Recommended for occupation exposure monitoring. This panel includes cadmium in blood and urine as well as beta-2-microglobulin and provides exposure guidance in accordance with OSHA regulations. To assess cadmium exposure in a non-occupational setting, Cadmium, Urine (0025040) and/or Cadmium, Blood (0099675) are preferred.
Creatinine, Urine: Spectrophotometry
Beta-2 Microglobulin Urine: Chemiluminescent Immunoassay
- Patient Preparation
- To avoid contamination, please collect specimens at the beginning of work shift. Blood and urine should be collected the same day.
Urine: Diet, medication, and nutritional supplements may introduce interfering substances. Patients should be encouraged to discontinue nutritional supplements, vitamins, minerals, and non-essential over-the-counter medications (upon the advice of their physician). High concentrations of iodine may interfere with elemental testing. Collection of urine specimens from patients receiving iodinated or gadolinium-based contrast media should be avoided for a minimum of 72 hours post-exposure. Collection from patients with impaired kidney function should be avoided for a minimum of 14 days post contrast media exposure.
- Royal blue (K2EDTA or Na2EDTA) AND minimum 40 mL urine using spot technique (single void) in an open-top urine collection cup.
- Specimen Preparation
- Transfer specimens to the appropriate transport device using the Cadmium exposure kit, ARUP supply #16450, available online through eSupply using ARUP Connect™ or by contacting ARUP Client Services at (800) 522-2787.
Blood: Transport 7 mL whole blood in the original collection tube. (Min: 0.5 mL)
Urine for Beta-2-Microglobulin: Transfer 3 mL aliquot from original urine collection to an ARUP Standard Transport Tube. Adjust the pH of this specimen immediately after pouring off collection, so the pH is between 6 and 8. Use 1M HCl or 5 percent NaOH to adjust the urine pH. Label tube as β2 Microglobulin. Freeze within one hour of collection.
Urine for Cadmium: Transfer 7 mL aliquot from original urine collection to ARUP Trace Element-Free Transport Tubes (ARUP supply #43116). Available online through eSupply using ARUP Connect™ or by contacting ARUP Client Services at (800) 522-2787. (Min: 0.5 mL) Label tube as Cadmium.
Urine for Creatinine: Transfer 2 mL aliquot from original urine collection to an ARUP Standard Transport Tube. (Min: 0.5 mL) Label tube as Creatinine.
- Storage/Transport Temperature
- Blood: Refrigerated.
Urine for Beta-2-Microglobulin: Frozen
Urine for Cadmium: Refrigerated.
Urine for Creatinine: Refrigerated.
- Unacceptable Conditions
- Blood: Specimens collected in tubes other than Royal Blue (EDTA). Specimens transported in containers other than Royal Blue (EDTA) tube or Trace Element-Free Transport Tube. Heparin anticoagulant. Clotted specimens.
Urine: Specimens transported in non-trace element free transport tube (with the exception of the original device).Specimens collected within 72 hours after administration of iodinated or gadolinium-based contrast media. Specimens containing blood or fecal materials.
- Trace Elements requisition form may be required (ARUP form #32990).
- Blood: Ambient: Indefinitely; Refrigerated: Indefinitely; Frozen: Unacceptable
Urine for Beta-2-Microglobulin: Ambient: 8 hours; Refrigerated: 48 hours; Frozen: 2 months
Urine for Cadmium: Ambient: 1 week; Refrigerated: 2 weeks; Frozen: 1 year
Urine for Creatinine: Ambient: 2 days; Refrigerated: 1 month; Frozen: 6 months
|Test Number||Components||Reference Interval|
|0099675||Cadmium, Blood||0.0-5.0 µg/L|
| ||Cadmium, Urine - per volume||Effective November 13, 2017|
| ||Creatinine, Urine - per volume||No reference interval|
| ||Cadmium, Urine - ratio to CRT||Effective Novermber 13,2017|
0.0-3.2 µg/g CRT
| ||Beta-2-Microglobulin, Urine||Effective February 18, 2014|
| ||Beta-2-Microglobulin, ratio to CRT||0-300 µg/g CRT|
Urine cadmium levels can be used to assess cadmium body burden. In chronic exposures, the kidneys are the primary target organ. Symptoms associated with cadmium toxicity vary based upon route of exposure and may include tubular proteinuria, fever, headache, dyspnea, chest pain, conjunctivitis, rhinitis, sore throat and cough. Ingestion of cadmium in high concentration may cause vomiting, diarrhea, salivation, cramps, and abdominal pain.
Urine β2 Microglobulin is an early marker of irreversible kidney damage and disease.
Urine creatinine values less than 20 mg/dL represent very dilute urine and collections should be repeated.
|CADMIUM ACTION LEVELS BEGINNING JANUARY 1999 (Federal Register 1999, Std. CFR, Part 1910. 1027 Appendix A)|
|Cadmium, Urine (µg/g CRT)||≤ 3||> 3 to ≤ 7||> 7|
|Cadmium, Blood (µg/L)||0-5||> 5 to ≤ 10||> 10|
|β2 Microglobulin, Urine (µg/g CRT)||≤ 300||> 300 to ≤ 750||> 750*|
|Reassess Cadmium exposure in less than two weeks||---------||Discretionary||Mandatory removal|
|*If an employee's β2 Microglobulin level is above 750 µg/g CRT, in order for mandatory medical removal to be required, either the employee's CdU level must also be >3 µg/g CRT or CdB level must also be >5 µg/L.|
The determination of discretionary or mandatory removal is made by the examining physician consistent with the medical surveillance specifications in the Federal Register 42456 to 42463.
1. US Department of Labor (2004). Cadmium. Occupational Safety and Health Administration. 3136-06R.
2. US Department of Labor (1999). Cadmium. Occupational Safety and Health Standards. 1910.1027
|Component Test Code*||Component Chart Name||LOINC|
|0020207||Creatinine, Urine - per volume||2161-8|
|0025039||Cadmium, Urine - ratio to CRT||13471-8|
|0025042||Cadmium, Urine - per volume||5611-9|
|0080052||Beta-2-Microglobulin, ratio to CRT||13485-8|
- blood cadmium concentration
- blood cadmium level
- cadmium level