Bespoke Panel 4 is a broad blood chemistry panel of 19 tests. It looks at kidney and liver function, muscle and tissue enzymes, calcium and phosphate, uric acid, vitamin D, glucose, CRP and a cholesterol profile, bringing together the routine tests clinicians use to review how the kidneys, liver, bones and metabolism are working.
It contains the same tests as Bespoke Panel 3 without D-dimer, and it can be collected at our Maidstone clinic.
What is measured
- Kidney: urea, creatinine, eGFR
- Liver: bilirubin, total protein, albumin, globulin, ALP, ALT, gamma GT
- Muscle and tissue: creatine kinase, LDH
- Bone and minerals: calcium, phosphate, vitamin D
- Metabolic: glucose, uric acid
- Heart and cholesterol: cholesterol profile
- Inflammation: CRP
Useful for
- A general chemistry baseline covering several organs in one sample
- Rechecking results such as liver tests, calcium, uric acid or vitamin D that a clinician has suggested repeating
- Reviewing cholesterol and glucose alongside kidney and liver function
Sample: venous blood, ideally after an overnight fast. Biomarkers: 19 named tests; the cholesterol profile reports several values. Price includes: laboratory analysis and the laboratory report with reference ranges; interpretation is optional.
Bespoke Panel 4 (excl. D-Dimer)
All values are measured unless marked as calculated.
Kidney
- Urea: kidney clearance, hydration and protein intake.
- Creatinine: muscle waste product cleared by the kidneys; eGFR is calculated from it.
Liver
- ALT: liver cell injury. ALP and gamma GT: bile duct enzymes (ALP also from bone).
- Bilirubin, albumin and total protein: liver processing and protein production; globulin is calculated as total protein minus albumin.
Muscle and tissue
- Creatine kinase: muscle enzyme. LDH: non-specific tissue enzyme.
Bone, minerals and metabolism
- Calcium (an albumin-adjusted value may also be reported) and phosphate: bone mineral balance.
- Vitamin D (25-hydroxyvitamin D): vitamin D status.
- Glucose: blood sugar at the time of sampling. Uric acid: purine breakdown product linked to gout.
- CRP: acute-phase marker of infection and inflammation.
Cholesterol profile
- Total cholesterol, HDL cholesterol and triglycerides, with LDL cholesterol, non-HDL cholesterol and the total/HDL ratio usually calculated. The laboratory report confirms the exact values included.
Calculated values: eGFR, globulin, non-HDL cholesterol, total/HDL ratio and, usually, LDL cholesterol.
Kidney function
Creatinine is produced fairly steadily from creatine in muscle and cleared by the kidneys, so it rises as filtration falls. eGFR turns creatinine, age and sex into a filtration estimate, which NICE NG203 notes is less accurate at extremes of muscle mass or with very high protein intake. Urea also reflects hydration and protein intake. Kidney damage can exist while eGFR is still normal, which is why NICE pairs eGFR with a urine albumin to creatinine ratio; that urine test is not included here.
Liver tests
ALT is released when liver cells are damaged (a hepatocellular pattern). ALP and gamma GT rise when bile flow is impaired (a cholestatic pattern); ALP also comes from bone and, in pregnancy, the placenta. Albumin is made by the liver and bilirubin is processed by it, and globulin adds information about antibodies and carrier proteins. British Society of Gastroenterology guidance sets out how abnormal liver tests are followed up, and the pattern usually matters more than any single value.
Muscle, bone and metabolism
Creatine kinase leaks from muscle after exertion or injury and can rise with some medicines, including statins; LDH comes from almost every tissue. Almost all the body's calcium is in bone, and blood calcium and phosphate are held in range by parathyroid hormone and vitamin D. Uric acid comes from the breakdown of purines in food and the body's own cells and is excreted by the kidneys. Glucose is a snapshot of blood sugar, CRP rises within hours of inflammation, and the cholesterol profile gives the values used with QRISK3 in NHS cardiovascular risk assessment (NICE NG238).
With 19 tests and several cholesterol values, a borderline result or two is not unusual in healthy people, so the overall pattern matters.
Reading patterns
- Raised creatine kinase and LDH after hard training point towards muscle rather than liver.
- A raised ALP with normal gamma GT suggests bone rather than bile ducts; ALP is also higher during growth and pregnancy.
- A mildly raised bilirubin with otherwise normal liver tests is often Gilbert's syndrome, a common, harmless inherited variation that shows more when fasting or unwell.
- Higher urea and albumin together can simply reflect mild dehydration.
- Creatine supplements, a muscular build or a large meat meal can raise creatinine and lower eGFR; statins can raise CK; alcohol raises gamma GT; haemolysis raises LDH.
Recognised UK thresholds
- Calcium: NICE NG132 advises repeating an adjusted calcium of 2.6 mmol/L or above (2.5 mmol/L or above with symptoms).
- Uric acid: NICE NG219 uses 360 micromol/L or above to support a gout diagnosis in someone with symptoms.
- Vitamin D: below 25 nmol/L is defined as deficiency.
- Cholesterol: NICE NG238 advises specialist assessment when total cholesterol is above 9.0 mmol/L or non-HDL above 7.5 mmol/L.
- Kidney: chronic kidney disease requires changes lasting more than three months.
A result outside the range is a prompt for review, not a diagnosis. Where a result needs medical attention, we advise you to see your GP and, with your consent, Juvenology can write to them. Symptoms should never wait for a test result.
Early chronic kidney disease, raised cholesterol, a high calcium and vitamin D deficiency often cause few or no symptoms at first, which is why blood tests are used to find them. Measuring these markers together lets each be read in context: kidney function beside uric acid and calcium, liver enzymes beside muscle enzymes, glucose beside cholesterol. The panel does not include a blood count, thyroid tests or HbA1c; a broader package may suit you better if those matter.
May be helpful for
- Adults who want a chemistry baseline across the kidneys, liver, bones and metabolism.
- People asked to recheck liver tests, calcium, uric acid, vitamin D or cholesterol.
- People considering Bespoke Panel 3 who have not been asked for D-dimer.
Probably not the right choice if
- You have yellowing skin or eyes, severe abdominal pain, very dark urine or pale stools: contact your GP urgently or NHS 111.
- You have a hot, painful, swollen joint: see your GP, as uric acid can be normal during a gout flare.
- Your kidney or liver condition is already monitored, or you are pregnant: follow your existing care plan.
Established clinical use. Kidney function, cholesterol and glucose are part of standard NHS risk assessment. Kidney filtration tends to decline gradually with age, so a baseline helps interpret later results.
Population associations. Higher uric acid is associated with high blood pressure and cardiovascular disease in observational research, but lowering it in people without gout has not been shown to improve those outcomes.
Unproven ideas. In large trials, vitamin D supplements given to people who were not deficient did not show broad benefits for preventing heart disease or cancer, so raising a normal level is not an evidence-based goal. No chemistry panel can measure biological age.
- Fasting: an overnight fast with water only is recommended so glucose can be read as a fasting value; we confirm at booking. If you take diabetes medicines, ask your diabetes team before fasting.
- Exercise, food and alcohol: avoid strenuous or unaccustomed exercise for 48 hours, a large meat meal the evening before and heavy drinking in the days before.
- Supplements: tell us about creatine, vitamin D, calcium or biotin; high-dose biotin can interfere with some immunoassays.
- Medicines: keep taking prescribed medicines and list them, particularly statins, diuretics, gout treatments and anti-inflammatory painkillers.
Choose how your sample is taken when you book. We confirm the collection option, any collection fee and the expected turnaround time before you book.
- Juvenology Clinic, Maidstone (82 King Street, Maidstone ME14 1BH): Available.
- Partner collection location, including London: Available on request. We confirm availability for your postcode before you book.
- Postal home finger-prick kit: Not available for this test.
Sample: Venous blood samples (serum, with a separate tube for glucose if the laboratory requires one; tube types confirmed by the laboratory)
Collection notes: Venous sample at the Maidstone clinic or, on request, a partner location. Overnight fast (water only) recommended for glucose. Avoid strenuous exercise for 48 hours (CK, LDH). Not offered as a postal finger-prick kit: glucose falls during transit and finger-prick haemolysis can falsely raise LDH.
The price of this test covers laboratory analysis and the laboratory's results report. The report lists each result beside the laboratory's reference range.
Beyond the blood test: optional support, priced separately
- Personalised written interpretation report: £50
- General consultation: £50
- Results consultation (results discussion and follow-up advice): £100
- Personalised programme: from £150, after we assess whether a programme suits you
Consultations are with Marina, an NMC-registered nurse with an Executive MSc in Longevity from the Geneva College of Longevity Science. She explains what your results show and how they relate to lifestyle. No prescription service is offered with these tests.
If a result suggests you need medical follow-up, we will recommend that you see your GP and, with your consent, can provide a letter to take with you. A blood test cannot rule out every condition. If you have symptoms, speak to your GP or NHS 111, and call 999 in an emergency.
How is Bespoke Panel 4 different from Bespoke Panel 3?
The tests are the same except that Bespoke Panel 3 adds D-dimer, appropriate only when a doctor has requested it. Bespoke Panel 4 costs less and can be collected at our Maidstone clinic; Bespoke Panel 3 is London only.
Do I need to fast?
An overnight fast is recommended for glucose. Cholesterol can be measured without fasting, although triglycerides are higher after food.
My bilirubin is slightly high but other liver tests are normal. Why?
A common explanation is Gilbert's syndrome, an inherited and harmless difference in bilirubin processing. Your GP can confirm it and decide whether other tests are needed.
Does a high uric acid mean I have gout?
No. Many people with raised uric acid never develop gout. NICE uses uric acid to support a diagnosis in people with typical joint symptoms.
Does this panel fully assess my kidneys?
It describes filtration (creatinine, eGFR, urea). A full NICE kidney assessment also uses a urine albumin to creatinine ratio, which is not included.
Is interpretation of my results included?
The price covers laboratory analysis and the laboratory's report, showing each result beside its reference range. Interpretation is optional: a personalised written report costs £50 and a results consultation £100. Marina Kostadinova-Yankova, an NMC-registered nurse, provides these; she does not diagnose or prescribe, and will advise you to see your GP where a result needs medical attention.
Can I use a home finger-prick kit?
No. Glucose falls in a sample that waits in the post, and finger-prick sampling can damage red cells and falsely raise LDH.
- Chronic kidney disease: assessment and management (NG203). NICE, 2021. https://www.nice.org.uk/guidance/ng203
- Newsome PN, Cramb R, Davison SM, et al. Guidelines on the management of abnormal liver blood tests. Gut, 2018;67(1):6–19. https://gut.bmj.com/content/67/1/6
- Hyperparathyroidism (primary): diagnosis, assessment and initial management (NG132). NICE, 2019. https://www.nice.org.uk/guidance/ng132
- Gout: diagnosis and management (NG219). NICE, 2022. https://www.nice.org.uk/guidance/ng219
- Cardiovascular disease: risk assessment and reduction, including lipid modification (NG238). National Institute for Health and Care Excellence (NICE), 2023. https://www.nice.org.uk/guidance/ng238
- Lactate dehydrogenase (LDH). Lab Tests Online UK, Association for Laboratory Medicine. https://labtestsonline.org.uk/tests/lactate-dehydrogenase-ldh
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