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Mobilization tests and urine reference ranges: an overview.

Urine is a liquid waste product. This fluid produced by the kidneys consists of excess water and the toxic waste products from food and drink. It normally is a clear, transparent fluid of amber color. The urine of an inadequately hydrated person is more concentrated and darker in color, while the urine of a well-hydrated person is light. The more hydrated a person is, the more watery the appearance of the urine. When taking riboflavin-containing B vitamins, urine turns to dark-yellowish. After the consumption of red beets, urine turns purplish red, because the beet color is not metabolized by the body and thus excreted as is.

The average amount of urine excreted in 24 hours is from 40 to 60 ounces (about 1200 cubic centimeters or 1.2 liters). Chemically, the urine is mainly an aqueous (watery) solution of salts (sodium chloride and other metals), urea, and uric acid. Normally, urine contains about 960 parts of water to 40 parts of solid matter. Abnormally, it may contain sugar (in diabetes), albumen (as in some forms of kidney disease), bile pigments, or abnormal quantities of one or another of its normal components.

Why Test Urine Creatinine?

Creatinine is a breakdown product of creatine, an important part of muscle. Creatinine is removed from the body entirely by the kidneys.

Urine creatinine levels reflect fluid intake and excretion. Therefore, creatinine levels are used as a mathematical factor for determining the urinary metal output. Metal levels based on urine creatinine take into account the fluid volume passing through the kidneys. Laboratories no longer need to ask the patient to provide information regarding urine volume or output.

Urine creatinine results depend on age, sex, and body mass. A high protein intake can result in elevated levels. A high fluid intake causes urine creatinine levels to drop; a reduced fluid intake or kidney stress raises levels.

Urine Creatinine Levels in Baseline Urine

Micro Trace Minerals, Germany, and Trace Minerals International of Boulder, Colorado, statistically evaluated creatinine levels of first morning urines, also called baseline urines. We tested 977 patients of both sexes, 12 years and older. The mean value was 1.1 g/L creatinine. For children under 12 years of age, the statistical evaluation showed a mean value of 0.9 g/L creatinine.

A urine creatinine test is by itself not a reliable indicator of kidney function. Often, abnormal results of urine creatinine are nonspecific, easily influenced by fluid intake (or dehydration). In the presence of abnormal results, check if the following conditions are present:

* glomerulonephritis

* pyelonephritis

* reduced renal blood flow (as in shock or congestive heart failure)

* renal failure

* rhabdomyolysis

* urinary tract obstruction

* muscular dystrophy (late stage)

* myasthenia gravis

* high-meat diet

During chelation, the urine creatinine concentration tends to fall below the baseline value. Kidney stress or dehydration causes the urine creatinine concentration to rise above the baseline level. This indicates a need for blood tests and other means to evaluate kidney function.

A thorough evaluation of kidney function is necessary prior to chelation.

Abnormal urine creatinine results must be confirmed with serum creatinine measurements, creatinine clearance, the GFR, and other kidney function tests.

When abnormal creatinine levels are seen, evaluate the patient's muscle mass and physical exercise. Also check the patient's drug intake.

Urine creatinine levels reflect fluid intake: the greater the fluid consumption, the lower the urine creatinine value. Dehydration causes urine creatinine to rise. Attention to urine creatinine values provides the physician a simple means to evaluate the patient's reaction to chelation, it also provides a means to "view" fluid intake.

A consistent fluid intake during urine collection time will result in comparable urine creatinine values, which allows a direct comparison of urine metal output. By following protocols we receive diagnostically and therapeutically significant results.

Baseline Urine

In chelation, we distinguish between a baseline and a challenge test.

After all renal function tests have been completed and before any type of chelation treatment is started, a baseline urine test is recommended. The test is simple and laboratory results are generally inconspicuous. For patients who don't smoke, don't work or live in a contaminated environment, or are not exposed to metals in normal daily life, the test results are generally within the range of an unexposed population.

Baseline urine reference ranges are developed by environmental agencies for common metals such as lead, cadmium, or manganese, for instance. If no ranges are given, laboratories are asked to develop their own, using the same statistical principles of range development. It should be pointed out that baseline urine reference ranges are developed from a so-called healthy population and thus apply to this so-called healthy and nonexposed population, which is in contrast to the ranges used in occupational medicine.

For a so-called nonexposed individual, a urine metal concentration higher than the baseline reference range indicates immediate exposure. The source may be dietary (from arsenic in fish), or medical as in exposure to chemotherapy agents such as platinum, mercury through thimerosal-containing vaccines, or aluminum through thimerosal-free vaccines or other medications such as antacids.

For the physician practicing chelation, the baseline urine test is used to compare the urine metal concentration of the unprovoked or unchallenged (baseline) urine with the metal values of the urine challenge test. The baseline urine should be taken once prior to the start of the chelation treatment. The initial comparison of the baseline urine metal concentration with the first, second, or last urine challenge test result aids patient understanding of the chelation process and helps physicians to set up a realistic treatment schedule. In case of an insurance inquiry, the comparison of urine baseline and challenge test results provides treatment proof.

Baseline Urine Collection Information

* A baseline urine test is generally the first morning specimen. Since the urine is collected in the bladder overnight, it is not important if the sample submitted to the laboratory is a first, or mid- or last stream urine. It is easiest for the patient to collect some urine in a regular urine cup and fill 10 ml of that in the urine tube, provided by the lab.

* To avoid arsenic and mercury contamination, it is advisable that the patient not eat fish for at least one or two days prior to urine sampling. Better would be 3 to 4 days of no fish. Algae products should be avoided for the same duration of time.

* Any type of nutritional supplementation, including vitamin B12, which contains cobalt, should be discontinued at least 24 hours prior to sampling.

* Medicine containing metals such as lithium should be temporarily omitted, un less medically necessary. Read the pharmaceutical's label and discuss this with your physician and pharmacist.

* Smoking should be stopped at least the night before sampling. The longer the better. Smoke contains a number of toxic elements, including arsenic, beryllium, lead, cadmium, and nickel. Hence, the urine of an active smoker automatically shows a higher concentration of potentially toxic metals than the urine of a nonsmoker.

* Provide the laboratory with patient name, date of birth or age, and sex. This information is necessary for the laboratory to make reports based on age and sex-relevant reference ranges. This information is needed to convert mg/I and mcg/L data to mg/g and mcg/g creatinine levels.

The Urine Challenge Test

A chelating agent forces metal binding. Even if a person has a limited detoxification potential due to missing detoxification enzymes, the chelating agent will bind and mobilize metals. For this reason, we cannot compare urine concentrations of a provoked urine with ranges developed for unprovoked urines. First of all, the urine concentrations of the provoked urine would almost always seem high and be cause for alarm. It is exactly this point that opponents of chelation therapy have criticized, and rightly so.

For this reason, we developed chelator-specific ranges, we call them orientation ranges (OR), and this concept is not new to German laboratory medicine. In fact, this logical and analytically correct concept was introduced back in the 1970s by the German toxicologist Dr. Max Daunderer. At that time, he had evaluated hundreds of data sets and concluded that after the intravenous administration of 1 ampoule DMPS, a chelation agent used to detoxify arsenic and mercury, the copper urine concentration can be expected to be above 500 mcg/g creatinine. Our statistical evaluation of over 3000 patients' data treated with 1 ampoule DMPS showed an orientation range (OR) of 700 mcg/g creatinine. The reference range of unprovoked urine is less than 60 mcg/g creatinine, a considerable difference.

The following list compares DMPS OR for some elements to reference ranges (RR) of baseline urines in mcg/g creatinine:

Notes:

* From these data, it is clear that DMPS has a strong affinity to copper, arsenic, and mercury. lf, after DMPS administration, the urine excretion shows a concentration above the OR, the patient has a considerable body burden. A test value higher than the baseline RR and lower than the OR indicates a low to moderate toxic burden.

* It must be pointed out, however, that the summation of two or more slightly elevated toxic metal levels signals the need to reduce the total body burden.

* The patient's treatment schedule has to take into account patient history, symptoms, test results, and patient response.

Each chelating agent has a specific half-life, which dictates the optimum urine collection time and the chelator's maximum binding capacity. We have developed ORs for DMSA, DMPS, and the EDTAs. In cooperation with IBCMT members, we also participated in the development of specific urine collection protocols. A DMPS protocol follows.

DMPS Urine Challenge Test Protocol

* Prior to administering the chelating agent of choice, the patient must void bladder.

* DMPS is slowly injected intravenously, 1 m1/1-2 min. Do not use metal needles.

* Watch blood pressure. Some patients experience a drop in blood pressure. If that happens, slow down injection or stop.

* After administering the chelating agent, and during the following required collection time of 1 hour, the patient should drink 1-2 glasses of water and refrain from eating, unless clinically necessary.

* It is important that the fluid intake remains the same during this and all other follow-up challenge tests that are followed with a urine collections. This allows the direct correlation of results.

* After 1 hour, collect a small portion of urine into a clean urine cup. Of that 10 ml are needed for testing. Do not acidify urine.

Micro Trace Minerals has developed chelator-specific reference ranges for EDTA IV, DMPS IV, and oral DMSA. Logically, the ORs are different for the various elements, and at the same token, urine collections times differ. If we administer 2 g EDTA (NaMgEDTA or CaEDTA) the infusion time is 2 hours, and the urine collection time would be 2 hours plus 45 minutes.

Case History

A male patient suffering from severe muscle and skeletal pain, headaches, and insomnia came to Dr. R. Strey of Germany, who practices internal and occupational medicine. After history taking, a spot urine (unprovoked) was taken. It showed a urine lead level of 7.9 mcg/g crea compared with a reference range of 5 mcg/g crea (again, this range is provided by the German Environmental Agency). Another urine sample was taken after the first NaMgEDTA IV chelation treatment (3 g administered IV in 3 hrs). The lead level of this provocation urine was 456 mcg/g creatinine, and we confirmed this extreme value through multiple testing. Interestingly, after the first treatment and on the following day, the patient was pain free for the first time in a long time. After 20 treatments, he was completely pain free, no longer suffering from insomnia or headaches. The follow-up provocation test showed a urine lead concentration of 32.5 mcg/g crea. This level is still high compared with our chelator-specific range of 22 mcg/g crea, and the patient still receives treatment but more infrequently.

By German medical insurance laws, this patient would have been entitled to free pain medication, sleeping pills, physiotherapy, psychotherapy, and spa visits (up to 6 weeks every other year). I suppose I don't need to explain how insurance companies saved money on this patient.

We know that chelation therapy is a useful and safe therapy. We also know that publishing case histories will help to provide a better understanding within the medical profession and for the people. Therefore we recommend that chelation doctors send us patient histories, similar or complementary to the one above. Be brief and clear, provide history, laboratory results before and after, just as I did above. I will place them into a case history article or book, depending on the response I get, and we will get that published - because every research article or book published provides important proof.

Histories may be e-mailed to service@microtrace.de or info@ tracem in.com.

E. Blaurock-Busch

Trace Minerals International Laboratory

P.O. Box 4613

Boulder, Colorado 80306-4613

or

Micro Trace Minerals Laboratory

Rohrenstr 20

D-91217 Hersbruck

Germany

E. Blaurock-Busch, PhD, founded the specialty laboratories Micro Trace Minerals of Germany in 1975 and Trace Minerals International of Boulder, Colorado in 1984. Past president of both, she is now their research director and considered an expert on metal toxicology. She has published various books and, in cooperation with universities, important research articles. Her interest and all of her studies focus on the impact of global pollution on human health. Her work demonstrates that early prevention and detoxification treatments can reverse environmental damage to people of all ages. In cooperation with IBCMT (International Board of Clinical Metal Toxicology, Netherlands) and KMT (Arztegesellschaft fur Klinische Metalltoxikologie, Germany) she has developed chelation protocols. She teaches chelation around the world and in her free time studies poetry at Exeter University, Oxford and Edinburgh University. For more information www.tracemin.com, www.microtrace.de, and www.ibcmt.com.

Element    Baseline RR  OR

Copper          60     700
Manganese      4.5      10
Arsenic         15     100
Cadmium        0.8     1.5
Mercury        1.0      18
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Author:Blaurock-Busch, E.
Publication:Townsend Letter
Article Type:Report
Date:Jan 1, 2015
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