Article

The benefit of pre- and post-challenge urine heavy metal testing: Part 2

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Abstract

Measuring heavy metal levels in the urine is an accepted method for assessing the presence of a heavy metal burden in an individual. Random samples (without a flushing agent) are excellent for showing current exposures, as they reflect the level of heavy metals in the bloodstream during the hours immediately before bladder voiding. Samples taken after using a heavy metal mobilizing agent are a reflection of total body burden. Part 1 reviewed the benefits of doing pre-flush (baseline) testing utilizing the published Centers for Disease Control (CDC) heavy metal normal ranges for interpretation that allow the clinician to identify current exposures to lead and mercury and to identify cadmium toxicity. In part 2 the benefits of doing both pre- and post-challenge testing are reviewed. Information gleaned from performing both tests is unparalleled in allowing the clinician to identify which chelating agent will be most effective for the patient. If oral agents are employed, then possible absorption problems can be identified. Since none of these benefits are realized with only post-flush testing, it is recommended that clinicians do heavy metal testing both before and after a challenge with an effective and proven heavy metal mobilizing agent. The pitfalls of oral chelation in the case of malabsorption syndromes, such as gluten intolerance, are also discussed.

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... Although people are exposed to multiple heavy metals at the same time, the dose that enters the body and acts on target organs is different due to different pathways in different environments. It has been proposed to use heavy metals in urine to represent the true exposure levels of the body (Crinnion, 2009). Moreover, some studies found that co-exposure to heavy metals may have different health effects, but they only discussed either one heavy metal or a few heavy metals (Sanders et al., 2019;Wu et al., 2018). ...
... Third, urinary heavy metal concentrations may not provide a comprehensive assessment of human exposure to heavy metals. However, previous studies have demonstrated that heavy metals in urine are well represented (Crinnion, 2009), and we used urine creatinine to correct them. Finally, we have only measured the internal exposure of heavy metals, which may limit this study to assess their external exposure level and source. ...
Article
Heavy metals are important risk factors for kidney, but their co-exposure effect on kidney and related mechanism remain unclear. This study evaluated the relationship between heavy metals and renal function, and the feasible mediation effect of oxidative stress. Based on the Dongdagou-Xinglong cohort, participants were recruited and their information were collected through questionnaires and physical examinations. The urine concentration of heavy metals like Cobalt, Nickel, Molybdenum, Cadmium, Antimony, Copper, Zinc, Mercury, Lead, Manganese, and renal injury biomarkers like β2-microglobulin, β-N-Acetylglucosaminidase, retinol-binding protein, 8-hydroxyguanine (8-OHG) were measured and corrected by creatinine. Linear regression was conducted to analyze the relationship between metals and renal biomarkers. Bayesian kernel machine regression, weighted quantile sum and quantile-based g-computation were applied to analyze the association between metal mixtures and renal biomarkers. Finally, the mediating effect of 8-OHG was analyzed through the mediation model. We found that these metals were positively related with renal biomarkers, where copper showed the strongest relationship. The co-exposure models showed that renal biomarkers increased with the concentration of mixtures, particularly for cadmium, copper, mercury, manganese. In addition, the proportion of 8-OHG in mediating effect of metals on renal function ranged from 2.6% to 86.9%. Accordingly, the renal function damage is positively associated with metals, and 8-OHG may play an important mediating role.
... Доведено, що після тривалого контакту з цими хімічними полютантами відбувається їх акумулювання в організмі, а найшвидшими та найдоступнішими індикаторами для реєстрації коливання вмісту ВМ в організмі є кров та сеча [5,10,12]. Беручи до уваги інтригуючі дані щодо мінливості рівня елімінації ВМ за допомогою сечовидільної системи [3,5,12] і тривале накопичення/резервування урини у сечовому міхурі (СМ) [4], метою нашого дослідження стало встановлення особливостей екскреції хімічних елементів з сечею та їх зв'язку зі зміною морфометричних показників слизової оболонки органа під час вживання СВМ у підвищених концентраціях і в період реадаптації. ...
... Також, зацікавленість до даного дослідження привертає факт різкого зниження рівня екскреції хімічних елементів в урині з поступовою стабілізацією морфометричних даних у період відновлення. Хоча надходження ВМ до організму було зупинено, вони все ще, були вище вихідних рівнів у контролі, що можливо пояснюється частковим компенсаторно-адаптативним виведенням з органів [3,5,10,11]. ...
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Introduction. Nowadays our environment is polluted by the exogenous pollutants that have negative impact on the ecosystem and causes health risks. Heavy metal salts (HMS) possess the leading place among all human-made xenobiotics. Extensive spreading of HMS leads to their ingestion into the body and increases their concentration in the urine that is a sensitive indicator for the imbalance of chemical elements. Therefore, the object of our study is to determine the features of the urinal excretion of chemical elements and their relation to the changes of morphometric indicators in the mucous membrane of the urinary bladder (UB) in the period of HMS intake in increased concentrations and during the readaptation period. Materials and Methods. Our research was carried out on the Wistar rats, which were divided into 3 groups, according to different experimental scenarios of HMS influence. Collected urine specimens were studied by using atomic absorption spectrometry (AAS). Morphometric indicators of UB mucous membrane were studied by using standard histological techniques and software "ZEN 2 (blue edition)". Results. It has been proved that the intake of HMS significantly increases its urinal excretion due to considerable morphometric changes in the components of the mucous membrane of the UB. It should be mentioned that if the intake of chemical pollutants is cancelled, their concentration in the urine is sharply reduced and the stabilization in the histomorphometric parameters is observed. The dependence between indicated parameters is confirmed by the presence of the correlation. Conclusions. Heavy metals intake is accompanied by the changes in the morphometric indicators of the components of the mucous membrane of the urinary bladder due to the increased concentration in the urine, caused by their correlation.
... It is suggested that air, high-fructose corn syrup, anytime lifetime history of dental amalgams, or even remote childhood exposure to secondhand smoke can be considered sources of exposure to metals necessitating further testing. If a source is not identified, it has been recommended that maternal exposures prior to conception be sought, even for adult patients [8]. In essence, it can be interpreted that one should continue searching for a history of exposure until any potential source is identified so that testing can be justified. ...
... The focus on factor increase is interesting because advocates of chelation challenge tests sometimes assert that, based on an individual's exposure history, the factor increase can be predicted. If the result is not as predicted, that serves as an indicator of a problem with excretion of metals due to another treatable condition [8]. The results from the Archbold study provide a good example of how useless the factor increase actually is. ...
Article
"Urine mobilization test," "challenge test," and "provoked urine test" are all terms used to describe the administration of a chelating agent to a person prior to collection of their urine to test for metals. There is no standard, validated challenge test. Despite recommendations by professional and government organizations against the use of provoked urine testing, the tests are still commonly used and recommended by some practitioners. Challenge testing utilizes a variety of chelating agents, including dimercaptosuccinic acid (DMSA), dimercaptopropanesulfonate (DMPS), and ethylenediaminetetraacetic acid (EDTA). The agents are given by a variety of routes of administration, doses used are inconsistent, and urine collection procedures vary. Additional problems with challenge tests include comparison of results to inappropriate reference ranges and creatinine correction of urine obtained within hours of chelator administration. Human volunteer studies demonstrate that mercury is detected in the urine of most people even in the absence of known exposure or chelator administration, and that urinary mercury excretion rises after administration of a chelator, regardless of exposure history and in an unpredictable fashion. Studies also demonstrate that challenge testing fails to reveal a "body burden" of mercury due to remote exposure. Chelating agents have been associated with adverse reactions. Current evidence does not support the use of DMPS, DMSA, or other chelation challenge tests for the diagnosis of metal toxicity. Since there are no established reference ranges for provoked urine samples in healthy subjects, no reliable evidence to support a diagnostic value for the tests, and potential harm, these tests should not be utilized.
... In addition, this study only analyzes the content of metal ions in serum and plasma. Compared with blood, urine can better reflect the heavy metal burden (Crinnion, 2009;Zhou et al., 2015). ...
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Diabetes mellitus (DM) is the most widely recognized metabolic illness with expanding morbidity among ongoing years. Its high incapacity rate and death rate badly affect individuals’ quality of life. Increasing proofs backed the relationship between metal exposures with the risk of DM, but the methodological boundedness cannot clarify the complexity of the internal relationship of metal mixtures. We fitted the logistic regression model, weighted quantile sum regression model, and Bayesian kernel machine regression model to assess the relationship between the metal exposures with DM in adults who participated in the National Health and Nutrition Examination Survey 2013–2016. The metals (lead, cadmium, and copper) levels were significantly higher among diabetic compared to the healthy controls. In the logistic regression model established for each single metal, lead and manganese were associated with DM in both unadjusted and mutually adjusted models (highest vs. lowest concentration quartile). When considering all metal as a mixed exposure, we found a generally positive correlation between metal mixtures with DM (binary outcome) and glycohemoglobin (HbA1c) levels (continuous outcome). Exposure to metal mixtures was associated with an increased risk of DM and elevated levels of HbA1c.
... Results for 24-hour collections may also be used to estimate body burden (eg, provocation, mobilization procedures) or quantify decontamination efforts for a patient who has received therapeutic chelation therapy. 10 Many laboratories report concentration of toxic elements as a function of urine volume collected during a 24-hour period. Normalizing results per gram of creatinine is also common (eg, µg/mg creatinine), particularly if comparing results to the biological exposure index (BEI) published by the American Conference of Government Industrial Hygienists (ACGIH), for relevant elements ( Table 1). ...
Article
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Toxic elements ("heavy metals") are common to the environment and are responsible for both intentional poisonings and unintentional exposures that can lead to adverse health effects and potentially death. Dangerous exposures can be prevented by recognizing and minimizing common sources of toxic elements in our diet, water, workplace, and homes. Laboratory testing is an important tool for detecting and managing toxic element exposure; several analytical methods are available. However, the clinical value of elemental testing is dependent upon collecting an appropriate specimen at an appropriate time, with consideration of many pre-analytical variables that can compromise testing. In this review, toxicokinetics and pre-analytical variables associated with toxic element testing are discussed, with emphasis on arsenic, cadmium, lead, and mercury.
... For more details on pre-and post-challenge urine heavy metal testing, see articles in previous volumes of this journal. 25,26 Table 6 provides blood levels of mercury, lead, and cadmium for clinicians utilizing blood testing. 1 These levels are much lower than established lab reference ranges for these three heavy metals, as the reference ranges are based on acute toxicity data (and are typically derived from industrial exposure data). ...
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