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Test Code HMETRU Heavy Metal/Creatinine Ratio, with Reflex, Urine

Important Note

Mayo test code HMCRU

Additional Codes

Sunrise Clinical Manager (SCM) Orderable:   Heavy Metals Random Urine

AllScripts (AEHR) Orderable:  Heavy Metals Screen, Random Urine


Specimen Required


Patient Preparation:

-Patient should not eat seafood for a 48-hour period prior to start of collection.

-High concentrations of gadolinium and iodine are known to interfere with most metals tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for 96 hours.

Supplies: Urine Tubes, 10 mL (T068)

Collection Container/Tube: Clean, plastic urine container with no metal cap or glued insert

Submission Container/Tube: Plastic, 10-mL urine tube or clean, plastic aliquot container with no metal cap or glued insert

Specimen Volume: 6 mL

Collection Instructions:

1. Collect a random urine specimen.

2. See Trace Metals Analysis Specimen Collection and Transport in Special Instructions for complete instructions.


Useful For

Preferred screening test for detection of arsenic, cadmium, mercury, and lead using random urine specimens

Profile Information

Test ID Reporting Name Available Separately Always Performed
ARSC Arsenic/Creatinine Ratio, U Yes, (order ARSCR) Yes
CDRC Cadmium/Creatinine Ratio, U Yes, (order CDRCR) Yes
HGRC Mercury/Creatinine Ratio, U Yes, (order HGRCR) Yes
PBRC Lead/Creatinine Ratio, U Yes, (order PBRCR) Yes
CDCR Creatinine Conc No Yes

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
ASFRU Arsenic Fractionation, Random, U Yes No

Testing Algorithm

If arsenic concentration is greater than or equal to 35 mcg/L, then fractionation will be performed at an additional charge.

 

See Porphyria (Acute) Testing Algorithm in Special Instructions.

Method Name

ARSC, CDRC, HGRC, and PBRC: Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)

CDCR: Enzymatic Colorimetric Assay

Reporting Name

Heavy Metal/Creat Ratio, w/Reflex,U

Specimen Type

Urine

Specimen Minimum Volume

3 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Urine Refrigerated (preferred) 7 days
  Frozen  7 days

Reject Due To

All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.

Clinical Information

Arsenic (As), lead (Pb), cadmium (Cd), and mercury (Hg) are well-known toxins and toxic exposures are characterized by increased urinary excretion of these metals.

 

Arsenic is a naturally occurring element that is widely distributed in the Earth's crust. Elemental arsenic is a steel grey solid material. However, arsenic is usually found in the environment combined with other elements such as oxygen, chlorine, and sulfur. Arsenic combined with these elements is called inorganic arsenic. Arsenic combined with carbon and hydrogen is referred to as organic arsenic. The organic forms (eg, arsenobetaine and arsenocholine) are relatively nontoxic, while the inorganic forms are toxic. The toxic inorganic forms are arsenite (As[3+]/As[III]) and arsenate (As[5+]/As[V]). Inorganic As(V) is readily reduced to inorganic As(III) which is then primarily broken down to less toxic methylated metabolites monomethylarsinic acid (MMA) and subsequently dimethylarsinic acid (DMA).

 

People are exposed to arsenic by eating food, drinking water, or breathing air. Of these, food is usually the largest source of arsenic. The predominant dietary source of arsenic is seafood, followed by rice/rice cereal, mushrooms, and poultry. While seafood contains the greatest amounts of arsenic, for fish and shellfish, this is mostly in an organic form of arsenic called arsenobetaine, which is much less harmful. Some seaweed may contain arsenic in the inorganic form, which is more toxic. In the United States, some areas also contain high natural levels of arsenic in rock, which can lead to elevated levels in the soil and drinking water. Occupational (eg, copper or lead smelting, wood treating, or pesticide application) exposure is another source where people may be introduced to elevated levels of arsenic. Lastly, hazardous waste sites may contain large quantities of arsenic and if not disposed of properly may get into the surrounding water, air, or soil.

 

A wide range of signs and symptoms may be seen in acute arsenic poisoning including headache, nausea, vomiting, diarrhea, abdominal pain, hypotension, fever, hemolysis, seizures, and mental status changes. Symptoms of chronic poisoning, also called arseniasis, are mostly insidious and nonspecific. The gastrointestinal tract, skin, and central nervous system are usually involved. Nausea, epigastric pain, colic abdominal pain, diarrhea, and paresthesias of the hands and feet can also occur. Arsenic toxicity affects a number of organ systems.

 

Lead toxicity primarily affects the gastrointestinal, neurologic, and hematopoietic systems.

 

Chronic exposure to cadmium causes accumulated renal damage.

 

The correlation between the levels of mercury (Hg) excretion in the urine and the clinical symptoms is considered poor. However, urinary Hg is the most reliable way to assess exposure to inorganic Hg.

Reference Values

ARSENIC/CREATININE:

0-17 years: not established

≥18 years: <24 mcg/g creatinine

 

CADMIUM/CREATININE:

0-17 years: not established

≥18 years: <0.6 mcg/g creatinine

 

MERCURY/CREATININE:

0-17 years: not established

≥18 years: <2 mcg/g creatinine

 

LEAD/CREATININE:

0-17 years: not established

≥18 years: <2 mcg/g creatinine

Day(s) and Time(s) Performed

Monday through Saturday; 7 p.m.

Analytic Time

1 day

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information

82175

82300

83825

83655

82570

LOINC Code Information

Test ID Test Order Name Order LOINC Value
HMCRU Heavy Metal/Creat Ratio, w/Reflex,U 29589-9

 

Result ID Test Result Name Result LOINC Value
48544 Cadmium/Creatinine Ratio, U 13471-8
48546 Mercury/Creatinine Ratio, U 13465-0
48548 Lead/Creatinine Ratio, U 13466-8
CDCR Creatinine Conc 2161-8
48541 Arsenic/Creatinine Ratio, U 13463-5
48542 Arsenic Concentration w/Reflex 5586-3

NY State Approved

Yes
Northwell Health Laboratories Additional Information:

Computer Interface Code:

   PDM #  1459882