Beyond Renal Pathology:Lab Issues for Nephrologists

To some extent, the lab is probably a nephrologist’s most important tool, suggests Csaba Kovesdy, MD. “We are dealing by and large with an asymptomatic disease, and the way we track the disease and its consequences is by using the lab,” explains the division chief of nephrology at the VA Medical Center in Salem, Virginia. “Having a good laboratory support service is essential to our work.”


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Still, renal pathology is not an everyday activity for most nephrologists. “It’s really the clinical chemistry laboratory and the hematology laboratory that we rely on multiple times every day.”

To that end, Dr. Kovesdy outlines two key lab issues for nephrologists:

  • Nephrologists used to assess each inpatient’s urine themselves, but now the only official assessment can come from a laboratory certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA ’88). “I think it was thought that the lab could do an equally good or better job than we nephrologists could, and I would venture to say that 99% of my colleagues would vehemently disagree with that. It is a major issue that is unresolved and probably will remain unresolved from our standpoint.”
  • The measurement of serum creatinine is not standardized, and the varying measurements between labs can amount to significant differences in glomerular filtration rate. This can lead to the misdiagnosis of certain conditions, especially if the patient’s kidney function is relatively close to normal. Parathyroid hormone is not standardized, either, making it difficult to follow recommendations for treatment based on parathyroid hormone measurements done with different assays. “Again,” Dr. Kovesdy says, “it’s one of those issues that probably won’t be resolved in the near future because it affects a relatively narrow segment of physicians since parathyroid hormones are measured predominantly by nephrologists.”