Blood lead and maximal urinary excretion of delta-aminolevulinic acid

Reliability and ease of use are certainly the two major qualities of a screening test or medical surveillance in the workplace. The advantages of using a reliable urinary test thus are evident: the sampling is easy, rapid, noninvasive and, therefore, well accepted. Screening tests or medical surveillance can measure the toxic chemical itself, its metabolites or its consequences on metabolism. In this study the relation between blood lead levels--the most commonly used test for screening and surveillance of saturnism--and urinary excretion of delta-aminolevulinic acid (ALA-U) was measured. The original part of this study is that it takes into account the chronobiology of ALA-U excretion. The samples are collected in the afternoon when ALA urinary excretion is at its highest level. Using a 5 mg/g of creatinine level as a threshold to detect blood lead levels equal to or higher than 60 micrograms/dL the test has an 88% sensitivity, a 91% specificity and a 37% positive predictive value. No worker whose blood lead level is equal to or higher than 65 micrograms/dL has been missed. It is suggested that using 5 mg of ALA-U/g of creatinine as a threshold to prescreen workers who should have their blood lead level measured could be useful in workplaces where lead exposure is moderate or low.