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Recommendations for provoked challenge urine testing.

Anne-Michelle Ruha1

  • 1Department of Medical Toxicology, Banner Good Samaritan Medical Center, Center for Toxicology and Pharmacology Education and Research, University of Arizona College of Medicine, Phoenix, AZ, USA, michelle.ruha@bannerhealth.com.

Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology
|October 12, 2013
PubMed
Summary
This summary is machine-generated.

Provoked urine tests using chelating agents like DMSA or DMPS are not validated for diagnosing metal toxicity. These unreliable tests show unpredictable results and carry potential risks, leading to recommendations against their use.

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Area of Science:

  • Toxicology
  • Environmental Health
  • Clinical Chemistry

Background:

  • Urine mobilization tests, also known as challenge or provoked urine tests, involve administering chelating agents to assess metal levels.
  • Despite professional and governmental recommendations against their use, these tests are still employed by some practitioners.
  • Various chelating agents (DMSA, DMPS, EDTA) are used inconsistently in terms of administration route, dosage, and urine collection.

Purpose of the Study:

  • To evaluate the validity and reliability of urine mobilization (challenge) tests for diagnosing metal toxicity.
  • To review the scientific evidence supporting or refuting the diagnostic utility of these tests.
  • To assess the potential risks and adverse effects associated with chelating agents used in these tests.

Main Methods:

  • Review of human volunteer studies on mercury detection and excretion after chelator administration.
  • Analysis of the variability in challenge test protocols, including chelating agents, dosages, and collection procedures.
  • Examination of reference ranges and creatinine correction methods used for provoked urine samples.

Main Results:

  • Human studies show mercury is detectable in urine even without known exposure.
  • Urinary mercury excretion increases unpredictably after chelator administration, irrespective of exposure history.
  • Challenge tests fail to accurately determine mercury body burden from past exposures and have inconsistent reference ranges.

Conclusions:

  • Current evidence does not support the diagnostic value of DMPS, DMSA, or other chelation challenge tests for metal toxicity.
  • Inconsistent methodologies, lack of validated reference ranges, and potential for adverse reactions undermine the reliability of these tests.
  • Due to their unproven diagnostic value and potential harm, provoked urine tests should not be utilized in clinical practice.