Sign in →

Test Code AL Aluminum, Serum

Important Note

  • Must be drawn at Outpatient Lab at the Main Campus
  • Must be collected in Royal Blue with RED Label

Reporting Name

Aluminum, S

Useful For

Preferred monitoring for aluminum toxicity in patients undergoing dialysis

 

Preferred test for routine aluminum screening

 

Monitoring metallic prosthetic implant wear

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Specimen Type

Serum


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:

-Metal Free B-D Tube (No Additive), 6 mL (T184)

-Metal Free Specimen Vial (T173)

Container/Tube: 6-mL Plain, royal blue-top Vacutainer plastic trace element blood collection tube

Submission Container/Tube: 7-mL Metal-free, screw-capped, polypropylene vial

Specimen Volume: 1.2 mL

Collection Instructions: See Metals Analysis Specimen Collection and Transport for complete instructions.


Specimen Minimum Volume

0.3 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 7 days METAL FREE
  Ambient  7 days METAL FREE
  Frozen  7 days METAL FREE

Reference Values

<7 ng/mL

<60 ng/mL (dialysis patients)

 

For International System of Units (SI) conversion for Reference Values, see www.mayocliniclabs.com/order-tests/si-unit-conversion.html

Day(s) Performed

Tuesday

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

82108

LOINC Code Information

Test ID Test Order Name Order LOINC Value
AL Aluminum, S 5574-9

 

Result ID Test Result Name Result LOINC Value
8373 Aluminum, S 5574-9

Interpretation

Patients in kidney failure not receiving dialysis therapy invariably have serum aluminum levels above the 60 ng/mL range.

 

McCarthy(1) and Hernandez(2) describe a biochemical profile that is characteristic of aluminum overload disease in dialysis patients:

-Patients in kidney failure with no signs or symptoms of osteomalacia or encephalopathy usually had serum aluminum below 20 ng/mL and parathyroid hormone (PTH) concentrations above 150 pg/mL, which is typical of secondary hyperparathyroidism.

-Patients with signs and symptoms of osteomalacia or encephalopathy had serum aluminum above 60 ng/mL and PTH concentrations below 50 pg/mL (PTH above the reference range, but low for secondary hyperparathyroidism).

-Patients who had serum aluminum above 60 ng/mL but below 100 ng/mL were identified as candidates for later onset of aluminum-overload disease and required aggressive efforts to reduce their daily aluminum exposure. This was done by switching them from aluminum-containing phosphate binders to calcium-containing phosphate binders, by ensuring that their dialysis water had less than 10 ng/mL of aluminum, and ensuring the albumin used during postdialysis therapy was aluminum free.

 

Prosthesis wear is known to result in increased circulating concentration of metal ions.(3) Modest increase (6-10 ng/mL) in serum aluminum concentration is likely to be associated with a prosthetic device in good condition. Serum concentrations above 10 ng/mL in a patient with an aluminum-based implant not undergoing dialysis suggest significant prosthesis wear. Increased serum trace element concentrations in the absence of corroborating clinical information do not independently predict prosthesis wear or failure.

Clinical Reference

1. McCarthy JT, Milliner DS, Kurtz SB, Johnson WJ, Moyer TP. Interpretation of serum aluminum values in dialysis patients. Am J Clin Pathol. 1986;86(5):629-636

2. Hernandez JD, Wesseling K, Salusky IB. Role of parathyroid hormone and therapy with active vitamin D sterols in renal osteodystrophy. Semin Dial. 2005;18(4):290-295

3. Liu TK, Liu SH, Chang CH, Yang RS. Concentration of metal elements in the blood and urine in the patients with cementless total knee arthroplasty. Tohoku J Exp Med. 1998;185(4):253-262

4. Schwarz C, Sulzbacher R, Oberbauer R. Diagnosis of renal osteodystrophy. Eur J Clin Invest. 2006;36 Suppl 2:13-22

5. Sharma AK, Toussaint ND, Pickering J, Beeston T, Smith ER, Holt SG. Assessing the utility of testing aluminum levels in dialysis patients. Hemodial Int. 2015;19(2):256-262 doi:10.1111/hdi.12231

6. Riihimaki V, Aitio A. Occupational exposure to aluminum and its biomonitoring in perspective. Crit Rev Toxicol. 2012;42(10):827-853 doi:10.3109/10408444.2012.725027

7. Strathmann FG, Blum LM: Toxic elements In: Rifai N, Chiu RWK, Young I, Burnham CAD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:455e55

8. US Department of Health and Human Services, Agency for Toxic Substances and Disease Registry. Toxicological Profile for Aluminum. HHS; 2006. Accessed August 29, 2023. Available at www.atsdr.cdc.gov/toxprofiles/tp22.pdf

9. Willhite CC, Karyakina NA, Yokel RA, et al. Systematic review of potential health risks posed by pharmaceutical, occupational and consumer exposures to metallic and nanoscale aluminum, aluminum oxides, aluminum hydroxide, and its soluble salts. Crit Rev Toxicol. 2014;44 Suppl 4(Suppl 4):1-80. doi:10.3109/10408444.2014.934439

Report Available

2 to 8 days

Method Name

Dynamic-Reaction Cell Inductively-Coupled Plasma Mass Spectrometry (DRC-ICP-MS)

Forms

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