Thanks to those who replied to my query last month. It's difficult to draw
any firm conclusions from the 8 replies I had, but no-one uses a ULN which
rises for the elderly. (Good.) There is a 50:50 split in the use or not of
gender-related ranges. A couple of labs use an additional comment at 150
umol/l pointing out renal impairment and to consider referral to a
nephrologist.
A different approach (from a non-UK colleague) is to link results to a
calculation of GFR, a classification table and a clinical guideline. The
reference range is therefore of lesser importance. I am sure this is beyond
the IT capabilities of most NHS institutions at present. (Although I bet
Jonathan Kay would disagree!)
Paul
Dr Paul Masters
Consultant Chemical Pathologist
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