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Cadmium and Creatinine Ratio in Urine


Useful For 

Detecting exposure to cadmium, in random urine specimens

Clinical Information 

The toxicity of cadmium resembles the other heavy metals (arsenic, mercury and lead) in that it attacks the kidney; renal dysfunction with proteinuria with slow onset (over a period of years) is the typical presentation. Measurable changes in proximal tubule function, such as decreased clearance of para-aminohippuric acid also occur over a period of years, and precede overt renal failure.


Breathing the fumes of cadmium vapors leads to nasal epithelial deterioration and pulmonary congestion resembling chronic emphysema.


The most common source of cadmium exposure is tobacco smoke, which has been implicated as the primary sources of the metal leading to reproductive toxicity in both males and females.


Chronic exposure to cadmium causes accumulated renal damage. The excretion of cadmium is proportional to creatinine except when renal damage has occurred. Renal damage due to cadmium exposure can be detected by increased cadmium excretion relative to creatinine.


The Occupational Safety and Health Administration (OSHA) mandated that all monitoring of employees exposed to cadmium in the workplace should be done using the measurement of urine cadmium and creatinine, expressing the results of mcg of cadmium per gram of creatinine.

Reference Values 

0-17 years: not established

≥18 years: <0.6 mcg/g creatinine


Cadmium excretion above 3.0 mcg/g creatinine indicates significant exposure to cadmium.


Results above15 mcg/g creatinine are considered indicative of severe exposure.


Collection of urine specimens through a catheter frequently results in elevated values, because rubber contains trace amounts of cadmium that are extracted as urine passes through the catheter.

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