Urine · 2 analyses
Cobalt
Measures cobalt in your urine, as a measure of recent exposure. For anyone exposed to cobalt at work, for example in the hard metal industry.
€ 62,00
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Metals, toxins and medication · Urine
Cobalt (urine)
Cobalt in urine is a measure of recent exposure to cobalt, mainly with work in, for example, the hard metal industry.
At a glance
- Measured in urine
- In 2 test panels
- Check the preparation
Explanation
Cobalt (urine): what is measured?
The analysis measures how much cobalt leaves the body in the urine. Cobalt is a metal used in alloys for cutting and grinding tools, magnets and prostheses, and in pigments for glass, ceramics and paint. Everyone takes in a small amount of cobalt through food, including as part of vitamin B12. Absorbed cobalt is mainly excreted in the urine, so the value mainly says something about the recent past.
What can it detect?
- Exposure to cobalt at work, for example when making or grinding hard metal tools or in the glass and ceramics industry
- Cobalt released from a metal-on-metal hip replacement
Result
What does the result mean?
Cobalt (urine) too high
A raised value fits exposure to cobalt, for example at work. Excretion can also be higher with a metal-on-metal hip replacement. The level does not tell exactly how much cobalt someone has taken in and does not predict symptoms. According to the ATSDR, breathing in cobalt particles can cause symptoms of the nose, throat and lungs, and cobalt taken in through the mouth can affect the blood and the thyroid.
Cobalt (urine) too low
A low or unmeasurable value is normal. The body only needs cobalt as part of vitamin B12, so a low result is not a deficiency. With a metal-on-metal hip replacement, a low value does not rule out reactions in the tissue around the implant.
After an abnormal result
With a raised result, the GP looks for the source, together with the occupational physician if needed, and has the measurement repeated if needed. With a metal-on-metal hip replacement, a raised value is a reason to have cobalt measured in blood and to contact the orthopedic surgeon.
Reliability
How reliable is the test?
Cobalt in urine is mainly informative with known exposure at work; in people without known exposure, a single value says little. With exposure at work, the urine is usually collected at the end of a working day, after several working days in a row. For the check-up of a metal-on-metal hip replacement, the NOV uses cobalt in blood, not in urine. The result says something about exposure, not about a buildup that you can remove with a course of treatment.
What can affect the result?
- A single urine sample depends strongly on how much you have drunk; the result is easier to compare when it is expressed per gram of creatinine, which requires measuring creatinine in the same sample.
- With reduced kidney function, the body excretes less cobalt, so the urine value is lower than the load.
- With exposure at work, the result depends on when the urine is collected; urine at the end of a working day is the easiest to compare.
- There are no agreed cutoff values; the limit between normal and raised comes from the laboratory itself.
Preparation
- Do you work with cobalt? Then collect the urine at the end of a working day, after a few working days in a row.
Who it is for
Who is the test useful for?
Useful for
Useful with known exposure to cobalt at work, usually in consultation with the occupational physician. Anyone with a metal-on-metal hip replacement is better off having cobalt measured in blood, because the NOV check-up agreements are based on that. In people without exposure and without an implant, the measurement adds nothing. A cobalt allergy is diagnosed with a patch test, not with a urine test.
How common is it?
Exposure to cobalt mainly occurs with work involving hard metal cutting and grinding tools and in the production of cobalt alloys. According to a survey of 95 Dutch hospitals, more than 8,400 metal-on-metal hip replacements had been placed up to 2012; since the NOV advice of 2012 they are hardly placed anymore.
ATSDR, Ned Tijdschr Geneeskd 2012 (Dutch Poisons Information Center, NVIC) and LROI (Dutch Arthroplasty Register)
Drawbacks and risks
- A diluted or, conversely, concentrated urine sample can give a raised or low result that has nothing to do with exposure.
- A normal urine value can be falsely reassuring with a metal-on-metal hip replacement.
Get tested
Cobalt (urine): test panels
Cobalt (urine) is part of these test panels. You order online and have your blood drawn at a collection point or collect the sample at home.
Evidence
Sources
This explanation is based on Dutch guidelines and independent information. It is general information, not a diagnosis. Discuss an abnormal result with your GP.
More about risks and results- ATSDR (CDC), ToxFAQs: Cobalt
- Nederlandse Orthopaedische Vereniging (NOV): Advies metaal-op-metaal heupprothesen per 1 augustus 2015
- Dijkman e.a. (NVIC, UMC Utrecht): Kobaltvergiftiging door metaal-op-metaalheupprothese. Ned Tijdschr Geneeskd. 2012;156:A4983
- LROI: NOV-advies tegen grote kop en resurfacing metaal-op-metaal heupprothesen terecht (Nederlands Tijdschrift voor Orthopedie, 2020)
More explanations
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