Ulta Lab Tests

Coimbra Protocol Panel

The following is a list of what is included in the item above. Click the test(s) below to view what biomarkers are measured along with an explanation of what the biomarker is measuring.

Also known as: ALB, Albumin ALB

Albumin

Albumin is a protein made by the liver. A serum albumin test measures the amount of this protein in the clear liquid portion of the blood.

Also known as: BUNCreatinine Ratio

Bun/Creatinine Ratio

A ratio between a person’s BUN and blood creatinine to help determine what is causing these concentrations to be higher than normal. The ratio of BUN to creatinine is usually between 10:1 and 20:1. An increased ratio may be due to a condition that causes a decrease in the flow of blood to the kidneys, such as congestive heart failure or dehydration. It may also be seen with increased protein, from gastrointestinal bleeding, or increased protein in the diet. The ratio may be decreased with liver disease (due to decrease in the formation of urea) and malnutrition.

Creatinine

The creatinine blood test measures the level of creatinine in the blood. This test is done to see how well your kidneys work.

Egfr African American

Glomerular filtration rate (GFR) is a test used to check how well the kidneys are working. Specifically, it estimates how much blood passes through the glomeruli each minute. Glomeruli are the tiny filters in the kidneys that filter waste from the blood.

Egfr Non-Afr. American

Glomerular filtration rate (GFR) is a test used to check how well the kidneys are working. Specifically, it estimates how much blood passes through the glomeruli each minute. Glomeruli are the tiny filters in the kidneys that filter waste from the blood.

Urea Nitrogen (Bun)

BUN stands for blood urea nitrogen. Urea nitrogen is what forms when protein breaks down. BUN measures the amount of urea nitrogen in the blood.

Also known as: Calcium 24Hour Urine without Creatinine

Calcium, 24 Hour Urine

You have more calcium in your body than any other mineral. Calcium has many important jobs. The body stores more than 99 percent of its calcium in the bones and teeth to help make and keep them strong. The rest is throughout the body in blood, muscle and the fluid between cells. Your body needs calcium to help muscles and blood vessels contract and expand, to secrete hormones and enzymes and to send messages through the nervous system.

Total Volume

Also known as: Calcium Ionized

Calcium, Ionized

You have more calcium in your body than any other mineral. Calcium has many important jobs. The body stores more than 99 percent of its calcium in the bones and teeth to help make and keep them strong. The rest is throughout the body in blood, muscle and the fluid between cells. Your body needs calcium to help muscles and blood vessels contract and expand, to secrete hormones and enzymes and to send messages through the nervous system.

Ferritin

Ferritin is a protein found inside cells that stores iron so your body can use it later. A ferritin test indirectly measures the amount of iron in your blood. The amount of ferritin in your blood (serum ferritin level) is directly related to the amount of iron stored in your body.

Also known as: Inorganic Phosphate, P, Phosphate as Phosphorus, Phosphorus, PO4

Phosphate (As Phosphorus)

This test is performed to see how much phosphorus in your blood. Kidney, liver, and certain bone diseases can cause abnormal phosphorus levels.

Also known as: Phosphate 24 Hour Urine WCreatinine

Creatinine, 24 Hour Urine

Phosphate, 24 Hour Urine

Phosphate/Creat Ratio

Total Volume

Also known as: "Biointact" PTH and Calcium, Intact PTH and Calcium, Parathyroid Hormone and Calcium, PTH and Calcium, PTH Intact and Calcium

Calcium

You have more calcium in your body than any other mineral. Calcium has many important jobs. The body stores more than 99 percent of its calcium in the bones and teeth to help make and keep them strong. The rest is throughout the body in blood, muscle and the fluid between cells. Your body needs calcium to help muscles and blood vessels contract and expand, to secrete hormones and enzymes and to send messages through the nervous system.

PARATHYROID HORMONE,

PTH stands for parathyroid hormone. It is a protein hormone released by the parathyroid gland. Parathyroid hormone controls calcium, phosphorus, and vitamin D levels in the blood and bone. Release of PTH is controlled by the level of calcium in the blood. Low blood calcium levels cause increased PTH to be released, while high blood calcium levels block PTH release.

Vitamin D, 25-Oh, D2

Vitamin D2 ((ergocalciferol,) is found in fortified foods and in most vitamin preparations and supplements. Vitamin D comes from two sources: endogenous, which is produced in the skin on exposure to sunlight, and exogenous, which is ingested in foods and supplements. The D2 form is found in fortified foods and in most vitamin preparations and supplements. Vitamin D2 is effective when it is converted by the liver and the kidney into the active form, 1,25-dihydroxyvitamin D.

Vitamin D, 25-Oh, D3

Vitamin D3 (cholecalcifero) which comes from animals. Vitamin D comes from two sources: endogenous, which is produced in the skin on exposure to sunlight, and exogenous, which is ingested in foods and supplements. Vitamin D3 is the form produced in the body and is also used in some supplements. Vitamin D3 are is converted by the liver and the kidney into the active form, 1,25-dihydroxyvitamin D.

Vitamin D, 25-Oh, Total

Vitamin D comes from two sources: endogenous, which is produced in the skin on exposure to sunlight, and exogenous, which is ingested in foods and supplements. The chemical structures of the types of vitamin D are slightly different, and they are named vitamin D2 (ergocalciferol, which comes from plants) and vitamin D3 (cholecalciferol, which comes from animals). The D2 form is found in fortified foods and in most vitamin preparations and supplements. Vitamin D3 is the form produced in the body and is also used in some supplements. Vitamin D2 and D3 are equally effective when they are converted by the liver and the kidney into the active form, 1,25-dihydroxyvitamin D.

Also known as: Free T4, FT4, T4 Free

T4, Free

The free T4 test is not affected by protein levels. Since free T4 is the active form of thyroxine, the free T4 test is may be a more accurate reflection of thyroid hormone function.

Also known as: Thyroid Stimulating Hormone, Thyroid Stimulating Hormone (TSH), Thyrotropin

TSH

A TSH test is a lab test that measures the amount of thyroid stimulating hormone (TSH) in your blood. TSH is produced by the pituitary gland. It tells the thyroid gland to make and release thyroid hormones into the blood.
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The Coimbra Protocol Panel panel contains 11 tests with 22 biomarkers .

Coimbra Protocol Panel: Comprehensive Overview

The Coimbra Protocol Panel is a specialized set of laboratory tests designed to assess various biochemical and physiological markers essential for monitoring patients undergoing high-dose vitamin D therapy. This protocol is primarily utilized for patients with autoimmune disorders, particularly multiple sclerosis, and other chronic inflammatory conditions. The panel provides a detailed evaluation of kidney function, calcium metabolism, phosphate balance, iron storage, and thyroid function. By examining these key biomarkers, healthcare professionals can tailor high-dose vitamin D therapy to optimize patient outcomes while mitigating potential risks such as hypercalcemia and kidney dysfunction.

When and Why the Coimbra Protocol Panel May Be Ordered

The Coimbra Protocol Panel is typically ordered for individuals who are either beginning or currently undergoing high-dose vitamin D therapy as part of the Coimbra Protocol. This protocol, pioneered by Dr. Cicero Coimbra, is based on the concept that autoimmune diseases may be linked to vitamin D resistance. High-dose vitamin D is administered to modulate the immune system, reduce inflammation, and improve disease outcomes. However, because excessive vitamin D can lead to complications such as hypercalcemia, kidney damage, and imbalances in phosphate metabolism, regular monitoring is crucial.

Healthcare providers order this panel to ensure that the patient’s kidney function remains stable, calcium and phosphate levels are maintained within a safe range, and thyroid function is not adversely affected by the therapy. Additionally, the panel assesses iron storage levels, as ferritin plays a role in immune function and overall metabolic health. By closely monitoring these biomarkers, providers can adjust vitamin D dosage, recommend dietary modifications, and implement supportive treatments as needed.

What the Coimbra Protocol Panel Checks For

The Coimbra Protocol Panel evaluates multiple physiological processes, including kidney function, calcium homeostasis, phosphate regulation, vitamin D status, and thyroid function. Each test provides critical insights that help guide treatment decisions.

Kidney Function

Kidney function is assessed through markers such as albumin, urea nitrogen, and creatinine. The kidneys play a vital role in filtering waste products, maintaining electrolyte balance, and regulating calcium and phosphate excretion. Elevated urea nitrogen or creatinine levels may indicate impaired kidney function, which is a crucial consideration when administering high-dose vitamin D, as excessive calcium levels can place strain on the kidneys. Albumin levels provide additional insight into kidney health, as low levels may indicate protein loss due to kidney dysfunction.

Calcium Metabolism

Calcium homeostasis is a central concern in high-dose vitamin D therapy, making the measurement of ionized calcium, total calcium, and 24-hour urine calcium essential. Ionized calcium represents the biologically active form of calcium in the bloodstream, whereas total calcium includes both bound and unbound calcium. Monitoring both ensures that calcium levels remain within a safe range. Excess calcium can lead to symptoms such as kidney stones, calcification of soft tissues, and neurological disturbances. Additionally, measuring 24-hour urine calcium helps assess whether the kidneys are excreting excess calcium appropriately or if there is a risk of hypercalciuria, which can indicate impending kidney stress or damage.

Phosphate Balance

Phosphate metabolism is closely linked to vitamin D and calcium regulation. The panel includes measurements of serum phosphate and 24-hour urine phosphate. Vitamin D plays a role in phosphate absorption, and imbalances can lead to bone demineralization or ectopic calcification. Monitoring phosphate levels ensures that vitamin D therapy is not causing an abnormal phosphate retention or loss, which could have detrimental effects on bone health and overall metabolic function.

Vitamin D Status

Vitamin D total with D2 and D3 quantifies the levels of circulating vitamin D in its different forms. Vitamin D2 is typically derived from plant sources and supplements, while vitamin D3 is synthesized in the skin and obtained from animal sources. This test helps determine whether vitamin D levels are within the desired therapeutic range for the Coimbra Protocol. Since patients on this protocol receive exceptionally high doses, ensuring that levels are neither deficient nor excessively high is critical for preventing toxicity.

Thyroid Function

The thyroid panel within the Coimbra Protocol Panel includes T4 Free and TSH (thyroid-stimulating hormone). These tests assess thyroid function, which can be influenced by high-dose vitamin D therapy. T4 Free represents the active form of thyroxine, which is essential for metabolism and overall endocrine balance. TSH is produced by the pituitary gland and regulates thyroid hormone production. Since thyroid dysfunction can mimic some symptoms of vitamin D toxicity, monitoring these markers ensures that symptoms are correctly attributed to their underlying cause rather than misinterpreted.

How Healthcare Professionals Use the Results of the Coimbra Protocol Panel

Healthcare professionals use the Coimbra Protocol Panel results to guide treatment decisions, adjust vitamin D dosages, and mitigate potential side effects. If kidney function markers such as creatinine or urea nitrogen are elevated, physicians may lower the vitamin D dose or recommend increased hydration to support renal clearance. Elevated calcium levels may prompt dietary modifications, increased fluid intake, or the use of calcium-lowering agents. Conversely, if calcium levels are too low, vitamin D dosing may be increased cautiously to achieve the desired immunomodulatory effect.

Phosphate balance results are carefully reviewed to prevent complications such as bone demineralization or ectopic calcification. If phosphate levels are too high, dietary restrictions or phosphate binders may be considered. For patients with suboptimal vitamin D levels despite high-dose therapy, absorption issues or genetic factors may be explored.

Thyroid function tests help differentiate between symptoms caused by vitamin D imbalances and those resulting from thyroid disorders. If abnormal TSH or T4 Free levels are detected, further endocrinological evaluation may be required to rule out thyroid disease or adjust vitamin D therapy accordingly.

Conclusion

The Coimbra Protocol Panel is an essential tool for safely managing high-dose vitamin D therapy in patients with autoimmune and chronic inflammatory conditions. By evaluating kidney function, calcium metabolism, phosphate regulation, vitamin D status, and thyroid function, this panel ensures that therapy remains effective while minimizing potential risks. Healthcare providers rely on this panel to make informed decisions, adjust treatment plans, and optimize patient outcomes. With proper monitoring and interpretation, the Coimbra Protocol can be administered safely, allowing patients to reap the full benefits of vitamin D therapy while safeguarding against complications.

 

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