Centralized Core Laboratory - Mayo Clinic Laboratories :
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PATIENT INFO
Patient Name:
Medical Record #:
BD: //Sex: F M
PHYSICIAN INFO
Physician Name :
Address:
Ph: ()-Fax: ()-
Additional Report to:
Ph: ()-Fax: ()-
TESTS REQUESTED
Test Name:
ICD9 Code: (required)
1. Cystatin C
2.
3.
4.
5.
6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
CYSTC
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
GOLD TOP (SST) TUBE
Alternate Tube Type:
Red top tube
Collection Volume:
1.5 mL (minimum 1.0 mL)
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Immunoturbidimetric
Special Instructions:
Cystatin C:
1849 years: 0.631.03 mg/L;
> or =50 years: 0.671.21 mg/L;
017 years: Reference values have not been established. Refer to estimated glomerular filtration rate (eGFR).
Estimated GFR:
>60 mL/min/BSA;
Adult eGFR: Estimated GFR calculated using CKDEPI Cystatin C equation.
Pediatric eGFR: Estimated GFR calculated using Schwartz Cystatin C equation
Lab/Phone:
330-543-8418
CPT Code:
82610
Panel Includes:
Cystatin C, Serum
Estimated Glomerular Filtration Rate (eGFR) by Cystatin C
Cystatin C
Test ID/Workstation :
CYSTC
Specimen Type:
Blood
Tube Type:
GOLD TOP (SST) TUBE
Collection Volume:
1.5 mL (minimum 1.0 mL)
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Immunoturbidimetric
Special Instructions:
Cystatin C:
1849 years: 0.631.03 mg/L;
> or =50 years: 0.671.21 mg/L;
017 years: Reference values have not been established. Refer to estimated glomerular filtration rate (eGFR).
Estimated GFR:
>60 mL/min/BSA;
Adult eGFR: Estimated GFR calculated using CKDEPI Cystatin C equation.
Pediatric eGFR: Estimated GFR calculated using Schwartz Cystatin C equation
Lab/Phone:
330-543-8418
CPT Code:
82610
Panel Includes:
Cystatin C, Serum
Estimated Glomerular Filtration Rate (eGFR) by Cystatin C
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