Comprehensive Urine Element Profile

Comprehensive Urine Element Profile

The Comprehensive Urine Element Profile (CUEP) is a toxic exposure panel that measures urinary excretion of 20 toxic metals and 15 nutrient elements. This profile is ideal for patients suspected of toxic metal exposure as well as mineral imbalances.

When should testing for urine elements be considered?

Patients suspected of having exposure to toxic heavy metals may benefit from testing. While the nutrient elements (minerals) are generally considered beneficial, some may be problematic in toxic doses. Urine mineral testing reflects recent dietary intake.

Occupational and industrial exposure, or exposure through various hobbies may put patients at higher risk for toxicity. Those most at risk include workers in industries such as metal refining, alloying, parts manufacturing in aerospace and machine tools, electronics and computer manufacturing, welding, plumbing, construction, oil refining, mining, waste disposal, pesticide manufacturing and application, pigment and coating manufacturing, petrochemical production, dentistry, firearms and ammunition, and work with glass, dyes, ceramics, or paints.1-5

In addition to occupational exposures, everyday activities may put patients at risk of increased exposure to toxic metals: proximity to the above-mentioned industries where groundwater and air contamination can distribute metals, smoking, living in homes with older wells, pipes, and building materials, consumption of foods known to be contaminated with metals (seafood, rice), taking supplements from manufacturers lacking good manufacturing practice (GMP), use of personal care products and cosmetics, taking certain medications, exposure to emissions and exhaust fumes, and exposure to paints, dental amalgams, and fireworks.1-5

Symptoms and conditions associated with heavy metal toxicity and mineral imbalances

A wide range of acute and chronic conditions have been associated with toxic heavy metals and mineral imbalances including, but not limited to:

Chart of Toxic and Nutrient Elements
  • Neurological disorders (neuropathy, headaches)2,6-9
  • Cognitive decline2,6
  • Mood disorders (depression)6
  • Cardiac abnormalities (arrhythmias, abnormal ECG)10-12
  • Diabetes7,13
  • Cancer3,7,14
  • Reproductive issues7,11,12
  • GI concerns (vomiting, diarrhea)6,8,11,12
  • Lung issues5,6,11,12
  • Renal impairment6,8,11
  • Skin rashes5,6,12
  • Anemia and other hematologic disorders5,11,15

View our Toxic and Nutrient Elements chart for more information on these metals and their sources and clinical significance.

The Comprehensive Urine Element Profile Analytes

  • Lead
  • Mercury
  • Aluminum
  • Antimony
  • Arsenic
  • Barium
  • Bismuth
  • Cadmium
  • Cesium
  • Gadolinium
  • Gallium
  • Nickel
  • Niobium
  • Platinum
  • Rubidium
  • Thallium
  • Thorium
  • Tin
  • Tungsten
  • Uranium
  • Chromium
  • Cobalt
  • Copper
  • Iron
  • Lithium
  • Manganese
  • Molybdenum
  • Selenium
  • Strontium
  • Vanadium
  • Zinc
  • Calcium
  • Magnesium
  • Potassium
  • Sulfur

The element levels measured on the CUEP are ratioed to creatinine. By utilizing creatinine concentration as the given ratio standard, the variations in time frames provide useful comparisons upon subsequent testing. Random samplings and/or timed collections provide useful information to screen for exposures.16 Clinicians often use timed samples as part of provoked chelation protocols, however the clinical utility of provoked minerals is unknown. The Toxic Element Clearance Profile may be a better option for clinicians choosing to do provocation testing. Please note, Genova does not provide chelation or provocation protocols and reference ranges apply to non-provoked/non-chelated conditions.

What advantage does the Comprehensive Urine Element Profile offer compared to other diagnostics?

Metals and minerals can be measured in various sample types including blood, urine, hair, and nails as the most accessible tissues to quantify exposure. However, there are multiple variables that impact which sample type is most appropriate including the element's half-life, valence state/form/species, toxicokinetics, dose, time span of exposure, and route of exposure.3,17,18

Genova offers testing for minerals and metals in either blood or urine with the CUEP being one of the most comprehensive urine element profiles available. Both sample types indicate recent exposure with a few exceptions. In general, the window of exposure for urine is approximately a few hours to a few days, whereas blood is often a longer window, from a few hours to up to a few months. The actual time frame that each sample type represents varies for each metal being measured due to the variables listed above.1,3,17 For example, urinary cadmium is thought to reflect kidney cadmium concentrations with a half-life of 15-30 years. Urine is thought to reflect cumulative body burden of cadmium.19 Urinary levels do not rise significantly after acute exposure. Elevated blood cadmium levels confirm recent acute exposure.20-22 More information on the nuances of metals and sample types can be found in the Toxic Element Chart.

Once an element enters the body, it is either eliminated or deposited into tissue, which can result in long-term storage. Elements are eliminated through feces, bile, urine, sweat, hair, and nails. Assessment of tissue accumulation of toxic metals, also referred to as "body burden", is challenging. Some clinicians perform a provoked urine test by using a chelator to liberate stored metals from the tissues.17 Many clinicians opt to perform two tests -- a pre- and post-provoked sample -- to distinguish between recent exposure versus tissue storage. The clinical utility of provoked minerals is unknown. The Toxic Element Clearance Profile (TECP) may be a better option for clinicians choosing to do provocation testing. A clinician may choose to run a CUEP as a pre-provocation test and a TECP as a post provocation test. Please note, Genova does not provide chelation or provocation protocols and reference ranges apply to non-provoked/non-chelated conditions.

Hair analysis is not offered at Genova, as external contamination may interfere with results. In general, hair is not a reliable sample type to determine exposure to most elements.3

Genova's Methodology

Elements are measured using Inductively Coupled Plasma Mass Spectrometry (ICP-MS) and creatinine via alkaline picrate. Genova measures total levels and does not speciate individual elements. Reference ranges were developed from a healthy population under non-provoked/non-chelated conditions. Reference ranges do not provide absolute levels at which a related symptom may occur -- clinical correlation is recommended. Provocation with challenge substances/chelators may raise the urine level of some elements and is thought to represent "body burden" of toxic metals.17 Reference ranges have not been established for provoked urine samples. All elements are reported as micrograms/g creatinine.

What can clinicians and patients expect from urine element testing?

The CUEP assesses urinary excretion of mineral and toxic elements acquired through either chronic or acute exposure. Minimizing or eliminating continued exposure to the toxic element is crucial. Mineral wasting may necessitate nutrient repletion and further testing for nutritional status may be warranted. Clinicians may choose to initiate detoxification and/or nutritionally supportive treatments based on results if medically appropriate.

For additional information about toxic metals and their effects, as well as mineral information please visit these websites:

References

  1. Zhang T, Ruan J, Zhang B, et al. Heavy metals in human urine, foods and drinking water from an e-waste dismantling area: Identification of exposure sources and metal-induced health risk. Ecotoxicol Environ Safety. 2019;169:707-713.
  2. Tchounwou PB, Yedjou CG, Patlolla AK, Sutton DJ. Heavy metal toxicity and the environment. Exp Suppl. 2012;101:133-164.
  3. Klaassen CD. Casarett & Doull's Toxicology 9th ed: McGraw-Hill Education; 2019.
  4. Aschner M, Erikson K. Manganese. Adv Nutr. 2017;8(3):520-521.
  5. Leyssens L, Vinck B, Van Der Straeten C, Wuyts F, Maes L. Cobalt toxicity in humans-A review of the potential sources and systemic health effects. Toxicology. 2017;387:43-56.
  6. Rafati-Rahimzadeh M, Rafati-Rahimzadeh M, Kazemi S, Moghadamnia AA. Current approaches of the management of mercury poisoning: need of the hour. Daru : J Faculty Pharm. 2014;22(1):46.
  7. Hong YS, Song KH, Chung JY. Health effects of chronic arsenic exposure. J Prev Med Public Health. 2014;47(5):245-252.
  8. Wang R, Li H, Sun H. Bismuth: environmental pollution and health effects. Encycl Environ Health. 2019:415.
  9. Peres TV, Schettinger MRC, Chen P, et al. Manganese-induced neurotoxicity: a review of its behavioral consequences and neuroprotective strategies. BMC Pharm Toxicol. 2016;17(1):1-20.
  10. Melnikov P, Zanoni LZ. Clinical effects of cesium intake. Bio Trace Elem Res. 2010;135(1-3):1-9.
  11. Goyer RA, Clarkson TW. Toxic effects of metals. Casarett & Doull's Toxicology The Basic Science of Poisons, Fifth Edition McGraw-Hill Health Professions Division. 1996;23:813-858.
  12. Sundar S, Chakravarty J. Antimony toxicity. Int J Environ Res Public Health. 2010;7(12):4267-4277.
  13. Lehmler HJ, Gadogbe M, Liu B, Bao W. Environmental tin exposure in a nationally representative sample of U.S. adults and children: The National Health and Nutrition Examination Survey 2011-2014. Environ Poll. 2018;240:599-606.
  14. Witten ML, Sheppard PR, Witten BL. Tungsten toxicity. Chem-biol Int. 2012;196(3):87-88.
  15. Chitambar CR. Gallium and its competing roles with iron in biological systems. Biochim Biophys Acta. 2016;1863(8):2044-2053.
  16. Keil DE, Berger-Ritchie J, McMillin GA. Testing for toxic elements: a focus on arsenic, cadmium, lead, and mercury. Lab Med. 2011;42(12):735-742.
  17. Bernhoft RA. Mercury toxicity and treatment: a review of the literature. J Environ Public Health. 2012;2012:460508.
  18. Council NR. Arsenic in Drinking Water. Washington, DC: The National Academies Press; 1999.
  19. Tellez-Plaza M, Navas-Acien A, Menke A, Crainiceanu CM, Pastor-Barriuso R, Guallar E. Cadmium exposure and all-cause and cardiovascular mortality in the U.S. general population. Environ Health Perspect. 2012;120(7):1017-1022.
  20. ATSDR. Cadmium Toxicity Clinical Assessment - Laboratory Tests. Environ Health Med Ed 2008; https://www.atsdr.cdc.gov/csem/cadmium/docs/cadmium.pdf 2020.
  21. Lauwerys R, Buchet J, Roels H. The relationship between cadmium exposure or body burden and the concentration of cadmium in blood and urine in man. Int Arch Occup Environ Health. 1976;36(4):275-285.
  22. Adams SV, Newcomb PA. Cadmium blood and urine concentrations as measures of exposure: NHANES 1999-2010. J Exp Sci Environ Epidemiol. 2014;24(2):163-170.
Analyte List
Aluminum
Antimony
Arsenic
Barium
Bismuth
Cadmium
Calcium
Cesium
Chromium
Cobalt
Copper
Creatinine
Gadolinium
Gallium
Iron
Lead
Length of Collection
Lithium
Magnesium
Manganese
Mercury
Molybdenum
Nickel
Niobium
Platinum
Potassium
Rubidium
Selenium
Strontium
Sulfur
Thallium
Thorium
Tin
Total Urine Volume
Tungsten
Uranium
Vanadium
Zinc
CPT Codes  
Aluminum 82108
Antimony 83018
Arsenic 82175
Barium 83018
Bismuth 83018
Cadmium 82300
Calcium 82340
Lead 83655
Magnesium 83735
Mercury 83825
Nickel 83885
Specimen Requirements
2 tubes of urine, 15ml each