Lead, Urine

CPT: 82570; 83655
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Test Details

Synonyms

  • Pb, Urine

Test Includes

Lead, urine; creatinine, urine; lead:creatinine ratio; lead, urine (24-hour)

Use

Monitor exposure to lead or lead chelation therapy

Methodology

Inductively coupled plasma/mass spectrometry (ICP/MS)

Reference Interval

Environmental exposure: <50 μg/L, <80 μg/24 hours

Occupation exposure: BEI® (sampling time is not critical): 150 μg/g creatinine;1 chelation therapy: <600 μg/24 hours (after 1 g EDTA I.V. or 2 g DMSA P.O.)

Additional Information

Lead poisoning through chronic exposure is characterized by gastrointestinal disturbance, anemia, insomnia, weight loss, motor weakness, muscle paralysis, and neuropathy. Ingestion of large quantities may produce death.2

Increased urinary lead excretion indicates excessive lead exposure, regardless of clinical presentation. Erythrocyte protoporphyrin and whole blood lead levels are probably more sensitive indicators of excessive lead exposure. In cases of borderline blood levels, an EDTA lead mobilization test may be considered. Chelation therapy monitoring may be indicated. Lead and organic lead compounds have numerous commercial and industrial applications, use in paints, plastics, storage batteries, bearing alloys, insecticides, and ceramics. Exposure may also occur through the inhalation of dust containing lead emitted by automobile exhausts. A common source of lead exposure among children is derived through the mouthing of inanimate objects, specifically objects with paint and paint chips that contain lead. Acute lead exposure is rare; however, toxicity may occur through acute ingestion of a lead salt or acetate. Urine is suggested specimen in which chronic lead poisoning may be monitored.

BEI® are reference values intended as guidelines for evaluation of occupational exposure. BEI® represent biological levels of chemicals that correspond to workers with inhalation exposure equivalent to the threshold limit value (TLV®) of the chemicals. TLVs refer to the airborne concentrations of substances and represent conditions under which it is believed that nearly all workers may be repeatedly exposed, day after day, without adverse health effects.3

Specimen Requirements

Specimen

Urine (random or 24-hour)

Volume

5 mL

Minimum Volume

2.5 mL

Container

Plastic urine container, no preservative

Collection

Sampling time is not critical for industrial exposure monitoring. Metals with timing “not critical” have very long elimination half-lives and accumulate in the body over years, some for a lifetime. After a couple of weeks of exposure, specimens can be collected at any time.

Optional protocol: If the specimen is a 24-hour collection, instruct the patient to void at 8 AM and discard the specimen. Then collect all urine including the final specimen voided at the end of the 24-hour collection period (ie, 8 AM the next morning). Screw the lid on securely. Collect without preservatives. Mix well. Sampling time is not critical for industrial monitoring.

Storage Instructions

Maintain specimen at room temperature.

Stability Requirements

Temperature

Period

Room temperature

14 days

Refrigerated

14 days

Frozen

14 days

Freeze/thaw cycles

Stable x3

Clinical Information

Special Instructions

Request form must state total volume collected in 24-hour, if applicable. Do not use preservative. Preservatives used for routine analysis may contain mercuric oxide (ie, Stabilur), which interferes with all metal testing. If both urinalysis and metal testing are ordered, please submit a separate urine specimen (containing no additive) for the metal testing.

Footnotes

1. BEI® (Biological Exposure Indices) based on 1994-1995 Recommendations of the American Conference of Governmental Industrial Hygienists (ACGIH).
2. Baselt RC, Cravey RH, Disposition of Toxic Drugs and Chemicals in Man, 4th ed, Chemical Toxicology Institute, 1995.
3. TLVs and BEIs, Threshold Limit Values for Chemical Substances and Physical Agents and Biological Exposure Indices 2004, American Conference of Governmental Industrial Hygienists (ACGIH).

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
007633 Lead, Urine 019315 Lead, Urine ug/L 20625-0
007633 Lead, Urine 723280 Creatinine(Crt),U g/L 2161-8
007633 Lead, Urine 019317 Lead/Creat. Ratio ug/g creat 13466-8
007633 Lead, Urine 019364 Lead, Urine (24 Hr) ug/24 hr 5677-0
Reflex Table for Creatinine(Crt),U
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 723284 Comment: 723284 Comment: N/A

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