Technical Questions

1) Can Formalin interfere with a stone analysis and/or alter a stone’s composition?

2) Does Herring Lab locate the nidus in every stone?

3) Does Herring Lab provide a custom written description of the stone structure and quantitate the chemical analytes as a percentage of the whole specimen?

4) Does Herring Lab ever analyze specimens that are not stones?

5) Does Herring Lab offer photographs of the stone specimen?

6) Does Herring Lab use a secure connection for On-line Internet Resulting that is HIPAA compliant?

7) Does Herring Lab participate in Proficiency Testing?

8) Is Herring Lab a Nationally Accredited Lab?

Answers

1) Can Formalin interfere with a stone analysis and/or alter a stone’s composition?

Yes. Although relatively infrequent, formalin solution can convert Struvite to Newberyite. It may also partially or completely dissolve uric acid and/or convert it to addition products. These conversions are usually limited to the surfaces of specimens. Formalin can also reduce the sensitivity of, or inhibit, certain micro-chemical tests such as a determination of ammonia using Nessler’s solution.

Specimens exposed to formalin should be thoroughly air dried before submission. Please note “formalin” on the lab requisition.

2) Does Herring Lab locate the nidus in every stone?

No. Identifying the location of the “nidus” (plural: “nidi”) is achieved by a thorough optical examination of the specimen. Non-optical means to accomplish this currently do not exist. The validity of an identification of the “nuclear area(s)” of a stone is directly related to the long-term experience and analytic ability of the analyst.

Several factors may prohibit, or make unreliable, a determination of the nuclear area(s) of stone specimens.

Intact stone structures can be quite irregular in deposition and composition unrevealing of centric, eccentric or multi-centric nuclear deposits.

Specimens submitted as partial stones or stone fragments are frequently unreliable for nuclear determinations for many reasons, such as misleading multi-radial structures presenting central foci or possibly, outer lamina. Therefore, we normally do not address the presence or the absence of the nidus for specimens submitted as fragments.

Long-term experience is most beneficial for reliable identifications of the nidus. Our analysts have between 17 to 30 years of continuous experience.

3) Does Herring Lab provide a custom written description of the stone structure and quantitate the chemical analytes as a percentage of the whole specimen?

Yes. Our descriptive written report reveals the structural order of deposition as presented and each chemical analyte is quantitated as a percentage of the whole.

Standardized non-written formats lack specificity regarding the applicable structure, order and quantitation of the specimen. Certain formats use a pre-analytical group of structural components (e.g., “Core/Shell/Layers” or “Nidus/Body/Surface”) for routine reporting and quantitate each structural component separately for analytes (i.e., core total = 100 %, surface total = 100%, etc.). Some include an additional quantitation of the structural components as a percentage of the whole. Few include a direct quantitation of the analytes as a percentage of the whole. Several factors (e.g., partial stones or fragments, deeply embedded crystalline structures, homogeny, etc.) place added concerns upon standardized reporting formats.

4) Does Herring Lab ever analyze specimens that are not stones?

Yes. Approximately 4% of all specimens submitted to Herring Lab are not kidney stones. Non-stone specimens usually consist of physiological (i.e., blood, mucoprotein, tissue, etc.) particulate matter. These specimens demonstrate none of the substances (typically crystalline) normally associated with endogenous concretions. The remaining types of particulate matter are probable mis-collections (i.e., synthetic fibers, vegetable matter, rocks, pipe scale, etc.) from the various settings in which they were obtained. A rare few are intentional deceptions (stone malingerers).

5) Does Herring Lab offer photographs of the stone specimen?

Yes. Detailed photomicrographs are available upon request for a small additional charge. Our photos are Kodak Professional Grade, 8½” x 12”, plastic laminated stock. Two magnified clear images, one of the exterior and one of the interior, when applicable, are provided on one sheet of heavy photographic paper.

6) Does Herring Lab use a secure connection for On-line Internet Resulting that is HIPAA compliant?

Yes. Our server transfers our results over a 128 bit encrypted https connection. As also required by HIPAA, the integrity of the transferred data cannot be modified by the end-user and logs of all client transfers are maintained.

7) Does Herring Lab participate in Proficiency Testing?

Yes. We have reciprocal arrangements with many of our competitors to provide semi-annual proficiency testing events. We are happy to provide proficiency testing services to any laboratory reporting the analytes composing the specimen. We do not provide this service to laboratories reporting only cations and anions as this type of analysis does not establish the analytes present. We are also happy to assist any laboratory with their difficult specimens for an additional charge.

8) Is Herring Lab a Nationally Accredited Lab?

Yes. We are inspected bi-annually by State and Federal agencies and hold the following licenses:

CLIA ---------------- 10D0275094

Florida --------------- L800000126

New York ----------- 3194 810043A0

Maryland ------------ 322

Rhode Island --------- 325

Medicare Provider --- L-8191

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