problem after signs or symptoms have started. A renal panel may be ordered if the doctor believes that symptoms could be related to an issue affecting the kidneys.

Screening is testing with the goal of early detection of a problem. Screening tests are done before any symptoms have occurred. For people who are at higher risk of developing kidney disease, a renal panel may be prescribed to try to reveal problems at an earlier stage.

Monitoring is how a patient’s situation can be tracked over time. Repeat testing with a renal panel can show if the condition of the kidneys is getting better or worse. This monitoring may be done after treatment for kidney disease. It can also be used to watch for changes to kidney function when taking medications that can cause kidney impairment.

What does the test measure?

A renal panel includes multiple measurements. However, not all renal panel tests are exactly the same. The components can depend on the laboratory or the measurements requested by the doctor prescribing the test.

The most common components tested in most renal panels include:

• Glucose: Also known as blood sugar, glucose provides energy for the body. Excess glucose in the blood, though, can be a sign of metabolic problems like diabetes.
• Phosphorus: Phosphorus is an essential mineral for your bones, teeth, nervous system, and muscles. Phosphorus comes primarily from the foods and drinks that you consume.
• Calcium: Calcium is a mineral that is vital for the bones, muscles, cardiovascular system, and nervous system. The main source of calcium is your diet, and the body stores calcium in the bones.
• Potassium: Potassium is a type of electrolyte. Electrolytes are minerals that enable acid-base balance, healthy fluid levels, and proper functioning of muscles and nerves. Potassium comes from your diet and is found throughout the body.
• Sodium: Sodium is another electrolyte that comes from your diet, and the amount of sodium in the body is largely controlled by the kidneys.
• Chloride: Chloride is an electrolyte that works in conjunction with other electrolytes to carry out various functions, including preserving a healthy balance of fluids.
• Bicarbonate: Bicarbonate is another electrolyte. Levels of bicarbonate help assess the amount of carbon dioxide (CO2) in your blood.
• Albumin: Albumin is a protein that is produced in the liver and found in the blood. It carries important substances through the body and helps maintain the proper pressure in the blood vessels so that fluids do not leak out of the blood.
• Creatinine: Creatinine is a waste byproduct that is consistently formed as a result of normal muscle activity. The kidneys remove creatinine from the blood so that it can be carried out of the body in urine.
• Blood urea nitrogen (BUN): Urea nitrogen, sometimes just called urea, is a waste product from protein activity. Like creatinine, it is removed from the blood by the kidneys and cleared from the body in urine.

Other measurements that may also included in a renal panel include:

• Anion gap: The anion gap is a comparison of different electrolytes. Specific electrolytes can be positively or negatively charged, and this test assesses the balance between the two types. This measurement helps determine if you have too much or too little acid in your blood.
• Estimated glomerular filtration rate (eGFR): The eGFR is an evaluation of kidney function. Glomeruli are tiny filters in the kidneys, and the eGFR is a calculation of how much blood they are filtering every minute. There are different ways to calculate eGFR, but most tests use a special formula based on your creatinine level.
• Total protein: There are several kinds of proteins that can be found in the blood, and total protein is a count of all of them. These proteins include albumin and multiple types of globulins, which are made by the immune system.
• BUN-to-creatinine ratio: In some cases, comparing the amounts of the waste products BUN and creatinine can provide information about whether abnormal levels are being caused by problems in the kidneys or another part of the body..

When should I get a renal panel test?

A renal panel test can be used in a range of circumstances, and the doctor may include specific measurements depending on your situation.

As a diagnostic test, a renal panel is most frequently used when you have symptoms that could be explained by a kidney problem. Examples of symptoms that can be tied to kidney impairment or disease include:

• Urinary changes including changes to the frequency, quantity, or appearance of your urine
• Unexplained swelling, especially in your arms, hands, legs, and/or face
• Itching
• Loss of concentration
• Appetite changes
• Difficulty breathing
• Nausea and/or vomiting
• Fatigue
• Muscle cramps or pain

A test like the renal panel may also be used for diagnosis when you have general symptoms without a clear cause or are being evaluated in an urgent care or emergency setting.

As a screening test, the renal panel or other tests of kidney health are most often prescribed if you have certain risk factors for kidney disease. Some of these risk factors include high blood pressure, diabetes, and a family history of kidney disease.

For people with an elevated risk of kidney problems, screening with a renal panel may be part of normal health checkups. Screening of this type is not standard in people who do not have risk factors.

A renal panel can be used as a monitoring test if you have had kidney problems in the past or have already had an abnormal renal panel test. If you are receiving treatment for kidney injury or disease, a renal panel may be used to gauge your response to that therapy.

If you are going to have a medical procedure or take any drugs that can impair kidney function, your doctor may prescribe a renal panel before and/or after to monitor for possible kidney-related side effects.

How to get tested

In general, a renal panel is ordered by a doctor, and the blood sample is drawn in a medical office, laboratory, or hospital.

Can I take the test at home?

Very few options exist for a complete renal panel test that can be taken with an at-home test kit. Some at-home kidney tests involve taking a fingerstick blood sample at home and sending it to a lab for analysis, but these tests do not include all of the same measurements that are included in a typical renal panel test.

How much does the test cost?

There is no universal fixed price for a renal panel test.

Different charges that can figure into the total price include office visits, fees related to the blood draw procedure, and costs of laboratory analysis. How much is billed for these charges can depend on several factors including:

• Where the blood draw is performed
• The laboratory that performs the testing
• The specific measurements included in the renal panel
• Whether you have health insurance

Many health insurance plans will cover some or all of the costs of a renal panel if the test is prescribed by your doctor, but some costs, such as for a deductible or copays, may still have to be paid out of pocket.

For more detailed information about what will be covered and your expected costs, talk directly with your doctor’s office and your health insurance company.

A blood sample is necessary for a renal panel test and can be taken with a routine blood draw at a doctor’s office, hospital, or medical laboratory

Before the test

For many renal panel tests, you will need to fast for 8 to 12 hours before your blood draw. During this time, you can only drink water. You cannot eat any food or drink other beverages.

However, because the exact components of a renal panel test can vary, you should ask your doctor about whether you need to fast beforehand.

You should also tell your doctor about any prescriptions, over-the-counter medications, or supplements that you take. If any of these can affect the test, your doctor may ask you to temporarily stop taking them before the test.

During the test

When it’s time for your test, you will be seated while a technician or nurse prepares to draw your blood. They will tie a band around your upper arm to enhance blood flow lower in your arm. An antiseptic wipe will be used to clean the skin around your vein, and then a needle will be inserted into the vein. The needle is used to withdraw a vial of blood and is then removed from your arm.

This type of blood draw is a routine procedure that normally lasts only a few minutes. You may experience some brief pain or a stinging sensation during the test.

After the test

When the needle is removed from your arm, a bandage or cotton swab will be used to stop any further bleeding. You may experience some soreness or bruising, but these effects are rarely long-lasting.

If you are required to fast, you may want to bring a snack for immediately after the test. Once your blood draw is finished, you can return to most normal activities, including driving.

Receiving test results

The results from a renal panel test typically become available in a few business days. The full test report may be sent to you by mail or made accessible electronically. Your doctor may also call or email to review the results with you directly.

Interpreting test results

The test report from a renal panel will show separate line items for each component of the test. Every line item will show the measurement in your sample as well as the reference interval for the laboratory that did the testing.

For many components of the test, there is no consensus range to define what is normal or abnormal. Instead, each lab sets the range for its own test based on its analytic methods and experience. Accordingly, interpretation of your test result must be done in relation to the laboratory ranges listed on your test report.

Examples of reference ranges for adults from the National Library of Medicine and the American Board of Internal Medicine are listed in the table below. The variation between these listed ranges demonstrates that there is no universal reference interval for the renal panel test.

The exact components of the renal panel can vary, so you may not see all of these line items on your test. You may also see other measurements that were included by the laboratory or that were requested by your doctor. For each component, though, you should see the laboratory’s reference interval clearly displayed.

Interpretation of your test is always done within the context of your particular situation. This means considering your health history, current health and symptoms, and the results from any other medical tests you’ve taken.

Abnormal test results may be an indication of a health problem or an issue affecting the kidneys. However, doctors rarely rely on one single test result alone. Instead, they may look for patterns in which measurements are abnormal and how high or low those levels are compared to the reference range.

It is important to take these diverse factors into account in order to understand the significance of your renal panel test. For that reason, the test result should always be reviewed with your doctor who can best explain what the test shows and what it means for your health and wellness.

Do I need follow-up tests?

If one or more of the measurements on your renal panel test are abnormal, you may need additional testing. The specific follow-up tests are determined based on your test results, symptoms, and overall health.

Other blood or urine tests, imaging tests, or, less often, a kidney biopsy, may be ordered. Your doctor can best describe the different potential follow-up tests and their benefits and risks.

Questions for your doctor about test results

When your test results are ready, you can learn more about their significance by discussing them with your doctor. Some questions that you can ask include:

• Were there any abnormal findings on my renal panel test? If so, what were they?
• For any abnormal findings, can you explain what might be the cause?
• Are there any follow-up tests that are warranted based on my renal panel test?
• Should I take this test again? If so, when?

Because there are several kinds of kidney function tests, it can be challenging to know what makes them different. The following sections explain what makes a renal panel test distinct from a number of related tests.

How is a renal panel test different from an estimated glomerular filtration rate test?

The renal panel is a broader test than an estimated glomerular filtration rate (eGFR) test, and in some cases, a renal panel involves eGFR.

The estimated glomerular filtration rate is a common method of evaluating kidney function. It can be calculated in several different ways and reflects how much blood is being filtered by the kidneys every minute.

The eGFR is usually determined with a mathematical formula based primarily on the amount of creatinine in the blood. Because creatinine is measured in most renal panels, the test report may also list eGFR. However, the renal panel also measures electrolytes, minerals, and other substances that can reflect the status of the kidneys.

How is a renal panel test different from a creatinine clearance test?

A creatinine clearance test includes both a blood and urine sample. The amount of creatinine is measured in each sample, and then the two figures are compared. This comparison provides a method for estimating the glomerular filtration rate and evaluating kidney function.

In contrast, a renal panel uses only a blood sample. While a standard renal panel measures creatinine in the blood, it does not include a urine collection or comparative measurement.

The renal panel also includes a more diverse set of measurements, including proteins, minerals, and electrolytes, than a creatinine clearance test.

How is a renal panel different from a kidney profile test?

The renal panel and kidney profile are designed to assess kidney health. However, there are important differences between them.

The renal panel is only a blood test, and it includes a combination of measurements that can vary based on the laboratory.

In contrast, the kidney profile is a standardized series of two different tests. It includes a blood test for the estimated glomerular filtration rate and a urine test to measure albumin and the albumin-to-creatinine ratio.

While eGFR is calculated on some renal panel tests, it is always included in the kidney profile test. The kidney profile also adds a second test component by measuring urine albumin, which can be an indicator of chronic kidney disease.

This specific two-part kidney profile test was formalized in 2018 through collaboration by professional medical organizations, advocacy groups, and laboratories to enhance the detection of kidney disease. When appropriate, the kidney profile can be ordered along with a renal panel to obtain a wider range of measurements related to kidney health.

How is a renal panel different from a comprehensive or basic metabolic panel?

There is considerable overlap between the measurements on a renal panel, basic metabolic panel (BMP), and comprehensive metabolic panel (CMP).

The BMP has 8 components, all of which are included in the CMP, which has a total of 14 measurements. The components of the BMP and CMP are more standardized than the renal panel, which can vary between laboratories.

The BMP, CMP, and most renal panels include measurements of glucose, electrolytes, calcium, and the waste products creatinine and urea nitrogen. The CMP and many renal panels also include measurement of albumin.

An important difference for the comprehensive metabolic panel is its inclusion of tests that help assess the condition of the liver. These are tests found on a typical liver panel test.

Because it is not as standardized, a renal panel test may include measurements, such as phosphorus or the anion gap, that are not found on the BMP or CMP.

Are all renal panel tests the same?

It is common for there to be some variation in the individual components of a renal panel based on the specific laboratory that performs your test. However, some test elements, such as the electrolytes, glucose, calcium, phosphorus, and albumin are found on the most common renal panel tests offered by major laboratories.

In addition, your doctor can request that other specific measurements be included with your renal panel. You will see a line item for each component when you review your test report, and your doctor can explain the significance of each component and the results in the context of your health situation.

Sources

A.D.A.M. Medical Encyclopedia. Comprehensive metabolic panel. Updated January 26, 2019. Accessed July 5, 2021. https://medlineplus.gov/ency/article/003468.htm

A.D.A.M. Medical Encyclopedia. Phosphorus in diet. Updated February 2, 2019. Accessed July 5, 2021. https://medlineplus.gov/ency/article/002424.htm

A.D.A.M. Medical Encyclopedia. Basic metabolic panel. Updated April 29, 2019. Accessed July 5, 2021. https://medlineplus.gov/ency/article/003462.htm

A.D.A.M. Medical Encyclopedia. BUN – blood test. Updated April 29, 2019. Accessed July 5, 2021. https://medlineplus.gov/ency/article/003474.htm

A.D.A.M. Medical Encyclopedia. Chloride test – blood. Updated April 29, 2019. Accessed July 5, 2021. https://medlineplus.gov/ency/article/003485.htm

A.D.A.M. Medical Encyclopedia. CO2 blood test. Updated April 29, 2019. Accessed July 5, 2021. https://medlineplus.gov/ency/article/003469.htm

A.D.A.M. Medical Encyclopedia. Potassium test. Updated April 29, 2019. Accessed July 5, 2021. https://medlineplus.gov/ency/article/003484.htm

A.D.A.M. Medical Encyclopedia. Total protein. Updated April 29, 2019. Accessed July 5, 2021. https://medlineplus.gov/ency/article/003483.htm

A.D.A.M. Medical Encyclopedia. Creatinine blood test. Updated July 4, 2019. Accessed May 13, 2021. https://medlineplus.gov/ency/article/003475.htm

A.D.A.M. Medical Encyclopedia. Calcium blood test. Updated September 29, 2019. Accessed July 5, 2021. https://medlineplus.gov/ency/article/003477.htm

A.D.A.M. Medical Encyclopedia. Phosphorus blood test. Updated September 29, 2019. Accessed July 5, 2021. https://medlineplus.gov/ency/article/003478.htm

A.D.A.M. Medical Encyclopedia. Blood sugar test. Updated January 26, 2020. Accessed July 5, 2021. https://medlineplus.gov/ency/article/003482.htm

American Board of Internal Medicine. ABIM laboratory test reference ranges. Updated January 2021. Accessed July 5, 2021. https://www.abim.org/Media/bfijryql/laboratory-reference-ranges.pdf

Emmett ME, Hoorn EJ. Serum anion gap in conditions other than metabolic acidosis. In: Sterns RH, ed. UpToDate. Updated April 13, 2020. Accessed July 2, 2021. https://www.uptodate.com/contents/serum-anion-gap-in-conditions-other-than-metabolic-acidosis

Gounden V, Bhatt H, Jialal I. Renal function tests. In: StatPearls. Updated July 20, 2020. Accessed July 5, 2021. https://www.ncbi.nlm.nih.gov/books/NBK507821/

Inker LA, Perrone RD. Lab interpretation: High blood urea nitrogen in adults. In: Sterns RH, ed. UpToDate. Updated June 26, 2019. Accessed July 5, 2021. https://www.uptodate.com/contents/high-blood-urea-nitrogen-in-adults

Inker LA, Perrone RD. Assessment of kidney function. In: Sterns RH, ed. UpToDate. Updated April 29, 2021. Accessed July 5, 2021. https://www.uptodate.com/contents/assessment-of-kidney-function

Kalantar-Zadeh K, McCullough PA, Agarwal SK, et al. Nomenclature in nephrology: preserving ‘renal’ and ‘nephro’ in the glossary of kidney health and disease. J Nephrol. 2021;34(3):639-648. doi:10.1007/s40620-021-01011-3

Malkina A. Acute kidney injury. Merck Manual Consumer Edition. Updated March 20, 2020. Accessed July 5, 2021.

https://www.msdmanuals.com/home/kidney-and-urinary-tract-disorders/kidney-failure/acute-kidney-injury

Malkina A. Chronic kidney disease. Merck Manual Consumer Edition. Updated March 20, 2020. Accessed July 5, 2021. https://www.merckmanuals.com/home/kidney-and-urinary-tract-disorders/kidney-failure/chronic-kidney-disease

MedlinePlus: National Library of Medicine. Albumin blood test. Updated July 30, 2020. Accessed July 5, 2021. https://medlineplus.gov/lab-tests/albumin-blood-test/

MedlinePlus: National Library of Medicine. Anion gap blood test. Updated July 30, 2020. Accessed July 2, 2021. https://medlineplus.gov/lab-tests/anion-gap-blood-test/

MedlinePlus: National Library of Medicine. Blood glucose test. Updated July 30, 2020. Accessed July 2, 2021. https://medlineplus.gov/lab-tests/blood-glucose-test/

MedlinePlus: National Library of Medicine. BUN (blood urea nitrogen). Updated July 30, 2020. Accessed July 5, 2021. https://medlineplus.gov/lab-tests/bun-blood-urea-nitrogen/

MedlinePlus: National Library of Medicine. Calcium blood test. Updated July 30, 2020. Accessed July 5, 2021. https://medlineplus.gov/lab-tests/calcium-blood-test/

MedlinePlus: National Library of Medicine. Carbon dioxide (CO2) in blood. Updated July 30, 2020. Accessed July 5, 2021. https://medlineplus.gov/lab-tests/carbon-dioxide-co2-in-blood/

MedlinePlus: National Library of Medicine. Chloride blood test. Updated July 30, 2020. Accessed July 5, 2021. https://medlineplus.gov/lab-tests/chloride-blood-test/

MedlinePlus: National Library of Medicine. Potassium blood test. Updated July 31, 2020. Accessed July 5, 2021. https://medlineplus.gov/lab-tests/potassium-blood-test/

MedlinePlus: National Library of Medicine. Sodium blood test. Updated July 31, 2020. Accessed July 5, 2021. https://medlineplus.gov/lab-tests/sodium-blood-test/

MedlinePlus: National Library of Medicine. Globulin test. Updated July 31, 2020. Accessed July 5, 2021. https://medlineplus.gov/lab-tests/globulin-test/

MedlinePlus: National Library of Medicine. Creatinine test. Updated December 22, 2020. Accessed July 5, 2021. https://medlineplus.gov/lab-tests/creatinine-test/

MedlinePlus: National Library of Medicine. Comprehensive metabolic panel (CMP). Updated March 2, 2021. Accessed July 5, 2021. https://medlineplus.gov/lab-tests/comprehensive-metabolic-panel-cmp/

National Institutes of Health Office of Dietary Supplements. Potassium. Updated March 26, 2021. Accessed July 5, 2021. https://ods.od.nih.gov/factsheets/Potassium-HealthProfessional/

National Institutes of Health Office of Dietary Supplements. Calcium. Updated March 29, 2021. Accessed July 5, 2021. https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/

National Kidney Foundation. National Kidney Foundation, American Society for Clinical Pathology, leading laboratories and clinical laboratory societies unite to diagnose chronic kidney disease. Published February 21, 2018. Accessed July 2, 2021. https://www.kidney.org/news/national-kidney-foundation-american-society-clinical-pathology-leading-laboratories-and

National Kidney Foundation and American Society for Clinical Pathology. Laboratory engagement plan: Transforming kidney disease detection. Published February 2018. Accessed July 2, 2021. https://www.ascp.org/content/docs/default-source/get-involved-pdfs/istp-ckd/laboratory-engagement-plan.pdf

Shrimanker I, Bhattarai S. Electrolytes. In: StatPearls. Updated September 12, 2020. Accessed July 5, 2021. https://www.ncbi.nlm.nih.gov/books/NBK541123/