Test ID: NIRU
Nickel, Random, Urine
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Detecting nickel toxicity in patients exposed to nickel carbonyl
Special Instructions and Forms Describes specimen collection and preparation information, test algorithms, and other information pertinent to test. Also includes pertinent information and consent forms to be used when requesting a particular test
Method Name A short description of the method used to perform the test
Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Collection Container/Tube: Clean, plastic urine collection container
Submission Container/Tube: Plastic, 6-mL tube (Supply T465) or a clean, plastic aliquot container with no metal cap or glued insert
Specimen Volume: 2 mL
Collection Instructions:
1. Collect a random urine specimen.
2. See Metals Analysis-Collection and Transport in Special Instructions for complete instructions.
Additional Information: High concentrations of gadolinium and iodine are known to interfere with most metals tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for 96 hours.
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | NA |
| Lipemia | NA |
| Icterus | NA |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Urine | Refrigerated (preferred) | 28 days |
| Ambient | 28 days | |
| Frozen | 28 days |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Nickel (Ni), a silvery white metal widely distributed in the earth's crust, is essential for the catalytic activity of some plant and bacterial Enzymes, but its role in humans has not been defined. Elemental nickel may be essential for life at very low concentrations and is virtually nontoxic.
Nickel is commonly used in industry. It is a pigment in glass, ceramics, and fabric dyes. It is converted in the Mond process to nickel carbonyl, Ni(CO)(4), and used as a catalyst in petroleum refining and in the plastics industry, is frequently employed in the production of metal alloys (which are popular for their anticorrosive and hardness properties) in nickel-cadmium rechargeable batteries, and is used as a catalyst in hydrogenation of oils.
Ni(CO)(4), a liquid with low vapor pressure, is 1 of the most toxic chemicals known to man. Ni(CO)(4) is absorbed after inhalation, readily crosses all biological membranes, and noncompetitively inhibits ATP-ase and RNA polymerase. Ni(CO)(4) binds avidly to hemoglobin with resultant inability to take up oxygen. The affinity for hemoglobin is higher than carbon monoxide. The binding to hemoglobin is the main transport mechanism for spreading Ni(CO)(4) throughout the body. Urine is the specimen of choice for the determination of nickel exposure via inhalation.
Breathing dust high in nickel content has been associated with development of neoplasms of the respiratory system and nasal sinuses. Most reactions to nickel are localized skin sensitivity and allergic skin disorders that occur on contact with nickel-containing alloys. These reactions do not correlate to urine concentrations; patients experiencing skin sensitivity reactions to nickel are likely to have normal nickel excretion.
Patients undergoing dialysis are exposed to nickel and accumulate nickel in blood and other organs; there appear to be no adverse health affects from this exposure. Hypernickelemia has been observed in patients undergoing renal dialysis. At the present time, this is considered to be an incidental finding as no correlation with toxic events has been identified. Routine monitoring of patients undergoing dialysis is currently not recommended.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
0.0-6.0 mcg/L
Reference values apply to all ages.
Interpretation Provides information to assist in interpretation of the test results
Values > or =7 mcg/L specimen represent possible environmental or occupational exposure.
Nickel concentrations >50 mcg/L are of concern, suggesting excessive exposure.
Clinical concern about nickel toxicity should be limited to patients with potential for exposure to toxic nickel compounds such as nickel carbonyl. Hypernickelemia, in the absence of exposure to that specific form of nickel, may be an incidental finding or could be due to specimen contamination.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Specimen collection procedures for nickel require special collection containers, rigorous attention to ultraclean specimen collection and handling procedures, and analysis in an ultraclean facility. Unless all of these procedures are followed, increased urinary nickel results may be an incidental and misleading finding.
High concentrations of gadolinium and iodine are known to interfere with most metals tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for 96 hours.
This test cannot determine the source compound (eg, nickel sulfate) responsible for the exposure.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Moreno ME, Acosta-Saavedra LC, Meza-Figueroa D, et al: Biomonitoring of metal in children living in a mine tailings zone in Southern Mexico: A pilot study. Int J Hyg Environ Hlth 2010;213:252-258
2. Schulz C, Angerer J, Ewers U, et al: Revised and new reference values for environmental pollutants in urine or blood of children in Germany derived from the German Environmental Survey on Children 2003-2006 (GerES IV). Int J Hyg Environ Health 2009;212:637-647
Method Description Describes how the test is performed and provides a method-specific reference
This assay is performed on an inductively coupled plasma-mass spectrometer. Calibrating standards and blanks are diluted with an aqueous acidic diluent containing internal standard(s). Quality control specimens and patient samples are diluted in an identical manner. In turn, all diluted blanks, calibrating standards, quality control specimens, and patient specimens are aspirated into a pneumatic nebulizer and the resulting aerosol directed to the hot plasma discharge by a flow of argon. In the annular plasma the aerosol is vaporized, atomized, then ionized. The ionized gases plus neutral species formed in the annular plasma space are aspirated from the plasma through an orifice into a quadrupole mass spectrometer. The mass range from 1 amu to 263 amu is rapidly scanned multiple times and ion counts tabulated for each mass of interest. Instrument response is defined by the linear relationship of analyte concentration versus ion count ratio (analyte ion count/internal standard ion count). Analyte concentrations are derived by reading the ion count ratio for each mass of interest and determining the concentration from the response line. (Unpublished Mayo method)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Thursday; 5 p.m.
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
83885
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| 60441 | Nickel, Random, U | 14099-6 |
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