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10.1002/iub.2341 47 LiaoY.HuaX.CaiJ.XiaX.WangX.HuangH.et al (2017)

In the human kidney, it usually builds up in the segment one section of the proximal tubule, which also causes phosphate reabsorption issues (Fanconi), amino acid, protein, and bicarbonate by damaging transport proteins and mitochondria, which may cause tubular cells to die (4345)

While a blood test is the definitive way to diagnose a clinical deficiency, it isnt always required to start B12 injections for general wellness purposes