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Wilson PB, Winter IP, Burdin J. Differences in urine creatinine and osmolality between black and white Americans after accounting for age, moisture intake, urine volume, and socioeconomic status. PLoS One 2024; 19:e0304803. [PMID: 38820483 PMCID: PMC11142698 DOI: 10.1371/journal.pone.0304803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/17/2024] [Indexed: 06/02/2024] Open
Abstract
Urine osmolality is used throughout research to determine hydration levels. Prior studies have found black individuals to have elevated urine creatinine and osmolality, but it remains unclear which factors explain these findings. This cross-sectional, observational study sought to understand the relationship of self-reported race to urine creatinine and urine osmolality after accounting for age, socioeconomic status, and fluid intake. Data from 1,386 participants of the 2009-2012 National Health and Nutrition Examination Survey were utilized. Age, poverty-to-income ratio (PIR), urine flow rate (UFR), fluid intake, estimated lean body mass (LBM), urine creatinine, and urine osmolality were measured. In a sex-specific manner, black and white participants were matched on age, dietary moisture, UFR, and PIR. Urine creatinine was greater in black men (171 mg/dL) than white men (150 mg/dL) and greater in black women (147 mg/dL) than white women (108 mg/dL) (p < .001). Similarly, urine osmolality was greater in black women than white women (723 vs. 656 mOsm/kg, p = .001), but no difference was observed between white and black men (737 vs. 731 mOsm/kg, p = .417). Estimated LBM was greater in black men (61.8 kg) and women (45.5 kg) than in white men (58.9 kg) and women (42.2 kg) (p≤.001). The strongest correlate of urine osmolality in all race-sex groups was urine creatinine (Spearman ρ = .68-.75). These results affirm that individuals identifying as black produce higher urine creatinine concentrations and, in women, higher urine osmolality after matching for age, fluid intake, and socioeconomic status. The findings suggest caution when comparing urine hydration markers between racial groups.
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Affiliation(s)
- Patrick B. Wilson
- Human Performance Laboratory, School of Kinesiology and Health Science, Old Dominion University, Norfolk, VA, United States of America
| | - Ian P. Winter
- Human Performance Laboratory, School of Kinesiology and Health Science, Old Dominion University, Norfolk, VA, United States of America
| | - Josie Burdin
- Human Performance Laboratory, School of Kinesiology and Health Science, Old Dominion University, Norfolk, VA, United States of America
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Trimigno A, Holderman NR, Dong C, Boardman KD, Zhao J, O’Day EM. NMR Precision Metabolomics: Dynamic Peak Sum Thresholding and Navigators for Highly Standardized and Reproducible Metabolite Profiling of Clinical Urine Samples. Metabolites 2024; 14:275. [PMID: 38786752 PMCID: PMC11122845 DOI: 10.3390/metabo14050275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
Metabolomics, especially urine-based studies, offers incredible promise for the discovery and development of clinically impactful biomarkers. However, due to the unique challenges of urine, a highly precise and reproducible workflow for NMR-based urine metabolomics is lacking. Using 1D and 2D non-uniform sampled (NUS) 1H-13C NMR spectroscopy, we systematically explored how changes in hydration or specific gravity (SG) and pH can impact biomarker discovery. Further, we examined additional sources of error in metabolomics studies and identified Navigator molecules that could monitor for those biases. Adjustment of SG to 1.002-1.02 coupled with a dynamic sum-based peak thresholding eliminates false positives associated with urine hydration and reduces variation in chemical shift. We identified Navigator molecules that can effectively monitor for inconsistencies in sample processing, SG, protein contamination, and pH. The workflow described provides quality assurance and quality control tools to generate high-quality urine metabolomics data, which is the first step in biomarker discovery.
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de la Bastide C, Soares L, Lui LY, Harrington J, Cawthon P, Orwoll E, Kado D, Meliker J. A protocol for the prospective study of urinary cadmium with risk of fracture, bone loss, and muscle loss. JBMR Plus 2024; 8:ziad006. [PMID: 38505523 PMCID: PMC10945722 DOI: 10.1093/jbmrpl/ziad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/11/2023] [Accepted: 11/17/2023] [Indexed: 03/21/2024] Open
Abstract
Cadmium (Cd) is a heavy metal and natural element found in soil and crops with increasing concentrations linked to phosphate fertilizers and sewage sludge applied to crop lands. A large fraction of older US men and woman have documented Cd exposure. Cd exposure has proven health concerns such as risk of lung cancer from inhalation and impaired renal function; however, growing evidence suggests it also influences bone and muscle health. Given that low levels of Cd could affect bone and muscle, we have designed prospective studies using the two largest and most detailed US studies of bone health in older men and women: the Osteoporotic Fractures in Men Study and the Study of Osteoporotic Fractures. We are investigating the association of urinary cadmium (U-Cd), as a surrogate for long-term Cd exposure, with bone and muscle health. Building off suggestive evidence from mechanistic and cross-sectional studies, this will be the first well-powered prospective study of incident fracture outcomes, bone loss, and muscle loss in relation to U-Cd, an established biomarker of long-term Cd exposure. The following is a proposed protocol for the intended study; if successful, the proposed studies could be influential in directing future US policy to decrease Cd exposure in the US population similar to recent policies adopted by the European Union to limit Cd in fertilizers.
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Affiliation(s)
| | - Lissa Soares
- Program in Public Health, Stony Brook University, Stony Brook, NY 11790, United States
| | - Li-Yung Lui
- California Pacific Medical Center Research Institute, San Francisco, CA 94107, United States
| | - James Harrington
- Analytical Science Division, RTI International, Research Triangle Park, NC 27709-2194, United States
| | - Peggy Cawthon
- California Pacific Medical Center Research Institute, San Francisco, CA 94107, United States
| | - Eric Orwoll
- Department of Medicine, School of Medicine, Oregon Health Sciences University, Portland, OR 97239, United States
| | - Deborah Kado
- Department of Medicine, School of Medicine, Stanford University, Palo Alto, CA 94305, United States
- Geriatric Research, Education, and Clinical Center (GRECC), VA Health Care System, Palo Alto, CA 94303, United States
| | - Jaymie Meliker
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11790, United States
- Program in Public Health, Stony Brook University, Stony Brook, NY 11790, United States
- Department of Family, Population, & Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11790, United States
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Fang D, Hu Y, Wang C, Tang C. Diagnostic value of urinary Tamm-Horsfall protein and 24 h urine osmolality for recurrent calcium oxalate stones of the upper urinary tract: Cross-sectional study. Open Med (Wars) 2023; 18:20230848. [PMID: 38025535 PMCID: PMC10656756 DOI: 10.1515/med-2023-0848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
We aimed to investigate the diagnostic value of urinary Tamm-Horsfall protein (THP) and 24 h urine osmolality for recurrent calcium oxalate (CaOx) stones. Clinical data of 120 patients with upper urinary tract stones admitted to our hospital between January 2020 and January 2022 were retrospectively reviewed. Patients were divided into recurrence (53 patients) and non-recurrence (67 patients) groups based on postoperative stone recurrence. Meanwhile, 50 healthy patients were selected as the control group. Urinary THP levels, 24 h urine osmolality, and biochemical indices were compared between the three groups; their diagnostic values for stone recurrence were evaluated using receiver operating characteristic (ROC) curves. Urinary THP, 24 h urine osmolality, and biochemical indices were significantly higher in the recurrence group than in the non-recurrence and control groups (P < 0.05). The 24 h urine osmolality was positively correlated with urinary oxalic acid and calcium excretion. ROC curve analysis showed that optimal cutoff values of urinary THP and 24 h urine osmolality for the diagnosis of stone development were ≥27.01 mg/L and ≥577.69 mOsm/(kg H2O), respectively. Furthermore, these indices combined significantly improved the accuracy of diagnosis. Urinary THP and 24 h urine osmolality were higher in patients with recurrent CaOx stones. Detection of both parameters combined can accurately diagnose stone recurrence.
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Affiliation(s)
- Daocheng Fang
- Department of Urology, Shanghai Songjiang District Central Hospital, Shanghai, 201600, China
| | - Yuanyuan Hu
- Department of Urology, Shanghai Songjiang District Central Hospital, Shanghai, 201600, China
| | - Chao Wang
- Department of Urology, Shanghai Songjiang District Central Hospital, Shanghai, 201600, China
| | - Chunhua Tang
- Department of Urology, Shanghai Songjiang District Central Hospital, Shanghai, 201600, China
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Kojima C, Umemura H, Shimosawa T, Nakayama T. Sex differences in the evaluation of proteinuria using the urine dipstick test. Front Med (Lausanne) 2023; 10:1148698. [PMID: 37435535 PMCID: PMC10332457 DOI: 10.3389/fmed.2023.1148698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/05/2023] [Indexed: 07/13/2023] Open
Abstract
Background The urine protein dipstick test is widely used, but false-positive and false-negative results may occur. This study aimed to compare the urine protein dipstick test with a urine protein quantification method. Methods The data were extracted using the Abbott Diagnostic Support System, which analyzes the inspection results using multiple parameters. This study included 41,058 specimens tested using the urine dipstick test and protein creatinine ratio from patients aged ≥18 years. The proteinuria creatinine ratio was classified according to the Kidney Disease Outcomes Quality Initiative guidelines. Results Urine protein on the dipstick test was negative in 15,548 samples (37.9%), trace in 6,422 samples (15.6%), and ≥1+ in 19,088 samples (46.5%). Among the trace proteinuria samples, A1 (<0.15 g/gCr), A2 (0.15-0.49 g/gCr), and A3 (≥0.5 g/gCr) category proteinuria accounted for 31.2, 44.8, and 24.0% of samples, respectively. All trace proteinuria specimens with a specific gravity of <1.010 were classified as A2 and A3 category proteinuria. In the trace proteinuria cases, women had a lower specific gravity and a higher percentage of A2 or A3 category proteinuria than men. The sensitivity in the "dipstick proteinuria" ≥ trace" group was higher than that in the "dipstick proteinuria ≥ 1+" group within the lower specific gravity group. The sensitivity in the "dipstick proteinuria ≥ 1+" group was higher for men than for women, and the sensitivity in the "dipstick proteinuria ≥ trace" group was higher than that in the "dipstick proteinuria ≥ 1+" group for women. Conclusion Pathological proteinuria assessment requires caution; this study suggests that evaluating the specific gravity of urine specimens with trace proteinuria is essential. Particularly for women, the sensitivity of the urine dipstick test is low, and caution is needed even with trace specimens.
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Affiliation(s)
- Chiari Kojima
- Department of Clinical Laboratory, International University of Health and Welfare Mita Hospital, Tokyo, Japan
- Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroshi Umemura
- Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Tatsuo Shimosawa
- Department of Clinical Laboratory, School of Medicine, International University of Health and Welfare, Chiba, Japan
| | - Tomohiro Nakayama
- Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
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6
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Seigner S, Weber K, Dorsch R. [Urinalysis in dogs and cats, part 1: physical and chemical urinalysis]. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2023; 51:168-181. [PMID: 37567179 DOI: 10.1055/a-2107-0361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
The urinalysis of dogs and cats is an important part of the diagnostic evaluation of urinary tract diseases as well as for the identification of systemic diseases. A routine urinalysis consists of a physical and chemical examination of the urine as well as an examination of the urine sediment. Various urine collection methods (free-catch, catheterization, cystocentesis) are available. Each method has multiple advantages and disadvantages. The appropriate method must be chosen individually for each patient depending on the emphasis of the examination. The urine should ideally be examined within 30 minutes of collection as it is prone to change due to time and storage. Physical examination of the urine consists of the determination of urine color, clarity, and specific gravity which provides information regarding the concentration of the urine. The latter is determined by refractometry and needs to be interpreted in the context of the hydration status of the patient. Chemical examination of the urine consists of the determination of the pH value and the presence of blood/hemoglobin/myoglobin, protein, glucose, bilirubin, urobilinogen, nitrite, and ketones. The use of commercially available urine dipsticks is common. These must be stored and used according to the manufacturer's instructions and when interpreting the results, veterinary aspects need to be taken into consideration. The physical and chemical examinations of the urine represent rapid and readily performable methods that provide important information for the diagnosis or the exclusion of numerous diseases.
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Affiliation(s)
- Sandra Seigner
- Medizinische Kleintierklinik, Ludwig-Maximilians-Universität München
| | - Karin Weber
- Medizinische Kleintierklinik, Ludwig-Maximilians-Universität München
| | - Roswitha Dorsch
- Medizinische Kleintierklinik, Ludwig-Maximilians-Universität München
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Lærkeholm Müller M, Busch AS, Ljubicic ML, Upners EN, Fischer MB, Hagen CP, Albrethsen J, Frederiksen H, Juul A, Andersson AM. Urinary concentration of phthalates and bisphenol A during minipuberty is associated with reproductive hormone concentrations in infant boys. Int J Hyg Environ Health 2023; 250:114166. [PMID: 37058994 DOI: 10.1016/j.ijheh.2023.114166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND The transient postnatal activation of the hypothalamic-pituitary-gonadal hormone axis is termed minipuberty and considered an important developmental period, which is highly sensitive to endocrine disruption. Here, we explore exposure-outcome associations during minipuberty between concentrations of potentially endocrine disrupting chemicals (EDCs) in urine of infant boys and their serum reproductive hormone concentrations. METHODS In total, 36 boys participating in the COPENHAGEN Minipuberty Study had data available for both urine biomarkers of target endocrine disrupting chemicals and reproductive hormones in serum from samples collected on the same day. Serum concentrations of reproductive hormones were measured by immunoassays or by LC-MS/MS. Urinary concentrations of metabolites of 39 non-persisting chemicals, including phthalates and phenolic compounds, were measured by LC-MS/MS. Nineteen chemicals had concentrations above the limit of detection in ≥50% of children and were included in data analysis. Associations of urinary phthalate metabolite and phenol concentrations (in tertiles) with hormone outcomes (age- and sex-specific SD-scores) were analysed by linear regression. Primarily, we focused on the EU regulated phthalates; butylbenzyl phthalate (BBzP), di-iso-butyl phthalate (DiBP), di-n-butyl phthalate (DnBP), and di-(2-ethylhexyl) phthalate (DEHP) as well as bisphenol A (BPA). Urinary metabolites of DiBP, DnBP and DEHP were summed and expressed as ∑DiBPm, ∑DnBPm and ∑DEHPm. RESULTS Compared to boys in the lowest ∑DnBPm tertile, urinary concentration of ∑DnBPm was associated with concurrent higher luteinizing hormone (LH) and anti-Müllerian hormone (AMH) SD-scores as well as lower testosterone/LH ratio in boys in the middle ∑DnBPm tertile (estimates (CI 95%) 0.79 (0.04; 1.54), 0.91 (0.13; 1.68), and -0.88 (-1.58;-0.19), respectively). Further, higher insulin-like peptide 3 (INSL3) SD-scores and lower DHEAS SD-score in boys in the highest ∑DnBPm tertile (0.91 (0.12; 1.70) and -0.85 (-1.51;-0.18), respectively) were observed. In addition, boys in the middle and highest ∑DEHPm tertile had higher LH (1.07 (0.35; 1.79) and 0.71 (-0.01; 1.43), respectively) and in the highest ∑DEHPm tertile also higher AMH (0.85 (0.10; 1.61)) concentration SD-scores, respectively. Boys in the highest BPA tertile had significantly higher AMH and lower DHEAS concentration compared to boys in the lowest BPA tertile (1.28 (0.54; 2.02) and -0.73 (-1.45; -0.01)), respectively. DISCUSSION Our findings indicate that exposure to chemicals with known or suspected endocrine disrupting potential, especially the EU-regulated DnBP, DEHP and BPA, may modify male reproductive hormone concentrations in infant boys suggesting that minipuberty is a critical window sensitive to endocrine disruption.
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Affiliation(s)
- Matilde Lærkeholm Müller
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Alexander Siegfried Busch
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; University of Münster, Department of General Pediatrics, Münster, Germany
| | - Marie Lindhardt Ljubicic
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Emmie N Upners
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Margit B Fischer
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Casper P Hagen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jakob Albrethsen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Hanne Frederiksen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anna-Maria Andersson
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
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van Duijl TT, Ruhaak R, Hoogeveen E, de Mutsert RE, Rosendaal F, le Cessie S, de Fijter J, Cobbaert C. Reference intervals of urinary kidney injury biomarkers for middle-aged men and women determined by quantitative protein mass spectrometry. Ann Clin Biochem 2022; 59:420-432. [PMID: 35957618 DOI: 10.1177/00045632221121780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS There is an ongoing need to recognize early kidney injury and its progression in structural chronic pathologies. The proteins NGAL, IGFBP7, TIMP2, KIM-1, CXCL9, TGF-β1, SLC22A2, nephrin, cubilin and uromodulin have been proposed as early kidney injury biomarkers. To guide clinical interpretation, their urinary concentrations should be accompanied by reference intervals, which we here establish in a representative Dutch middle-aged population. MATERIALS AND METHODS The 24-h urine samples from 1443 Caucasian middle-aged men and women, were analyzed for the biomarkers by quantitative LC-MS/MS. Biomarker excretion per 24-h were calculated, and urine creatinine and osmolality were measured for dilution normalization. This population was characterized by demographic and anthropometric parameters, comorbid conditions, and conventional kidney function measures. RESULTS NGAL, IGFBP7, TIMP2, KIM-1 and uromodulin could be quantified in this population, whereas nephrin, SLC22A2 and CXCL9 were below their detection limits. Urine creatinine and osmolality ( r= -were correlated to urine volume (r = -0.71; -0.74) and to IGFBP7 (r = 0.73; 0.71) and TIMP2 (r = 0.71; 0.69). Crude and normalized biomarker concentrations were affected by sex, but not by age, BMI, smoking, kidney function or common comorbid conditions. The reference intervals (men; women) were 18-108; 21-131 pmol IGFBP7/mmol creatinine, 1- 63; 4-224 pmol NGAL/mmol creatinine, 7-48; 7- 59 pmol TIMP2/mmol creatinine, <1-9; <1-12 pmol KIM-1/mmol creatinine and 0.1-1.2; 0.1-1.7 mg uromodulin/mmol creatinine. CONCLUSION We present dilution-normalized and sex-stratified urinary reference intervals of kidney injury biomarkers in a middle-aged Caucasian population.
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Affiliation(s)
| | | | - Ellen Hoogeveen
- Department of Clinical Epidemiology4501Leiden University Medical Center
| | - Renà E de Mutsert
- Department of Clinical Epidemiology4501Leiden University Medical Center
| | - Frits Rosendaal
- Department of Clinical Epidemiology4501Leiden University Medical Center
| | - Saskia le Cessie
- Department of Clinical Epidemiology4501Leiden University Medical Center
| | - Johan de Fijter
- Department of Nephrology4501Leiden University Medical Center
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Kuo CC, Balakrishnan P, Gribble MO, Best LG, Goessler W, Umans JG, Navas-Acien A. The association of arsenic exposure and arsenic metabolism with all-cause, cardiovascular and cancer mortality in the Strong Heart Study. ENVIRONMENT INTERNATIONAL 2022; 159:107029. [PMID: 34890900 PMCID: PMC9123362 DOI: 10.1016/j.envint.2021.107029] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 12/03/2021] [Accepted: 12/03/2021] [Indexed: 05/24/2023]
Abstract
The effect of low-moderate levels of arsenic exposure and of arsenic metabolism on mortality remains uncertain. We used data from a prospective cohort study in 3600 men and women aged 45 to 75 years living in Arizona, Oklahoma, and North and South Dakota. The biomarker of inorganic arsenic exposure was the sum of urine inorganic (iAs), monomethylated (MMA) and dimethylated (DMA) arsenic compounds (ƩAs) at baseline. The proportions of urine iAs, MMA and DMA over the ƩiAs, expressed as iAs%, MMA%, and DMA%, respectively, were used as biomarkers of arsenic metabolism. Arsenic exposure and arsenic metabolism were associated with all-cause, cardiovascular, and cancer mortality. For each interquartile range (IQR) increase in ƩAs (12.5 μg/L, overall range 0.7-194.1 μg/L), the adjusted hazard ratios (aHRs) were 1.28 (95% CI 1.16-1.41) for all-cause mortality, 1.28 (1.08-1.52) for cardiovascular mortality and 1.15 (0.92-1.44) for cancer mortality. The aHR for mortality for each IQR increase in MMA%, when iAs% is decreasing, was 1.52 (95% CI 1.16-1.99) for cardiovascular disease, 0.73 (0.55-0.98) for cancer, and 1.03 (0.90-1.19) for all-cause mortality. These findings at low-moderate levels of arsenic exposure highlight the need to implement public health measures to protect populations from involuntary arsenic exposure and for research to advance the biological and clinical understanding of arsenic-related health effects in general populations.
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Affiliation(s)
- Chin-Chi Kuo
- Big Data Center, China Medical University Hospital and China Medical University, Taichung, Taiwan; Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and China Medical University, Taichung, Taiwan; Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Poojitha Balakrishnan
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, NY, USA
| | - Matthew O Gribble
- Department of Environmental Health, Emory University, Atlanta, GA, USA; Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Lyle G Best
- Missouri Breaks Industries Research, Inc., Timber Lake, South Dakota
| | - Walter Goessler
- Institute of Chemistry - Analytical Chemistry, Karl-Franzens University Graz, Graz, Austria
| | - Jason G Umans
- MedStar Health Research Institute, Hyattsville, MD, USA; Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, NY, USA
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Associations of Urine Specific Gravity With Body Mass Index and Lean Body Mass at the Population Level: Implications for Hydration Monitoring. Int J Sport Nutr Exerc Metab 2021; 31:475-481. [PMID: 34470907 DOI: 10.1123/ijsnem.2021-0140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/10/2021] [Accepted: 06/30/2021] [Indexed: 11/18/2022]
Abstract
Urine specific gravity (USG) thresholds are used in practice and research to determine hypohydration. However, some limited research has found that body size and body composition may impact USG, suggesting that fixed cutoffs may be insensitive. Cross-sectional data from 3,634 participants of the 2007-2008 National Health and Nutrition Examination Survey were analyzed. Along with USG, body mass index (BMI), estimated lean body mass (LBM), and dietary intake were quantified. Logistic regression models were used to evaluate whether higher quintiles of BMI and LBM were associated with elevated USG (USG ≥ 1.020 and ≥1.025) after accounting for dietary moisture and sodium. The USG (1.018 ± 0.0003 vs. 1.015 ± 0.0004); BMI (28.4 ± 0.2 vs. 28.0 ± 0.2 kg/m2); LBM (60.9 ± 0.3 vs. 42.2 ± 0.2 kg); dietary moisture (3,401 ± 92 vs. 2,759 ± 49 g/day); and dietary sodium (4,171 ± 85 vs. 2,959 ± 50) were greater in men than in women (p < .05). Men and women in the fifth quintiles of BMI or LBM (vs. Quintile 1) had greater odds (2.00-3.68, p < .05) of elevated USG. (The only exception was for the association between BMI and USG ≥ 1.025 in men.) Being in Quintile 4 of LBM or BMI (vs. Quintile 1) also tended to be associated with higher odds of elevated of USG, though this pattern was more consistent when using USG ≥ 1.020 than USG ≥ 1.025. In summary, BMI and LBM are associated with USG at the population level. These results affirm that USG depends on body size and composition and raise questions about using fixed USG thresholds for determining hypohydration, particularly for people in the upper quintiles of BMI and LBM.
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Sears CG, Poulsen AH, Eliot M, Howe CJ, James KA, Harrington JM, Roswall N, Overvad K, Tjønneland A, Raaschou-Nielsen O, Wellenius GA, Meliker J. Urine cadmium and acute myocardial infarction among never smokers in the Danish Diet, Cancer and Health cohort. ENVIRONMENT INTERNATIONAL 2021; 150:106428. [PMID: 33571817 PMCID: PMC7940585 DOI: 10.1016/j.envint.2021.106428] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 05/11/2023]
Abstract
Cadmium exposure has been associated with cardiovascular disease. Cigarette smoking is a key source of cadmium exposure and thus a potential confounder in observational studies of environmental cadmium and cardiovascular disease that include tobacco smokers. We leveraged up to 20 years of follow-up in the Danish Diet, Cancer and Health cohort to test the hypothesis that cadmium exposure is associated with acute myocardial infarction (AMI) among people who never smoked. Between 1993 and 1997, 19,394 never-smoking participants (ages 50-64 years) were enrolled and provided a urine sample. From this sample, we randomly selected a subcohort of 600 males and 600 females. We identified 809 AMI cases occurring between baseline and the end of 2015 using the Danish National Patient Registry. We quantified cadmium, creatinine, and osmolality in baseline urine samples. Using an unweighted case-cohort approach, we estimated adjusted hazard ratios (aHR) for AMI in Cox proportional hazards models with age as the time axis. Participants had relatively low concentrations of urinary cadmium, as expected for never smokers (median = 0.20; 25th, 75th = 0.13, 0.32 μg cadmium/g creatinine). We did not find strong evidence to support an association between higher urinary cadmium and AMI when comparing the highest versus lowest quartile (aHR = 1.16; 95% CI: 0.86 - 1.56) and per IQR increment in cadmium concentration (aHR = 1.02; 95% CI: 0.93 - 1.12). Results were not materially different across strata defined by sex. Results were generally similar using creatinine or osmolality to account for differences in urine dilution. While cadmium exposure has been identified as a risk factor for cardiovascular disease, we did not find strong evidence that urinary cadmium at relatively low-levels is associated with AMI among people who have never smoked.
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Affiliation(s)
- Clara G Sears
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
| | | | - Melissa Eliot
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Chanelle J Howe
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Katherine A James
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, CO, USA
| | - James M Harrington
- Center for Analytical Science, Research Triangle Institute, Research Triangle Park, NC, USA
| | - Nina Roswall
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Gregory A Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Department of Environmental Health, Boston University, Boston, MA, USA
| | - Jaymie Meliker
- Program in Public Health, Department of Family, Population, & Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
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12
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Bouzouraa T, Rannou B, Cappelle J, Bonnet-Garin JM, Cadoré JL. Formula for the estimation of urine osmolality in healthy cats. Res Vet Sci 2021; 135:121-126. [PMID: 33477092 DOI: 10.1016/j.rvsc.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/01/2020] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
A simple and intuitive formula for the estimation of urine osmolality (Uosm) using the measured concentrations of major active urine osmolytes over a wide range of urine dilutions was proposed in healthy cats. Sixty-three urine samples were retrieved using ultrasound-guided cystocentesis from sixteen healthy cats under 5 years of age receiving intravenous infusion over a period of 24 h. Samples were collected at baseline (T0), T2, T6, T12, and T24. Urine osmolality was measured using a freezing-point osmometer, and the concentrations of osmolytes (urea, sodium, glucose, and potassium) were evaluated. A simple linear regression model for a clinical use was selected, and the agreement between the calculated and actual urine osmolalities was assessed. Urinary concentrations of urea, sodium and glucose were the three variables included in the model with the lowest AICC. Urine osmolality can be predicted accurately and precisely using urine urea, sodium and glucose with the following equation: Uosm = 1.25 × urea (mmol/l) or 20.87 × urea (g/l) + 1.1 × sodium (mmol/l) + 67 × glucose (mmol/l) or 3.72 × glucose (mg/dl). The concordance correlation coefficient for repeated measures between the actual and the calculated urine osmolality was extremely close to 1, which supported a high agreement: 0.996 (CI 95%: [0.993; 0.998]). In a population of healthy cats, urine osmolality can be predicted accurately and precisely using urinary urea, sodium and glucose concentrations. Similar formulae could potentially be established to help the clinician in pathological situations.
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Affiliation(s)
- Tarek Bouzouraa
- Clinique Vétérinaire Armonia - Internal Medicine Unit, Villefontaine, France.
| | - Benoit Rannou
- Department of Clinical Pathology, VetAgro Sup - Campus Vétérinaire, Marcy l'Etoile, France
| | - Julien Cappelle
- UMR EpiA, VetAgro Sup, INRA, F-69280 Marcy l'Étoile, France; CIRAD, UMR ASTRE, F-34398 Montpellier, France; ASTRE, CIRAD, INRA, Université de Montpellier, F-34398 Montpellier, France
| | | | - Jean-Luc Cadoré
- Department of Companion Animal, Internal Medicine Unit - UMR 754 INRA "Infections virales et pathologie comparée" (Cadoré), VetAgro Sup - Campus Vétérinaire, Marcy l'Etoile, France
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13
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Mervant L, Tremblay-Franco M, Jamin EL, Kesse-Guyot E, Galan P, Martin JF, Guéraud F, Debrauwer L. Osmolality-based normalization enhances statistical discrimination of untargeted metabolomic urine analysis: results from a comparative study. Metabolomics 2021; 17:2. [PMID: 33389209 DOI: 10.1007/s11306-020-01758-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/09/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Because of its ease of collection, urine is one of the most commonly used matrices for metabolomics studies. However, unlike other biofluids, urine exhibits tremendous variability that can introduce confounding inconsistency during result interpretation. Despite many existing techniques to normalize urine samples, there is still no consensus on either which method is most appropriate or how to evaluate these methods. OBJECTIVES To investigate the impact of several methods and combinations of methods conventionally used in urine metabolomics on the statistical discrimination of two groups in a simple metabolomics study. METHODS We applied 14 different strategies of normalization to forty urine samples analysed by liquid chromatography coupled to high-resolution mass spectrometry (LC-HRMS). To evaluate the impact of these different strategies, we relied on the ability of each method to reduce confounding variability while retaining variability of interest, as well as the predictability of statistical models. RESULTS Among all tested normalization methods, osmolality-based normalization gave the best results. Moreover, we demonstrated that normalization using a specific dilution prior to the analysis outperformed post-acquisition normalization. We also demonstrated that the combination of various normalization methods does not necessarily improve statistical discrimination. CONCLUSIONS This study re-emphasized the importance of normalizing urine samples for metabolomics studies. In addition, it appeared that the choice of method had a significant impact on result quality. Consequently, we suggest osmolality-based normalization as the best method for normalizing urine samples. TRIAL REGISTRATION NUMBER NCT03335644.
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Affiliation(s)
- Loïc Mervant
- Metatoul-AXIOM Platform, MetaboHUB, Toxalim, INRAE, Toulouse, France
- Toxalim, Toulouse University, INRAE, ENVT, INP-Purpan, UPS, Toulouse, France
| | - Marie Tremblay-Franco
- Metatoul-AXIOM Platform, MetaboHUB, Toxalim, INRAE, Toulouse, France.
- Toxalim, Toulouse University, INRAE, ENVT, INP-Purpan, UPS, Toulouse, France.
| | - Emilien L Jamin
- Metatoul-AXIOM Platform, MetaboHUB, Toxalim, INRAE, Toulouse, France
- Toxalim, Toulouse University, INRAE, ENVT, INP-Purpan, UPS, Toulouse, France
| | - Emmanuelle Kesse-Guyot
- Sorbonne Paris Nord University, Inserm, INRAE, Cnam, Nutritional Epidemiology, Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), 93017, Bobigny, France
| | - Pilar Galan
- Sorbonne Paris Nord University, Inserm, INRAE, Cnam, Nutritional Epidemiology, Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), 93017, Bobigny, France
| | - Jean-François Martin
- Metatoul-AXIOM Platform, MetaboHUB, Toxalim, INRAE, Toulouse, France
- Toxalim, Toulouse University, INRAE, ENVT, INP-Purpan, UPS, Toulouse, France
| | - Françoise Guéraud
- Toxalim, Toulouse University, INRAE, ENVT, INP-Purpan, UPS, Toulouse, France
| | - Laurent Debrauwer
- Metatoul-AXIOM Platform, MetaboHUB, Toxalim, INRAE, Toulouse, France
- Toxalim, Toulouse University, INRAE, ENVT, INP-Purpan, UPS, Toulouse, France
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14
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Bozack AK, Domingo-Relloso A, Haack K, Gamble MV, Tellez-Plaza M, Umans JG, Best LG, Yracheta J, Gribble MO, Cardenas A, Francesconi KA, Goessler W, Tang WY, Fallin MD, Cole SA, Navas-Acien A. Locus-Specific Differential DNA Methylation and Urinary Arsenic: An Epigenome-Wide Association Study in Blood among Adults with Low-to-Moderate Arsenic Exposure. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:67015. [PMID: 32603190 PMCID: PMC7534587 DOI: 10.1289/ehp6263] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 03/18/2020] [Accepted: 05/29/2020] [Indexed: 05/10/2023]
Abstract
BACKGROUND Chronic exposure to arsenic (As), a human toxicant and carcinogen, remains a global public health problem. Health risks persist after As exposure has ended, suggesting epigenetic dysregulation as a mechanistic link between exposure and health outcomes. OBJECTIVES We investigated the association between total urinary As and locus-specific DNA methylation in the Strong Heart Study, a cohort of American Indian adults with low-to-moderate As exposure [total urinary As, mean ( ± SD ) μ g / g creatinine: 11.7 (10.6)]. METHODS DNA methylation was measured in 2,325 participants using the Illumina MethylationEPIC array. We implemented linear models to test differentially methylated positions (DMPs) and the DMRcate method to identify regions (DMRs) and conducted gene ontology enrichment analysis. Models were adjusted for estimated cell type proportions, age, sex, body mass index, smoking, education, estimated glomerular filtration rate, and study center. Arsenic was measured in urine as the sum of inorganic and methylated species. RESULTS In adjusted models, methylation at 20 CpGs was associated with urinary As after false discovery rate (FDR) correction (FDR < 0.05 ). After Bonferroni correction, 5 CpGs remained associated with total urinary As (p Bonferroni < 0.05 ), located in SLC7A11, ANKS3, LINGO3, CSNK1D, ADAMTSL4. We identified one DMR on chromosome 11 (chr11:2,322,050-2,323,247), annotated to C11orf2; TSPAN32 genes. DISCUSSION This is one of the first epigenome-wide association studies to investigate As exposure and locus-specific DNA methylation using the Illumina MethylationEPIC array and the largest epigenome-wide study of As exposure. The top DMP was located in SLC7A11A, a gene involved in cystine/glutamate transport and the biosynthesis of glutathione, an antioxidant that may protect against As-induced oxidative stress. Additional DMPs were located in genes associated with tumor development and glucose metabolism. Further research is needed, including research in more diverse populations, to investigate whether As-related DNA methylation signatures are associated with gene expression or may serve as biomarkers of disease development. https://doi.org/10.1289/EHP6263.
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Affiliation(s)
- Anne K Bozack
- Department of Environmental Health Science, Columbia University, New York, New York, USA
| | - Arce Domingo-Relloso
- Department of Environmental Health Science, Columbia University, New York, New York, USA
- Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institutes, Madrid, Spain
| | - Karin Haack
- Population Health Program, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Mary V Gamble
- Department of Environmental Health Science, Columbia University, New York, New York, USA
| | - Maria Tellez-Plaza
- Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institutes, Madrid, Spain
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jason G Umans
- MedStar Health Research Institute, Washington, District of Columbia, USA
- Center for Clinical and Translational Sciences, Georgetown/Howard Universities, Washington, DC, USA
| | - Lyle G Best
- Missouri Breaks Industries Research, Eagle Butte, South Dakota, USA
| | - Joseph Yracheta
- Missouri Breaks Industries Research, Eagle Butte, South Dakota, USA
| | - Matthew O Gribble
- Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Andres Cardenas
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkley, California, USA
| | | | | | - Wan-Yee Tang
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - M Daniele Fallin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shelley A Cole
- Population Health Program, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Ana Navas-Acien
- Department of Environmental Health Science, Columbia University, New York, New York, USA
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15
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Seshia S, Dickinson RM. What is your diagnosis? Urine from a dog. Vet Clin Pathol 2020; 49:167-169. [PMID: 31997378 DOI: 10.1111/vcp.12813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 04/02/2019] [Accepted: 04/10/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | - Ryan M Dickinson
- Department of Veterinary Pathology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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16
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Mösch M, Reese S, Weber K, Hartmann K, Dorsch R. Influence of preanalytic and analytic variables in canine and feline urine specific gravity measurement by refractometer. J Vet Diagn Invest 2019; 32:36-43. [PMID: 31876254 DOI: 10.1177/1040638719896785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Urine specific gravity (USG), which is usually measured by refractometry, is an important indicator of renal concentrating ability. Few studies have evaluated refractometers with separate scales for canine and feline urine. Variables such as protein content or storage time may influence the USG. We compared the effects of measuring USG with a refractometer with single or separate scales for canine and feline urine, investigated inter- and intra-observer variability, and measured agreement between whole urine and supernatant. We evaluated the correlation between USG and osmolality, the influence of urinary protein on USG and osmolality, and the impact of storage time up to 6 mo. We examined 252 canine and 126 feline samples. Bland-Altman analysis revealed higher USG values of the single-scale refractometer than the dual-scale refractometer, with a mean difference (bias) of < 0.001 for canine and 0.003 for feline specimens. Inter- and intra-observer variability were acceptable. Good agreement was shown between USG of whole urine and supernatant. Correlations between USG and osmolality were excellent (0.98-0.99, p < 0.001). Proteinuria up to 1 g/L had no major impact on USG or osmolality. Storage time had no significant effect on USG. The difference between the refractometers is clinically irrelevant, and the use of a refractometer with separate feline and canine scales is unnecessary. Whole urine and supernatant stored up to 6 mo can both be used for USG measurement. The influence of proteinuria <1 g/L on USG and osmolality is negligible.
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Affiliation(s)
- Martina Mösch
- Clinic of Small Animal Medicine (Mösch, Weber, Hartmann, Dorsch), Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University, Munich, Bavaria, Germany.,Department of Anatomy, Histology and Embryology (Reese), Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University, Munich, Bavaria, Germany
| | - Sven Reese
- Clinic of Small Animal Medicine (Mösch, Weber, Hartmann, Dorsch), Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University, Munich, Bavaria, Germany.,Department of Anatomy, Histology and Embryology (Reese), Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University, Munich, Bavaria, Germany
| | - Karin Weber
- Clinic of Small Animal Medicine (Mösch, Weber, Hartmann, Dorsch), Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University, Munich, Bavaria, Germany.,Department of Anatomy, Histology and Embryology (Reese), Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University, Munich, Bavaria, Germany
| | - Katrin Hartmann
- Clinic of Small Animal Medicine (Mösch, Weber, Hartmann, Dorsch), Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University, Munich, Bavaria, Germany.,Department of Anatomy, Histology and Embryology (Reese), Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University, Munich, Bavaria, Germany
| | - Roswitha Dorsch
- Clinic of Small Animal Medicine (Mösch, Weber, Hartmann, Dorsch), Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University, Munich, Bavaria, Germany.,Department of Anatomy, Histology and Embryology (Reese), Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University, Munich, Bavaria, Germany
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17
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Heileson JL, Jayne JM. Validity of Digital and Manual Refractometers for Measuring Urine Specific Gravity During Field Operations: A Brief Report. Mil Med 2019; 184:e632-e636. [PMID: 31004429 DOI: 10.1093/milmed/usz082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/15/2019] [Accepted: 03/20/2019] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Dehydration can have an immediate negative impact on the performance of Soldiers in training or combat environments. Field expedient methods for assessing hydration status may be valuable for service members. Measurement of urine-specific gravity (USG) via refractometer is inexpensive, simple, fast, and a validated indicator of hydration status. Manual (MAN) and digital (DIG) refractometers are commonly used in laboratory settings however, digital (DIG) devices have not been validated in the field against MAN devices. The purpose of this study was to determine the validity and feasibility of using a DIG refractometer to assess USG compared to a MAN refractometer during a military field training exercise. MATERIALS AND METHODS Fifty-six military service members provided 672 urine samples during two 10-day field training exercises in central Texas. USG was assessed using a MAN and a DIG refractometer with cutoff value of ≥1.020 indicating hypohydration. The study received a non-human research determination. RESULTS The MAN measurements were strongly correlated with the DIG (r = 0.91, p < 0.0001) measurements. Bland-Altman analysis demonstrated agreement between the refractometers. The DIG displayed good sensitivity (93.9%) and specificity (85.8%) compared to the MAN. CONCLUSION The DIG refractometer used in this study was reliable and valid compared with a MAN device and was feasible for use in a field environment; however, the DIG refractometer tended to over overestimate hypohydration.
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Affiliation(s)
- Jeffery L Heileson
- Army Medical Department Center and School, Health Readiness Center of Excellence, 3630 Stanley Road, JBSA-Fort Sam Houston, TX 78234
| | - Julianna M Jayne
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, 10 General Greene Ave., Natick, MA 01760
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18
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Kang HW, Seo SP, Ha YS, Kim WT, Kim YJ, Yun SJ, Kim WJ, Lee SC. Twenty-four-hour urine osmolality as a representative index of adequate hydration and a predictor of recurrence in patients with urolithiasis. Int Urol Nephrol 2019; 51:1129-1135. [PMID: 31089946 DOI: 10.1007/s11255-019-02108-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/16/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE To determine the value of 24-h urine osmolality (UOsm) as a representative index of adequate hydration and predictor of stone recurrence in patients with urolithiasis. METHODS Medical records of consecutive patients presenting with renal or ureteric stones between 1994 and 2017 were retrospectively reviewed. Patients were grouped according to the results of 24-h UOsm (low ≤ 564 mOsm/kg H2O, high > 564 mOsm/kg H2O). Metabolic parameters and risk of stone recurrence were compared between the two groups. RESULTS The low urine concentration group were more likely to be older, to be female, and to have a lower body mass index and higher glomerular filtration rate than the high concentration group (each P < 0.005). A positive correlation was seen between 24-h UOsm and urinary calcium, sodium, uric acid, and magnesium excretion and 24-h specific gravity; a negative correlation was seen with 24-h urine volume. Stone-forming constituents, such as calcium and uric acid, were significantly higher in the high urine concentration group. Kaplan-Meier estimates showed that the low urine concentration group had a significantly longer stone recurrence-free period than the high urine concentration group (log-rank test, P < 0.001). In multivariate Cox regression analyses, 24-h UOsm was seen to be an independent risk factor for stone recurrence. CONCLUSIONS UOsm is a promising approach to assessing hydration and predicting stone recurrence in patients with urolithiasis. Maintaining UOsm < 564 mOsm/kg H2O may reduce the risk of stone recurrence.
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Affiliation(s)
- Ho Won Kang
- Department of Urology, College of Medicine and Institute for Tumor Research, Chungbuk National University, 776 1sunhwan-ro, Seowon-gu, Cheonju, 28644, Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, Korea
| | - Sung Pil Seo
- Department of Urology, College of Medicine and Institute for Tumor Research, Chungbuk National University, 776 1sunhwan-ro, Seowon-gu, Cheonju, 28644, Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, Korea
| | - Yun-Sok Ha
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Won Tae Kim
- Department of Urology, College of Medicine and Institute for Tumor Research, Chungbuk National University, 776 1sunhwan-ro, Seowon-gu, Cheonju, 28644, Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, Korea
| | - Yong-June Kim
- Department of Urology, College of Medicine and Institute for Tumor Research, Chungbuk National University, 776 1sunhwan-ro, Seowon-gu, Cheonju, 28644, Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, Korea
| | - Seok-Joong Yun
- Department of Urology, College of Medicine and Institute for Tumor Research, Chungbuk National University, 776 1sunhwan-ro, Seowon-gu, Cheonju, 28644, Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, Korea
| | - Wun-Jae Kim
- Department of Urology, College of Medicine and Institute for Tumor Research, Chungbuk National University, 776 1sunhwan-ro, Seowon-gu, Cheonju, 28644, Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, Korea
| | - Sang-Cheol Lee
- Department of Urology, College of Medicine and Institute for Tumor Research, Chungbuk National University, 776 1sunhwan-ro, Seowon-gu, Cheonju, 28644, Korea. .,Department of Urology, Chungbuk National University Hospital, Cheongju, Korea.
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19
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Megahed AA, Grünberg W, Constable PD. Clinical utility of urine specific gravity, electrical conductivity, and color as on-farm methods for evaluating urine concentration in dairy cattle. J Vet Intern Med 2019; 33:1530-1539. [PMID: 31025445 PMCID: PMC6524117 DOI: 10.1111/jvim.15502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 04/03/2019] [Indexed: 11/26/2022] Open
Abstract
Background Urine concentration (UC) provides clinically useful information concerning hydration status and renal function of animals. Objectives To characterize the clinical performance of urine specific gravity measured by optical refractometry (USG‐R) or Multistix‐SG urine reagent dipstick (USG‐D), urine electrical conductivity using an OAKTON Con 6 conductivity handheld meter (UEC), urine color (UColor) using a custom‐designed 8‐point color chart, and urine creatinine concentration (UCreat) for assessing UC in dairy cattle. Animals 20 periparturient Holstein‐Friesian cows. Methods Urine was obtained by perineal stimulation or urethral catheterization and urine osmolality (UOsm, reference method), USG‐R, USG‐D, UEC, UColor, and UCreat determined. Diagnostic test performance was evaluated using Spearman's rho and logistic regression to determine the area under the receiver operating curve (AUC) and optimal cut point for diagnosing hypohydration (UOsm ≥800 mOsm/kg). P < .05 was considered significant. Results The best performing test for diagnosing hypohydration was USG‐R (AUC = 0.90) at an optimal cut point ≥1.030. The second‐best performing test was UEC (AUC = 0.82) at a cut point of ≥23.7 mS/cm, followed by UCreat (AUC = 0.76) at a cut point of ≥95.3 mg/dL, and UColor (AUC = 0.74) at a cut point of ≥4 on an 8‐point scale. Urine specific gravity measured by dipstick performed poorly (AUC = 0.63). Conclusions and Clinical Importance USG‐R and UEC provide practical and sufficiently accurate methods for measuring UC in dairy cattle. Urine color had moderate clinical utility as a no‐cost cow‐side method for assessing UC, whereas dipstick refractometry is not recommended for assessing UC.
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Affiliation(s)
- Ameer A Megahed
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Champaign, Illinois.,Department of Animal Medicine, Internal Medicine, Faculty of Veterinary Medicine, Benha University, Benha, Egypt
| | - Walter Grünberg
- Clinic for Cattle, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Peter D Constable
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Champaign, Illinois
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20
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Burton C, Ma Y. Current Trends in Cancer Biomarker Discovery Using Urinary Metabolomics: Achievements and New Challenges. Curr Med Chem 2019; 26:5-28. [PMID: 28914192 DOI: 10.2174/0929867324666170914102236] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/26/2016] [Accepted: 08/08/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND The development of effective screening methods for early cancer detection is one of the foremost challenges facing modern cancer research. Urinary metabolomics has recently emerged as a potentially transformative approach to cancer biomarker discovery owing to its noninvasive sampling characteristics and robust analytical feasibility. OBJECTIVE To provide an overview of new developments in urinary metabolomics, cover the most promising aspects of hyphenated techniques in untargeted and targeted metabolomics, and to discuss technical and clinical limitations in addition to the emerging challenges in the field of urinary metabolomics and its application to cancer biomarker discovery. METHODS A systematic review of research conducted in the past five years on the application of urinary metabolomics to cancer biomarker discovery was performed. Given the breadth of this topic, our review focused on the five most widely studied cancers employing urinary metabolomics approaches, including lung, breast, bladder, prostate, and ovarian cancers. RESULTS As an extension of conventional metabolomics, urinary metabolomics has benefitted from recent technological developments in nuclear magnetic resonance, mass spectrometry, gas and liquid chromatography, and capillary electrophoresis that have improved urine metabolome coverage and analytical reproducibility. Extensive metabolic profiling in urine has revealed a significant number of altered metabolic pathways and putative biomarkers, including pteridines, modified nucleosides, and acylcarnitines, that have been associated with cancer development and progression. CONCLUSION Urinary metabolomics presents a transformative new approach toward cancer biomarker discovery with high translational capacity to early cancer screening.
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Affiliation(s)
- Casey Burton
- Department of Chemistry and Center for Single Nanoparticle, Single Cell, and Single Molecule Monitoring, Missouri University of Science and Technology, Rolla, MO, United States
| | - Yinfa Ma
- Department of Chemistry and Center for Single Nanoparticle, Single Cell, and Single Molecule Monitoring, Missouri University of Science and Technology, Rolla, MO, United States
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Markwalter CF, Corstjens PLAM, Mammoser CM, Camps G, van Dam GJ, Wright DW. Poly(amidoamine)-coated magnetic particles for enhanced detection of Schistosoma circulating anodic antigen in endemic urine samples. Analyst 2019; 144:212-219. [PMID: 30328427 DOI: 10.1039/c8an00941d] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Accurate and sensitive point-of-care diagnostic tools are critical for schistosomiasis control and elimination. The existing ultrasensitive lateral flow assay for the detection of Schistosoma circulating anodic antigen (CAA) has demonstrated excellent sensitivity but is time-consuming and requires significant laboratory infrastructure that limits its applicability at the point of care. To address this challenge, we sought to develop an alternative sample preparation method to concentrate CAA from large-volume urine samples requiring little-to-no laboratory equipment. The developed method relies on electrostatic interactions between the negatively-charged CAA biomarker and positively-charged poly(amidoamine) (PAMAM) dendrimers functionalized to the surface of magnetic particles. After CAA capture on the surface of the PAMAM-functionalized magnetic beads, the supernatant was removed, and CAA was eluted into a small-volume, high-salt elution buffer. This concentrated eluate was subsequently applied to the existing lateral flow assay. The PAMAM-functionalized magnetic bead-based CAA concentration method was extensively characterized for its robustness, evaluated on a set of endemic urine samples, and compared to spin filter-based concentration methods. The novel bead-based sample preparation method used only disposable laboratory materials, resulted in a 200-fold improvement in CAA limits of detection, and performed just as well as infrastructure-intensive and high-cost spin filter methods. Additionally, the functionalized beads were robust to variations in sample pH and storage conditions. The PAMAM-functionalized magnetic bead-based CAA concentration method represents a promising step toward ultrasensitive schistosomiasis diagnosis at the point of care.
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Affiliation(s)
| | - Paul L A M Corstjens
- Department of Molecular Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Claire M Mammoser
- Department of Chemistry, Vanderbilt University, Nashville, TN 37235, USA.
| | - Garrett Camps
- Department of Chemistry, Vanderbilt University, Nashville, TN 37235, USA.
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands.
| | - David W Wright
- Department of Chemistry, Vanderbilt University, Nashville, TN 37235, USA.
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22
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Defauw P, Daminet S, Leisewitz A, Goddard A, Paepe D, Duchateau L, Schoeman J. Renal azotemia and associated clinical and laboratory findings in dogs with Babesia rossi infection. Vet Parasitol 2018; 260:22-29. [DOI: 10.1016/j.vetpar.2018.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/28/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
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Lindsay A, Costello JT. Realising the Potential of Urine and Saliva as Diagnostic Tools in Sport and Exercise Medicine. Sports Med 2018; 47:11-31. [PMID: 27294353 DOI: 10.1007/s40279-016-0558-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Accurate monitoring of homeostatic perturbations following various psychophysiological stressors is essential in sports and exercise medicine. Various biomarkers are routinely used as monitoring tools in both clinical and elite sport settings. Blood collection and muscle biopsies, both invasive in nature, are considered the gold standard for the analysis of these biomarkers in exercise science. Exploring non-invasive methods of collecting and analysing biomarkers that are capable of providing accurate information regarding exercise-induced physiological and psychological stress is of obvious practical importance. This review describes the potential benefits, and the limitations, of using saliva and urine to ascertain biomarkers capable of identifying important stressors that are routinely encountered before, during, or after intense or unaccustomed exercise, competition, over-training, and inappropriate recovery. In particular, we focus on urinary and saliva biomarkers that have previously been used to monitor muscle damage, inflammation, cardiovascular stress, oxidative stress, hydration status, and brain distress. Evidence is provided from a range of empirical studies suggesting that urine and saliva are both capable of identifying various stressors. Although additional research regarding the efficacy of using urine and/or saliva to indicate the severity of exercise-induced psychophysiological stress is required, it is likely that these non-invasive biomarkers will represent "the future" in sports and exercise medicine.
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Affiliation(s)
- Angus Lindsay
- Program in Physical Therapy and Rehabilitation Sciences, School of Medicine, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
| | - Joseph T Costello
- Extreme Environments Laboratory, Department of Sport and Exercise Science, University of Portsmouth, Spinnaker Building, Cambridge Road, Portsmouth, PO1 2ER, UK
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Zubac D, Reale R, Karnincic H, Sivric A, Jelaska I. Urine specific gravity as an indicator of dehydration in Olympic combat sport athletes; considerations for research and practice. Eur J Sport Sci 2018; 18:920-929. [PMID: 29746803 DOI: 10.1080/17461391.2018.1468483] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Urine specific gravity (USG) is the most commonly reported biochemical marker used in research and applied settings to detect fluid deficits in athletes, including those participating in combat sports. Despite the popularity of its use, there has been a growing debate regarding the diagnostic accuracy and the applicability of USG in characterizing whole-body fluid status and fluctuations. Moreover, recent investigations report universally high prevalence of hypohydration (∼90%) via USG assessment in combat sport athletes, often in spite of stable body-mass. Given the widespread use in both research and practice, and its use in a regulatory sense as a 'hydration test' in combat sports as a means to detect dehydration at the time of weigh-in; understanding the limitations and applicability of USG assessment is of paramount importance. Inconsistencies in findings of USG readings, possibly as a consequence of diverse methodological research approaches and/or overlooked confounding factors, preclude a conclusive position stand within current combat sports research and practice. Thus the primary aim of this paper is to critically review the literature regarding USG assessment of hydration status in combat sports research and practice. When taken on balance, the existing literature suggests: the use of laboratory derived benchmarks in applied settings, inconsistent sampling methodologies, the incomplete picture of how various confounding factors affect end-point readings, and the still poorly understood potential of renal adaptation to dehydration in combat athletes; make the utility of hydration assessment via USG measurement quite problematic, particularly when diet and training is not controlled.
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Affiliation(s)
- Damir Zubac
- a Science and Research Center Koper , Institute for Kinesiology Research , Koper , Slovenia.,c Faculty of Kinesiology , University of Split , Split , Croatia
| | - Reid Reale
- b Gatorade Sports Science Institute , Bradenton , FL , USA
| | - Hrvoje Karnincic
- c Faculty of Kinesiology , University of Split , Split , Croatia
| | | | - Igor Jelaska
- c Faculty of Kinesiology , University of Split , Split , Croatia
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25
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Nigra AE, Ruiz-Hernandez A, Redon J, Navas-Acien A, Tellez-Plaza M. Environmental Metals and Cardiovascular Disease in Adults: A Systematic Review Beyond Lead and Cadmium. Curr Environ Health Rep 2018; 3:416-433. [PMID: 27783356 DOI: 10.1007/s40572-016-0117-9] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Published systematic reviews concluded that there is moderate to strong evidence to infer a potential role of lead and cadmium, widespread environmental metals, as cardiovascular risk factors. For other non-essential metals, the evidence has not been appraised systematically. Our objective was to systematically review epidemiologic studies on the association between cardiovascular disease in adults and the environmental metals antimony, barium, chromium, nickel, tungsten, uranium, and vanadium. We identified a total of 4 articles on antimony, 1 on barium, 5 on chromium, 1 on nickel, 4 on tungsten, 1 on uranium, and 0 on vanadium. We concluded that the current evidence is not sufficient to inform on the cardiovascular role of these metals because of the small number of studies. Few experimental studies have also evaluated the role of these metals in cardiovascular outcomes. Additional epidemiologic and experimental studies, including prospective cohort studies, are needed to understand the role of metals, including exposure to metal mixtures, in cardiovascular disease development.
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Affiliation(s)
- Anne E Nigra
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 W 168th St, 11 Floor Rm 1105, New York, NY, 10032, USA
| | - Adrian Ruiz-Hernandez
- Department of Internal Medicine, Hospital Clínico de Valencia, Avenida Blasco Ibañez, 17, 46010, Valencia, Spain.,Area of Cardiometabolic and Renal Risk, Institute for Biomedical Research Hospital Clinical of Valencia (INCLIVA), Av. Menendez Pelayo, 4 accesorio, 6010, Valencia, Spain
| | - Josep Redon
- Department of Internal Medicine, Hospital Clínico de Valencia, Avenida Blasco Ibañez, 17, 46010, Valencia, Spain.,Area of Cardiometabolic and Renal Risk, Institute for Biomedical Research Hospital Clinical of Valencia (INCLIVA), Av. Menendez Pelayo, 4 accesorio, 6010, Valencia, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Minister of Health, Madrid, Spain
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 W 168th St, 11 Floor Rm 1105, New York, NY, 10032, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Maria Tellez-Plaza
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Area of Cardiometabolic and Renal Risk, Institute for Biomedical Research Hospital Clinical of Valencia (INCLIVA), Av. Menendez Pelayo, 4 accesorio, 6010, Valencia, Spain.
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Bulka CM, Mabila SL, Lash JP, Turyk ME, Argos M. Arsenic and Obesity: A Comparison of Urine Dilution Adjustment Methods. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:087020. [PMID: 28858828 PMCID: PMC5783631 DOI: 10.1289/ehp1202] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 03/21/2017] [Accepted: 03/30/2017] [Indexed: 05/18/2023]
Abstract
INTRODUCTION A commonly used approach to adjust for urine dilution in analyses of biomarkers is to adjust for urinary creatinine. However, creatinine is a product of muscle mass and is therefore associated with body mass. In studies of urinary analytes and obesity or obesity-related outcomes, controlling for creatinine could induce collider stratification bias. We illustrate this phenomenon with an analysis of urinary arsenic. OBJECTIVE We aimed to evaluate various approaches of adjustment for urinary dilution on the associations between urinary arsenic concentration and measures of obesity. METHODS Using data from the National Health and Nutrition Examination Survey, we regressed body mass index (BMI) and waist-to-height ratios on urinary arsenic concentrations. We compared eight approaches to account for urine dilution, including standardization by urinary creatinine, osmolality, and flow rates, and inclusion of these metrics as independent covariates. We also used a recently proposed method known as covariate-adjusted standardization. RESULTS Inverse associations between urinary arsenic concentration with BMI and waist-to-height ratio were observed when either creatinine or osmolality were used to standardize or as covariates. Not adjusting for dilution, standardizing or adjusting for urinary flow rate, and using covariate-adjusted standardization resulted in null associations observed between arsenic concentration in relation to BMI and waist-to-height ratio. CONCLUSIONS Our findings suggest that arsenic exposure is not associated with obesity, and that urinary creatinine and osmolality may be colliders on the causal pathway from arsenic exposure to obesity, as common descendants of hydration and body composition. In studies of urinary biomarkers and obesity or obesity-related outcomes, alternative metrics such as urinary flow rate or analytic strategies such as covariate-adjusted standardization should be considered. https://doi.org/10.1289/EHP1202.
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Affiliation(s)
- Catherine M Bulka
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago , Chicago, Illinois, USA
- Institute for Minority Health Research, Section of General Internal Medicine, Department of Medicine, University of Illinois at Chicago , Chicago, Illinois, USA
| | - Sithembile L Mabila
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago , Chicago, Illinois, USA
| | - James P Lash
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago , Chicago, Illinois, USA
| | - Mary E Turyk
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago , Chicago, Illinois, USA
| | - Maria Argos
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago , Chicago, Illinois, USA
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Abstract
Abstract
Pteridines and their derivatives function as intermediates in the metabolism of several vitamins and cofactors, and their relevance to disease has inspired new efforts to study their roles as disease biomarkers. Recent analytical advances, such as the emergence of sensitive mass spectrometry techniques, new workflows for measuring pteridine derivatives in their native oxidation states and increased multiplexing capacities for the simultaneous determination of many pteridine derivatives, have enabled researchers to explore the roles of urinary pteridines as disease biomarkers at much lower levels with greater accuracy than with previous technologies or methods. As a result, urinary pteridines are being increasingly studied as putative cancer biomarkers with promising results being reported from exploratory studies. In addition, the role of urinary neopterin as a universal biomarker for immune system activation is being investigated in new diseases where it is anticipated to become a useful supplementary marker in clinical diagnostic settings. In summary, this review provides an overview of recent developments in the clinical study of urinary pteridines as disease biomarkers, covers the most promising aspects of advanced analytical techniques being developed for the determination of urinary pteridines and discusses the major challenges associated with implementing pteridine biomarkers in clinical laboratory settings.
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Affiliation(s)
- Casey Burton
- Department of Chemistry and Center for Single Nanoparticle, Single Cell, and Single Molecule Monitoring, Missouri University of Science and Technology, Rolla, MO, USA
| | - Yinfa Ma
- Department of Chemistry and Center for Single Nanoparticle, Single Cell, and Single Molecule Monitoring, Missouri University of Science and Technology, 400 West 11th Street, Rolla, MO 65409, USA
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28
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Decloedt A, Damen S, Vanhaecke L. Revealing the influence of glucocorticoid treatment on the excretion of anabolic-androgenic steroids in horses through in vitro digestive simulations and an in vivo case study. Res Vet Sci 2017; 115:132-137. [PMID: 28342428 DOI: 10.1016/j.rvsc.2017.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 09/04/2016] [Accepted: 02/23/2017] [Indexed: 10/20/2022]
Abstract
Anabolic-androgenic steroids (AAS) are strictly forbidden in equine sports because of their stimulating effect on muscle growth and performance. Nevertheless, low levels of AAS have been found in some horses, untreated with AAS. Glucocorticoids (GC), used as an anti-inflammatory therapy and structurally related to AAS, might play a role in this phenomenon. In order to unravel this possible correlation the influence of glucocorticoid treatment on the excretion of AAS was studied both in vivo and in vitro. In vivo effects were investigated by analysing urine samples collected from a gelding treated with betamethasone. Additionally, multiple in vitro digestion simulations were set up, according to a previously validated protocol, to study the possibility of a direct biotransformation of glucocorticoids to AAS, by the microbiota of the equine hindgut. Urine and in vitro digestion samples were extracted and analysed with UHPLC-MS/MS and UHPLC-Orbitrap-HRMS analytical methods. A significant influence on the urinary excretion of α-testosterone (αT), β-testosterone (βT) and androsta-1,4-diene-3,17-dione (ADD) was seen. αT-concentrations up to 20ng/mL were detected. ADD was not found before treatment but could be detected post-treatment. Cortisone and cortisol also peaked (>30ng/mL) between day 37 and 48 post-treatment. The in vitro digestion results however revealed no direct biotransformation of glucocorticoids to AAS by the microbiota of the equine hindgut. This study shows that a glucocorticoid treatment can disrupt the synthesis and excretion of AAS, not by direct biotransformation upon gastrointestinal digestion, but more likely by influencing the hypothalamic-pituitary-adrenal axis.
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Affiliation(s)
- Anneleen Decloedt
- Ghent University, Laboratory of Chemical Analysis, Faculty of Veterinary Medicine, Department of Veterinary Public Health and Food Safety, 133 Salisburylaan, B-9820 Merelbeke, Belgium; Ghent University, Laboratory of Biochemistry and Brewing, Faculty of Bioscience Engineering, Department of Applied Biosciences, 1 Valentin Vaerwyckweg, B-9000 Ghent, Belgium
| | - Sander Damen
- Ghent University, Laboratory of Chemical Analysis, Faculty of Veterinary Medicine, Department of Veterinary Public Health and Food Safety, 133 Salisburylaan, B-9820 Merelbeke, Belgium
| | - Lynn Vanhaecke
- Ghent University, Laboratory of Chemical Analysis, Faculty of Veterinary Medicine, Department of Veterinary Public Health and Food Safety, 133 Salisburylaan, B-9820 Merelbeke, Belgium.
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Vacchi-Suzzi C, Kruse D, Harrington J, Levine K, Meliker JR. Is Urinary Cadmium a Biomarker of Long-term Exposure in Humans? A Review. Curr Environ Health Rep 2016; 3:450-458. [PMID: 27696280 PMCID: PMC5453507 DOI: 10.1007/s40572-016-0107-y] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cadmium is a naturally-occurring element, and humans are exposed from cigarettes, food, and industrial sources. Following exposure, cadmium accumulates in the kidney and is slowly released into the urine, usually proportionally to the levels found in the kidneys. Cadmium levels in a single spot urine sample have been considered indicative of long-term exposure to cadmium; however, such a potentially exceptional biomarker requires careful scrutiny. In this review, we report good to excellent temporal stability of urinary cadmium (intraclass correlation coefficient 0.66-0.81) regardless of spot urine or first morning void sampling. Factors such as changes in smoking habits and diseases characterized by increased excretion of proteins may produce short-term changes in urinary cadmium levels. We recommend that epidemiologists use this powerful biomarker in prospective studies stratified by smoking status, along with thoughtful consideration of additional factors that can influence renal physiology and cadmium excretion.
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Affiliation(s)
- Caterina Vacchi-Suzzi
- Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY, 11794, USA.
| | - Danielle Kruse
- Stony Brook University School of Medicine, Stony Brook, NY, 11794, USA
| | - James Harrington
- Analytical Sciences Department, Innovation, Technology and Development RTI International, Research Triangle Park, NC, 27709, USA
| | - Keith Levine
- Analytical Sciences Department, Innovation, Technology and Development RTI International, Research Triangle Park, NC, 27709, USA
| | - Jaymie R Meliker
- Program in Public Health, Department of Family, Population and Preventive Medicine Stony Brook University, Stony Brook, NY, 11794, USA
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Liu G, Sun Q, Zhu M, Sun L, Wang Z, Li H, Li Z, Chen Y, Yin H, Lin X. Nickel exposure and prevalent albuminuria and β2-microglobulinuria: evidence from a population-based study. J Epidemiol Community Health 2015; 70:437-43. [PMID: 26612876 DOI: 10.1136/jech-2015-205994] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 11/07/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND High exposure to nickel could induce renal dysfunction in rodents and occupational workers. However, little is known about the effects of non-occupational exposure to nickel on renal health in the general population. We aimed to examine the associations of urinary nickel concentrations with albuminuria and β2-microglobulinuria in Chinese adults. METHODS 2115 non-institutionalised Chinese men and women aged 55-76 years from Beijing and Shanghai were included. Urinary nickel concentrations were assessed by inductively coupled plasma mass spectroscopy. Plasma uric acid, urea nitrogen, C reactive protein and urinary albumin, β2-microglobulin and creatinine were measured. Albuminuria was defined as urinary albumin ≥30 mg/g creatinine, and β2-microglobulinuria was defined as urinary β2-microglobulin ≥200 µg/g creatinine. RESULTS Median concentration of urinary nickel was 3.95 μg/g creatinine (IQR: 2.57-6.71 μg/g creatinine), and prevalence of albuminuria, β2-microglobulinuria and both albuminuria and β2-microglobulinuria was 22.1%, 24.5% and 9.7%, respectively. Comparing the highest with the lowest quartile of urinary nickel, the ORs (95% CIs) were 1.99 (1.46 to 2.78) for albuminuria, 1.44 (1.07 to 1.95) for β2-microglobulinuria, and 2.95 (1.74 to 4.97) for both albuminuria and β2-microglobulinuria, after adjustment for demographic characteristics, lifestyle behaviours, body mass index, hypertension and diabetes. The association remained significant when further controlling for inflammatory markers or other heavy metals (all p trend <0.05). CONCLUSIONS This study suggested that urinary nickel levels were positively associated with albuminuria and β2-microglobulinuria in Chinese men and women, who had relatively low background nickel exposure. More prospective studies are needed to confirm our findings.
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Affiliation(s)
- Gang Liu
- From the Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Chinese Academy of Sciences, and University of Chinese Academy of Sciences, Shanghai, China
| | - Qi Sun
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Mingjiang Zhu
- From the Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Chinese Academy of Sciences, and University of Chinese Academy of Sciences, Shanghai, China
| | - Liang Sun
- From the Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Chinese Academy of Sciences, and University of Chinese Academy of Sciences, Shanghai, China
| | - Zhenzhen Wang
- From the Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Chinese Academy of Sciences, and University of Chinese Academy of Sciences, Shanghai, China
| | - Huaixing Li
- From the Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Chinese Academy of Sciences, and University of Chinese Academy of Sciences, Shanghai, China
| | - Zi Li
- From the Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Chinese Academy of Sciences, and University of Chinese Academy of Sciences, Shanghai, China
| | - Yan Chen
- From the Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Chinese Academy of Sciences, and University of Chinese Academy of Sciences, Shanghai, China
| | - Huiyong Yin
- From the Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Chinese Academy of Sciences, and University of Chinese Academy of Sciences, Shanghai, China
| | - Xu Lin
- From the Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Chinese Academy of Sciences, and University of Chinese Academy of Sciences, Shanghai, China
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Mercury Exposure Assessment and Spatial Distribution in A Ghanaian Small-Scale Gold Mining Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:10755-82. [PMID: 26340636 PMCID: PMC4586641 DOI: 10.3390/ijerph120910755] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/18/2015] [Accepted: 08/26/2015] [Indexed: 01/12/2023]
Abstract
Mercury is utilized worldwide in artisanal and small-scale gold mining (ASGM) and may pose a risk for miners and mining communities. While a number of studies have characterized mercury in ASGM communities, most have focused on a single media and few have taken a holistic approach. Here, a multiple media exposure assessment and cross-sectional study of mercury was conducted in 2010 through 2012 in northeast Ghana with a small-scale gold mining community, Kejetia, a subsistence farming community, Gorogo, and an urban ASGM gold refinery in Bolgatanga. The objective was to assess mercury in a range of human (urine and hair) and ecological (household soil, sediment, fish, and ore) samples to increase understanding of mercury exposure pathways. All participants were interviewed on demographics, occupational and medical histories, and household characteristics. Participants included 90 women of childbearing age and 97 adults from Kejetia and 75 adults from Gorogo. Median total specific gravity-adjusted urinary, hair, and household soil mercury were significantly higher in Kejetia miners (5.18 µg/L, 0.967 µg/g, and 3.77 µg/g, respectively) than Kejetia non-miners (1.18 µg/L, 0.419 µg/g, and 2.00 µg/g, respectively) and Gorogo participants (0.154 µg/L, 0.181 µg/g, and 0.039 µg/g) in 2011. Sediment, fish, and ore Hg concentrations were below guideline values. Median soil mercury from the Bolgatanga refinery was very high (54.6 µg/g). Estimated mean mercury ingestion for Kejetia adults from soil and dust exceeded the U.S. Environmental Protection Agency reference dose (0.3 µg Hg/kg·day) for pica (0.409 µg Hg/kg·day) and geophagy (20.5 µg Hg/kg·day) scenarios. Most participants with elevated urinary and household soil mercury were miners, but some non-miners approached and exceeded guideline values, suggesting a health risk for non-mining residents living within these communities.
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An Investigation of Organic and Inorganic Mercury Exposure and Blood Pressure in a Small-Scale Gold Mining Community in Ghana. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:10020-38. [PMID: 26308023 PMCID: PMC4555326 DOI: 10.3390/ijerph120810020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 07/28/2015] [Accepted: 08/17/2015] [Indexed: 02/07/2023]
Abstract
There is increasing concern about the cardiovascular effects of mercury (Hg) exposure, and that organic methylmercury and inorganic Hg2+ may affect the cardiovascular system and blood pressure differentially. In small-scale gold mining communities where inorganic, elemental Hg exposures are high, little is known about the effects of Hg on blood pressure. In 2011, we assessed the relationship between Hg exposure and blood pressure (BP) in a cross-sectional study of adults from a small-scale gold mining community, Kejetia, and subsistence farming community, Gorogo, in Ghana’s Upper East Region. Participants’ resting heart rate and BP were measured, and hair and urine samples were provided to serve as biomarkers of organic and inorganic Hg exposure, respectively. Participants included 70 miners and 26 non-miners from Kejetia and 75 non-miners from Gorogo. Total specific gravity-adjusted urinary and hair Hg was higher among Kejetia miners than Kejetia non-miners and Gorogo participants (median urinary Hg: 5.17, 1.18, and 0.154 µg/L, respectively; hair Hg: 0.945, 0.419, and 0.181 µg/g, respectively). Hypertension was prevalent in 17.7% of Kejetia and 21.3% of Gorogo participants. Urinary and hair Hg were not significantly associated with systolic or diastolic BP for Kejetia or Gorogo participants while adjusting for sex, age, and smoking status. Although our results follow trends seen in other studies, the associations were not of statistical significance. Given the unique study population and high exposures to inorganic Hg, the work contained here will help increase our understanding of the cardiovascular effects of Hg.
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Is urinary density an adequate predictor of urinary osmolality? BMC Nephrol 2015; 16:46. [PMID: 25884505 PMCID: PMC4404565 DOI: 10.1186/s12882-015-0038-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 03/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Urinary density (UD) has been routinely used for decades as a surrogate marker for urine osmolality (Uosm). We asked if UD can accurately estimate Uosm both in healthy subjects and in different clinical scenarios of kidney disease. METHODS UD was assessed by refractometry. Uosm was measured by freezing point depression in spot urines obtained from healthy volunteers (N = 97) and in 319 inpatients with acute kidney injury (N = 95), primary glomerulophaties (N = 118) or chronic kidney disease (N = 106). RESULTS UD and Uosm correlated in all groups (p < 0.05). However, a wide range of Uosm values was associated with each UD value. When UD was ≤ 1.010, 28.4% of samples had Uosm above 350 mOsm/kg. Conversely, in 61.6% of samples with UD above 1.020, Uosm was below 600 mOsm/kg. As expected, Uosm exhibited a strong relationship with serum creatinine (Screat), whereas a much weaker correlation was found between UD and Screat. CONCLUSION We found that UD is not a substitute for Uosm. Although UD was significantly correlated with Uosm, the wide dispersion makes it impossible to use UD as a dependable clinical estimate of Uosm. Evaluation of the renal concentrating ability should be based on direct determination of Uosm.
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Singh GKS, Balzer BWR, Desai R, Jimenez M, Steinbeck KS, Handelsman DJ. Requirement for specific gravity and creatinine adjustments for urinary steroids and luteinizing hormone concentrations in adolescents. Ann Clin Biochem 2015; 52:665-71. [PMID: 25780247 DOI: 10.1177/0004563215580385] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Urinary hormone concentrations are often adjusted to correct for hydration status. We aimed to determine whether first morning void urine hormones in growing adolescents require adjustments and, if so, whether urinary creatinine or specific gravity are better adjustments. DESIGN AND METHODS The study population was adolescents aged 10.1 to 14.3 years initially who provided fasting morning blood samples at 0 and 12 months (n = 343) and first morning urine every three months (n = 644). Unadjusted, creatinine and specific gravity-adjusted hormonal concentrations were compared by Deming regression and Bland-Altman analysis and grouped according to self-rated Tanner stage or chronological age. F-ratios for self-rated Tanner stages and age groups were used to compare unadjusted and adjusted hormonal changes in growing young adolescents. Correlations of paired serum and urinary hormonal concentration of unadjusted and creatinine and specific gravity-adjusted were also compared. RESULTS Fasting first morning void hormone concentrations correlated well and were unbiased between unadjusted or adjusted by either creatinine or specific gravity. Urine creatinine concentration increases with Tanner stages, age and male gender whereas urine specific gravity was not influenced by Tanner stage, age or gender. Adjustment by creatinine or specific gravity of urinary luteinizing hormone, estradiol, testosterone, dihydrotestosterone and dehydroepiandrosterone concentrations did not improve correlation with paired serum concentrations. CONCLUSIONS Urine steroid and luteinizing hormone concentrations in first morning void samples of adolescents are not significantly influenced by hydration status and may not require adjustments; however, if desired, both creatinine and specific gravity adjustments are equally suitable.
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Affiliation(s)
- Gurmeet K S Singh
- Andrology Laboratory, ANZAC Research Institute, University of Sydney, Sydney, Australia Faculty of Pharmacy, Universiti Teknologi MARA, Bandar Puncak Alam, Selangor, Malaysia
| | - Ben W R Balzer
- Academic Department of Adolescent Medicine, Children's Hospital at Westmead, Westmead, Australia Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Reena Desai
- Andrology Laboratory, ANZAC Research Institute, University of Sydney, Sydney, Australia
| | - Mark Jimenez
- Andrology Laboratory, ANZAC Research Institute, University of Sydney, Sydney, Australia
| | - Katharine S Steinbeck
- Academic Department of Adolescent Medicine, Children's Hospital at Westmead, Westmead, Australia Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - David J Handelsman
- Andrology Laboratory, ANZAC Research Institute, University of Sydney, Sydney, Australia
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Currier JM, Ishida MC, González-Horta C, Sánchez-Ramírez B, Ballinas-Casarrubias L, Gutiérrez-Torres DS, Cerón RH, Morales DV, Terrazas FAB, Del Razo LM, García-Vargas GG, Saunders RJ, Drobná Z, Fry RC, Matoušek T, Buse JB, Mendez MA, Loomis D, Stýblo M. Associations between arsenic species in exfoliated urothelial cells and prevalence of diabetes among residents of Chihuahua, Mexico. ENVIRONMENTAL HEALTH PERSPECTIVES 2014; 122:1088-94. [PMID: 25000461 PMCID: PMC4181927 DOI: 10.1289/ehp.1307756] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 06/26/2014] [Indexed: 05/14/2023]
Abstract
BACKGROUND A growing number of studies link chronic exposure to inorganic arsenic (iAs) with the risk of diabetes. Many of these studies assessed iAs exposure by measuring arsenic (As) species in urine. However, this approach has been criticized because of uncertainties associated with renal function and urine dilution in diabetic individuals. OBJECTIVES Our goal was to examine associations between the prevalence of diabetes and concentrations of As species in exfoliated urothelial cells (EUC) as an alternative to the measures of As in urine. METHODS We measured concentrations of trivalent and pentavalent iAs methyl-As (MAs) and dimethyl-As (DMAs) species in EUC from 374 residents of Chihuahua, Mexico, who were exposed to iAs in drinking water. We used fasting plasma glucose, glucose tolerance tests, and self-reported diabetes diagnoses or medication to identify diabetic participants. Associations between As species in EUC and diabetes were estimated using logistic and linear regression, adjusting for age, sex, and body mass index. RESULTS Interquartile-range increases in trivalent, but not pentavalent, As species in EUC were positively and significantly associated with diabetes, with ORs of 1.57 (95% CI: 1.19, 2.07) for iAsIII, 1.63 (1.24, 2.15) for MAsIII, and 1.31 (0.96, 1.84) for DMAsIII. DMAs/MAs and DMAs/iAs ratios were negatively associated with diabetes (OR = 0.62; 95% CI: 0.47, 0.83 and OR = 0.72; 95% CI: 0.55, 0.96, respectively). CONCLUSIONS Our data suggest that uncertainties associated with measures of As species in urine may be avoided by using As species in EUC as markers of iAs exposure and metabolism. Our results provide additional support to previous findings suggesting that trivalent As species may be responsible for associations between diabetes and chronic iAs exposure.
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Affiliation(s)
- Jenna M Currier
- Curriculum in Toxicology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Normalization of urinary pteridines by urine specific gravity for early cancer detection. Clin Chim Acta 2014; 435:42-7. [DOI: 10.1016/j.cca.2014.04.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/24/2014] [Accepted: 04/24/2014] [Indexed: 11/17/2022]
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Atsariyasing W, Goldman MB. A systematic review of the ability of urine concentration to distinguish antipsychotic- from psychosis-induced hyponatremia. Psychiatry Res 2014; 217:129-33. [PMID: 24726819 PMCID: PMC6195808 DOI: 10.1016/j.psychres.2014.03.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/31/2014] [Accepted: 03/20/2014] [Indexed: 12/23/2022]
Abstract
Life-threatening hyponatremia in psychotic patients is common and typically is attributable to either antipsychotic medication or to acute psychosis in those with the polydipsia-hyponatremia syndrome. The preferred treatment for one situation may worsen the hyponatremia if caused by the other situation. Hence it is critical to distinguish between these two possibilities. Case reports and series were identified through electronic databases. Fifty-four cases of hyponatremia without recognized causes in psychotic patients were divided into those with dilute (<plasma osmolality) or concentrated (>plasma osmolality) urine. The distribution of urine concentration and measures likely to be associated with psychotic illness and its treatment were compared in both groups. Naranjo׳s scale was utilized to determine the probability hyponatremia was drug-induced. Urine osmolality fit a bimodal distribution (intersection 219mOsm/kg) better than a unimodal distribution. 'Probable' drug-induced cases occurred 6.8 (95%CI=1.6-28.9) times more often in those with concentrated urine. Acute psychotic exacerbations occurred 4.5 (95%CI=0.4-54.1) times more often in those with dilute urine. These findings, as well as several other trends in the data, indicate that measures of urine concentration can help distinguish between antipsychotic-induced and psychosis-induced hyponatremia.
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Affiliation(s)
- Wanlop Atsariyasing
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Morris B Goldman
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 446 East Ontario, Suite 7-100Chicago, IL 60611, USA.
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García-Esquinas E, Pollan M, Tellez-Plaza M, Francesconi KA, Goessler W, Guallar E, Umans JG, Yeh J, Best LG, Navas-Acien A. Cadmium exposure and cancer mortality in a prospective cohort: the strong heart study. ENVIRONMENTAL HEALTH PERSPECTIVES 2014; 122:363-70. [PMID: 24531129 PMCID: PMC3984227 DOI: 10.1289/ehp.1306587] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 12/10/2013] [Indexed: 05/05/2023]
Abstract
BACKGROUND Cadmium (Cd) is a toxic metal classified as a human carcinogen by the International Agency for Research on Cancer. OBJECTIVE We evaluated the association of long-term Cd exposure, as measured in urine, with cancer mortality in American Indians from Arizona, Oklahoma, and North and South Dakota who participated in the Strong Heart Study during 1989-1991. METHODS The Strong Heart Study was a prospective cohort study of 3,792 men and women 45-74 years of age who were followed for up to 20 years. Baseline urinary Cd (U-Cd) was measured using inductively coupled plasma mass spectrometry. We assessed cancer events by annual mortality surveillance. RESULTS The median (interquintile range) U-Cd concentration was 0.93 (0.55, 1.63) μg/g creatinine. After adjusting for sex, age, smoking status, cigarette pack-years, and body mass index, the adjusted hazard ratios (HRs) comparing the 80th versus the 20th percentiles of U-Cd were 1.30 (95% CI: 1.09, 1.55) for total cancer, 2.27 (95% CI: 1.58, 3.27) for lung cancer, and 2.40 (95% CI: 1.39, 4.17) for pancreatic cancer mortality. For all smoking-related cancers combined, the corresponding HR was 1.56 (95% CI: 1.24, 1.96). Cd was not significantly associated with liver, esophagus and stomach, colon and rectum, breast, prostate, kidney, or lymphatic and hematopoietic cancer mortality. On the basis of mediation analysis, we estimated that the percentage of lung cancer deaths due to tobacco smoking that could be attributed to Cd exposure was 9.0% (95% CI: 2.8, 21.8). CONCLUSIONS Low-to-moderate Cd exposure was prospectively associated with total cancer mortality and with mortality from cancers of the lung and pancreas. The implementation of population-based preventive measures to decrease Cd exposure could contribute to reducing the burden of cancer.
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Ayoub JA, Beaufrere H, Acierno MJ. Association between urine osmolality and specific gravity in dogs and the effect of commonly measured urine solutes on that association. Am J Vet Res 2013; 74:1542-5. [DOI: 10.2460/ajvr.74.12.1542] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Moon KA, Guallar E, Umans JG, Devereux RB, Best LG, Francesconi KA, Goessler W, Pollak J, Silbergeld EK, Howard BV, Navas-Acien A. Association between exposure to low to moderate arsenic levels and incident cardiovascular disease. A prospective cohort study. Ann Intern Med 2013; 159:649-59. [PMID: 24061511 PMCID: PMC4157936 DOI: 10.7326/0003-4819-159-10-201311190-00719] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Long-term exposure to high levels of arsenic is associated with increased risk for cardiovascular disease, whereas risk from long-term exposure to low to moderate arsenic levels (< 100μg/L in drinking water) is unclear. OBJECTIVE To evaluate the association between long-term exposure to low to moderate arsenic levels and incident cardiovascular disease. DESIGN Prospective cohort study. SETTING The Strong Heart Study baseline visit between 1989 and 1991, with follow-up through 2008. PATIENTS 3575 American Indian men and women aged 45 to 74 years living in Arizona, Oklahoma, and North and South Dakota. MEASUREMENTS The sum of inorganic and methylated arsenic species in urine at baseline was used as a biomarker of long-term arsenic exposure. Outcomes were incident fatal and nonfatal cardiovascular disease. RESULTS A total of 1184 participants developed fatal and nonfatal cardiovascular disease. When the highest and lowest quartiles of arsenic concentrations (> 15.7 vs. < 5.8 μg/g creatinine) were compared,the hazard ratios for cardiovascular disease, coronary heart disease, and stroke mortality after adjustment for sociodemographic factors, smoking, body mass index, and lipid levels were 1.65 (95%CI, 1.20 to 2.27; P for trend < 0.001), 1.71 (CI, 1.19 to 2.44; P for trend < 0.001), and 3.03 (CI, 1.08 to 8.50; P for trend = 0.061),respectively. The corresponding hazard ratios for incident cardiovascular disease, coronary heart disease, and stroke were 1.32 (CI,1.09 to 1.59; P for trend = 0.002), 1.30 (CI, 1.04 to 1.62; P for trend = 0.006), and 1.47 (CI, 0.97 to 2.21; P for trend = 0.032).These associations varied by study region and were attenuated after further adjustment for diabetes, hypertension, and kidney disease measures. LIMITATION Direct measurement of individual arsenic levels in drinking water was unavailable. CONCLUSION Long-term exposure to low to moderate arsenic levels was associated with cardiovascular disease incidence and mortality.
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García-Esquinas E, Pollán M, Umans JG, Francesconi KA, Goessler W, Guallar E, Howard B, Farley J, Yeh J, Best LG, Navas-Acien A. Arsenic exposure and cancer mortality in a US-based prospective cohort: the strong heart study. Cancer Epidemiol Biomarkers Prev 2013; 22:1944-53. [PMID: 23800676 PMCID: PMC3843229 DOI: 10.1158/1055-9965.epi-13-0234-t] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Inorganic arsenic, a carcinogen at high exposure levels, is a major global health problem. Prospective studies on carcinogenic effects at low-moderate arsenic levels are lacking. METHODS We evaluated the association between baseline arsenic exposure and cancer mortality in 3,932 American Indians, 45 to 74 years of age, from Arizona, Oklahoma, and North/South Dakota who participated in the Strong Heart Study from 1989 to 1991 and were followed through 2008. We estimated inorganic arsenic exposure as the sum of inorganic and methylated species in urine. Cancer deaths (386 overall, 78 lung, 34 liver, 18 prostate, 26 kidney, 24 esophagus/stomach, 25 pancreas, 32 colon/rectal, 26 breast, and 40 lymphatic/hematopoietic) were assessed by mortality surveillance reviews. We hypothesized an association with lung, liver, prostate, and kidney cancers. RESULTS Median (interquartile range) urine concentration for inorganic plus methylated arsenic species was 9.7 (5.8-15.6) μg/g creatinine. The adjusted HRs [95% confidence interval (CI)] comparing the 80th versus 20th percentiles of arsenic were 1.14 (0.92-1.41) for overall cancer, 1.56 (1.02-2.39) for lung cancer, 1.34 (0.66, 2.72) for liver cancer, 3.30 (1.28-8.48) for prostate cancer, and 0.44 (0.14, 1.14) for kidney cancer. The corresponding hazard ratios were 2.46 (1.09-5.58) for pancreatic cancer, and 0.46 (0.22-0.96) for lymphatic and hematopoietic cancers. Arsenic was not associated with cancers of the esophagus and stomach, colon and rectum, and breast. CONCLUSIONS Low to moderate exposure to inorganic arsenic was prospectively associated with increased mortality for cancers of the lung, prostate, and pancreas. IMPACT These findings support the role of low-moderate arsenic exposure in development of lung, prostate, and pancreas cancer and can inform arsenic risk assessment.
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Affiliation(s)
- Esther García-Esquinas
- Department of Environmental Health Science, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
- Environmental Epidemiology and Cancer Unit. National Center for Epidemiology. Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
| | - Marina Pollán
- Environmental Epidemiology and Cancer Unit. National Center for Epidemiology. Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
| | - Jason G. Umans
- MedStar Health Research Institute, Hyattsville, MD
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington DC
| | - Kevin A. Francesconi
- Institute of Chemistry-Analytical Chemistry, Karl-Franzens University, Graz, Austria
| | - Walter Goessler
- Institute of Chemistry-Analytical Chemistry, Karl-Franzens University, Graz, Austria
| | - Eliseo Guallar
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Barbara Howard
- MedStar Health Research Institute, Hyattsville, MD
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington DC
| | - John Farley
- Divison of Gynecology Oncology, Department of Obstetrics and Gynecology, Creighton University School of Medicine at St. Joseph’s Hospital and Medical Center, a member of Catholic Healthcare West, Phoenix, AZ
| | - Jeunliang Yeh
- Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center. Oklahoma City, OK
| | - Lyle G. Best
- Missouri Breaks Industries Research Inc. Timber Lake, SD
| | - Ana Navas-Acien
- Department of Environmental Health Science, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, MD
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Maull EA, Ahsan H, Edwards J, Longnecker MP, Navas-Acien A, Pi J, Silbergeld EK, Styblo M, Tseng CH, Thayer KA, Loomis D. Evaluation of the association between arsenic and diabetes: a National Toxicology Program workshop review. ENVIRONMENTAL HEALTH PERSPECTIVES 2012; 120:1658-70. [PMID: 22889723 PMCID: PMC3548281 DOI: 10.1289/ehp.1104579] [Citation(s) in RCA: 260] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 08/10/2012] [Indexed: 05/17/2023]
Abstract
BACKGROUND Diabetes affects an estimated 346 million persons globally, and total deaths from diabetes are projected to increase > 50% in the next decade. Understanding the role of environmental chemicals in the development or progression of diabetes is an emerging issue in environmental health. In 2011, the National Toxicology Program (NTP) organized a workshop to assess the literature for evidence of associations between certain chemicals, including inorganic arsenic, and diabetes and/or obesity to help develop a focused research agenda. This review is derived from discussions at that workshop. OBJECTIVES Our objectives were to assess the consistency, strength/weaknesses, and biological plausibility of findings in the scientific literature regarding arsenic and diabetes and to identify data gaps and areas for future evaluation or research. The extent of the existing literature was insufficient to consider obesity as an outcome. DATA SOURCES, EXTRACTION, AND SYNTHESIS Studies related to arsenic and diabetes or obesity were identified through PubMed and supplemented with relevant studies identified by reviewing the reference lists in the primary literature or review articles. CONCLUSIONS Existing human data provide limited to sufficient support for an association between arsenic and diabetes in populations with relatively high exposure levels (≥ 150 µg arsenic/L in drinking water). The evidence is insufficient to conclude that arsenic is associated with diabetes in lower exposure (< 150 µg arsenic/L drinking water), although recent studies with better measures of outcome and exposure support an association. The animal literature as a whole was inconclusive; however, studies using better measures of diabetes-relevant end points support a link between arsenic and diabetes.
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Affiliation(s)
- Elizabeth A Maull
- Biomolecular Screening Branch, Division of the National Toxicology Program, National Institute of Environmental Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Research Triangle Park, North Carolina, USA
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Zheng LY, Umans JG, Tellez-Plaza M, Yeh F, Francesconi KA, Goessler W, Silbergeld EK, Guallar E, Howard BV, Weaver VM, Navas-Acien A. Urine arsenic and prevalent albuminuria: evidence from a population-based study. Am J Kidney Dis 2012; 61:385-94. [PMID: 23142528 DOI: 10.1053/j.ajkd.2012.09.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 09/27/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND Long-term arsenic exposure is a major global health problem. However, few epidemiologic studies have evaluated the association of arsenic with kidney measures. Our objective was to evaluate the cross-sectional association between inorganic arsenic exposure and albuminuria in American Indian adults from rural areas of Arizona, Oklahoma, and North and South Dakota. STUDY DESIGN Cross-sectional. SETTING & PARTIPANTS: Strong Heart Study locations in Arizona, Oklahoma, and North and South Dakota. 3,821 American Indian men and women aged 45-74 years with urine arsenic and albumin measurements. PREDICTOR Urine arsenic. OUTCOMES Urine albumin-creatinine ratio and albuminuria status. MEASUREMENTS Arsenic exposure was estimated by measuring total urine arsenic and urine arsenic species using inductively coupled plasma mass spectrometry (ICPMS) and high-performance liquid chromatography-ICPMS, respectively. Urine albumin was measured by automated nephelometric immunochemistry. RESULTS The prevalence of albuminuria (albumin-creatinine ratio ≥30 mg/g) was 30%. Median value for the sum of inorganic and methylated arsenic species was 9.7 (IQR, 5.8-15.6) μg per gram of creatinine. Multivariable-adjusted prevalence ratios of albuminuria (albumin-creatinine ratio ≥30 mg/g) comparing the 3 highest to lowest quartiles of the sum of inorganic and methylated arsenic species were 1.16 (95% CI, 1.00-1.34), 1.24 (95% CI, 1.07-1.43), and 1.55 (95% CI, 1.35-1.78), respectively (P for trend <0.001). The association between urine arsenic and albuminuria was observed across all participant subgroups evaluated and was evident for both micro- and macroalbuminuria. LIMITATIONS The cross-sectional design cannot rule out reverse causation. CONCLUSIONS Increasing urine arsenic concentrations were cross-sectionally associated with increased albuminuria in a rural US population with a high burden of diabetes and obesity. Prospective epidemiologic and mechanistic evidence is needed to understand the role of arsenic as a kidney disease risk factor.
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Affiliation(s)
- Laura Y Zheng
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Yassine H, Kimzey MJ, Galligan MA, Gandolfi AJ, Stump CS, Lau SS. Adjusting for Urinary Creatinine Overestimates Arsenic Concentrations in Diabetics. Cardiorenal Med 2011; 2:26-32. [PMID: 22493600 DOI: 10.1159/000334225] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 10/01/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS: Arsenic (As) is linked to insulin resistance in animal studies, but the effect of low-level As exposure on the prevalence of diabetes in humans is uncertain. An optimal method to report inorganic As in humans has not been established. Measurements of As in spot urine are usually adjusted to creatinine (Cr). However, urinary Cr is an independent variable in diabetes. Our aims are to optimize reporting of urinary As in the setting of diabetes and insulin resistance. METHODS: Urinary inorganic As was measured in 24-hour or first-void spot urine from diabetic (n = 31) and non-diabetic (n = 12) subjects and normalized to Cr or specific gravity (SG). The relation of normalized urinary inorganic As to glycemia and surrogate measures of insulin resistance was investigated. Blood pressure, waist circumference, and glycated hemoglobin were also assessed. Homeostasis model assessment was used to determine insulin resistance. RESULTS: A strong correlation was found between spot urinary As adjusted to Cr (R(2) = 0.82) or SG (R(2) = 0.61) to 24-hour urinary As (p < 0.001), while non-adjusted urinary As did not correlate well (R(2) = 0.03, p = 0.46). Adjusting for Cr revealed significant differences in total 24-hour urinary As when comparing diabetic to normal subjects. In contrast, no differences were found when As was adjusted to SG using either 24-hour or spot urine. Moreover, adjusted urinary spot or 24-hour As measures did not correlate with measures of glycemia or insulin resistance. Conclusions: Urinary Cr is an independent variable in diabetes, therefore adjusting spot As for SG is preferred.
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Affiliation(s)
- Hussein Yassine
- Section of Endocrinology, Diabetes and Hypertension, Department of Medicine, College of Medicine, Southern Arizona Veterans Administration Healthcare System, University of Arizona, Ariz., USA
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Guzmán R, Campos C, López-Fernández E, Casado A. Biomarkers of age effect on renal function in Down syndrome. Biomarkers 2011; 16:679-85. [PMID: 22023562 DOI: 10.3109/1354750x.2011.626527] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess differences in kidney function between Down syndrome (DS) individuals and a control group related to aging. METHODS Creatinine (Cr) and specific gravity (SG) were assessed by spectrophotometric and refractometric assays in urine samples of 103 individuals with DS and 82 age-matched controls. RESULTS Significantly lower levels of Cr and SG were found in DS after puberty. Significant correlations were found between SG and age as well as between Cr and SG in DS and controls (p ≤ 0.05). CONCLUSIONS Premature aging in kidneys of DS patients could lead to an impaired renal function.
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Affiliation(s)
- Rodrigo Guzmán
- Departamento de Medicina Celular y Molecular, Centro de Investigaciones Biológicas (CSIC), Madrid, Spain
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Dai X, Kutschke K, Priest N. Rapid urinary output normalization method using specific gravity. HEALTH PHYSICS 2011; 101:140-143. [PMID: 21709500 DOI: 10.1097/hp.0b013e318213be69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Spot urine samples are often taken for emergency radiobioassay to provide a quick dose assessment for contaminated individuals. The subsequent dosimetric analysis requires a urinary output normalization method to adjust spot sampling to daily urine excretion. A rapid specific gravity method that was developed for 24-h urinary output correction is described. Spot urine samples were collected from volunteers of different race, gender, and age to validate the normalization method. Results show that a specific gravity test is a fast, easy and robust method to correct the urine excretion in the event of a radiation emergency.
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Affiliation(s)
- Xiongxin Dai
- Chalk River Laboratories, Atomic Energy of Canada Limited, Chalk River, Ontario K0J 1J0, Canada.
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Imran S, Eva G, Christopher S, Flynn E, Henner D. Is specific gravity a good estimate of urine osmolality? J Clin Lab Anal 2011; 24:426-30. [PMID: 21089176 DOI: 10.1002/jcla.20424] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
CONTEXT Urine specific gravity (USG) is often used by clinicians to estimate urine osmolality. USG is measured either by refractometry or by reagent strip. OBJECTIVE We studied the correlation of USG obtained by either method with a concurrently obtained osmolality. DESIGN Using our laboratory's records, we retrospectively gathered data on 504 urine specimens on patients on whom a simultaneously drawn USG and an osmolality were available. Out of these, 253 USG's were measured by automated refractometry and 251 USG's were measured by reagent strip. Urinalysis data on these subjects were used to determine the correlation between USG and osmolality, adjusting for other variables that may impact the relationship. The other variables considered were pH, protein, glucose, ketones, nitrates, bilirubin, urobilinogen, hemoglobin, and leukocyte esterase. The relationships were analyzed by linear regression. RESULTS This study demonstrated that USG obtained by both reagent strip and refractometry had a correlation of approximately 0.75 with urine osmolality. The variables affecting the correlation included pH, ketones, bilirubin, urobilinogen, glucose, and protein for the reagent strip and ketones, bilirubin, and hemoglobin for the refractometry method. At a pH of 7 and with an USG of 1.010 predicted osmolality is approximately 300 mosm/kg/H(2)O for either method. For an increase in SG of 0.010, predicted osmolality increases by 182 mosm/kg/H(2) O for the reagent strip and 203 mosm/kg/H(2)O for refractometry. Pathological urines had significantly poorer correlation between USG and osmolality than "clean" urines. CONCLUSION In pathological urines, direct measurement of urine osmolality should be used.
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Affiliation(s)
- Sethi Imran
- Berkshire Medical Center, Internal Medicine, Pittsfield, Massachusetts, USA.
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Lee EJ, Arbuckle TE. Urine-sampling methods for environmental chemicals in infants and young children. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2009; 19:625-33. [PMID: 19550439 DOI: 10.1038/jes.2009.36] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 05/19/2009] [Accepted: 05/26/2009] [Indexed: 05/23/2023]
Abstract
This review paper examines and evaluates urine-sampling methodologies in infants and young children, to determine which methods are suitable for use in large biomonitoring surveys or studies of environmental chemicals in children younger than 6 years. Methods for non-toilet-trained children include the use of urine bags, collection pads (e.g., cotton or gauze inserts), disposable diapers, cotton diapers, and the clean catch method. In toilet-trained children, collection methods include use of a commode insert pan as well as specimen collection cups. The advantages and disadvantages of these various methods need to be evaluated with respect to the target population, timing and frequency of collection, minimum sample volume required, method of urine extraction, potential for contamination of the sample, stability of the analyte of interest, and burden on participants and research team. Collection methods must not introduce contamination or affect the integrity of the sample, should be logistically practical, and should minimize discomfort experienced by the child. Although collection of urine samples from children who are not toilet-trained is more challenging than collection from older toilet-trained children, the vulnerability of younger children to the exposure to and health effects of environmental chemicals makes finding suitable methods a priority.
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Affiliation(s)
- Ellen J Lee
- Chemicals Surveillance Division, Risk Management Bureau, Health Canada, Ottawa, ON, Canada
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Smart L, Hopper K, Aldrich J, George J, Kass P, Haskins S. The Effect of Hetastarch (670/0.75) on Urine Specific Gravity and Osmolality in the Dog. J Vet Intern Med 2009; 23:388-91. [DOI: 10.1111/j.1939-1676.2008.0252.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Nermell B, Lindberg AL, Rahman M, Berglund M, Persson LA, El Arifeen S, Vahter M. Urinary arsenic concentration adjustment factors and malnutrition. ENVIRONMENTAL RESEARCH 2008; 106:212-8. [PMID: 17900556 DOI: 10.1016/j.envres.2007.08.005] [Citation(s) in RCA: 185] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Revised: 07/10/2007] [Accepted: 08/08/2007] [Indexed: 05/17/2023]
Abstract
This study aims at evaluating the suitability of adjusting urinary concentrations of arsenic, or any other urinary biomarker, for variations in urine dilution by creatinine and specific gravity in a malnourished population. We measured the concentrations of metabolites of inorganic arsenic, creatinine and specific gravity in spot urine samples collected from 1466 individuals, 5-88 years of age, in Matlab, rural Bangladesh, where arsenic-contaminated drinking water and malnutrition are prevalent (about 30% of the adults had body mass index (BMI) below 18.5 kg/m(2)). The urinary concentrations of creatinine were low; on average 0.55 g/L in the adolescents and adults and about 0.35 g/L in the 5-12 years old children. Therefore, adjustment by creatinine gave much higher numerical values for the urinary arsenic concentrations than did the corresponding data expressed as microg/L, adjusted by specific gravity. As evaluated by multiple regression analyses, urinary creatinine, adjusted by specific gravity, was more affected by body size, age, gender and season than was specific gravity. Furthermore, urinary creatinine was found to be significantly associated with urinary arsenic, which further disqualifies the creatinine adjustment.
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Affiliation(s)
- Barbro Nermell
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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