Gadolinium Toxicity

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Testing for Gadolinium Toxicity

Breaking News

breakingnews

July 21, 2017 – European Medical Authority takes action on Linear Contrast Agents.  Read all about it.

March 10, 2017 – European group recommends to stop using 4 linear GBCAs Read all about it.

February 27, 2017 – New Study Reports Gadolinium Retention in 70 Cases with Normal Kidney Function. Read all about it.

With the current status of Gadolinium Toxicity understanding by the medical community, there are no known and verified methods to know for sure if you are Gadolinium Toxic or have symptoms caused by Gadolinium.  There is not a medical provider or institution you can go to in order to have them tell you whether your symptoms are caused by Gadolinium retained from contrast MRIs, and there is no medical diagnosis of “Gadolinium Toxic”.

However, if you believe your symptoms are caused by Gadolinium, there are some tests that may be helpful to your thinking.  Urine testing for Gadolinium is easily done as described below.  Blood can be tested for Gadolinium as described below.  Dermal tissue (skin) biopsies, described later below, are possible; however, there is no published history of results for patients with normal kidney function.  The current diagnostic criteria for skin biopsies is based on what has been seen in NSF patients with severe kidney disease.

Since there are no established testing methodologies, none of the testing methods described below should be taken as the final word.  Since Gadolinium tends to deposit in bone and not remain in circulation, it could be that you are Gadolinium Toxic with negative test results.

Urine Testing

Although Urine Testing may not be definitive in determining if you are Gadolinium Toxic, we believe that consistent, high urine test results for Gadolinium are a positive indicator for Gadolinium Toxicity.  As described below, it can easily be repeated periodically for progress monitoring.

A word of caution – Having elevated urine levels of Gadolinium will not get you a Gadolinium-related diagnosis, it will only provide proof that you retained Gadolinium.  And having a lower level of Gadolinium in your urine long after your contrast MRI does not mean that you did not have a much higher level at earlier time points.

For those who believe they are suffering from Gadolinium Toxicity, a 24-hour unprovoked urine test can provide some insight.

If you have not done so yet, we recommend that you read the Study of Retained Gadolinium from Contrast MRIs and our latest report: Gadolinium Retention from Contrast MRIs in 70 Cases with Normal Renal Function – 24-hour Urine Test Results to understand the urine testing results that we have documented.  If you would like to learn more about the symptoms of gadolinium toxicity, read our  Survey of the Chronic Effects of Retained Gadolinium from Contrast MRIs report.

Before providing information about having your urine tested for Gadolinium, a few words about types of testing, urine collection, and results reporting are appropriate.

First, a test can be either Provoked or Unprovoked as described in our Study of Retained Gadolinium from Contrast MRIs.

An Unprovoked test will tell you the amount of Gadolinium that is normally being excreted.  We recommend this as the first test you have done to establish a baseline measurement.  Later you can have other Unprovoked tests to see how your level has come down.  Your unprovoked levels can be compared with the results of others as reported in the Study of Retained Gadolinium from Contrast MRIs.  Results can also be compared with the reference range established by Mayo Labs for their 24-hour Gadolinium Urine test (0.0-0.4 mcg Gd/specimen).  Other testing labs may use lower ranges, but we typically refer to the Mayo Labs range in our discussions.

A Provoked test is done by collecting the urine sample after taking a provoking agent (or having an IV with a chelating formula) to attempt to ‘draw out’ additional toxic metals from tissues that would not have come out with an Unprovoked test.  While a provoked test may identify a higher ‘body burden’ of Gadolinium, these tests cannot easily be compared with results from other individuals because the specific provoking or chelating formula used by each doctor will significantly affect the test results.  There are no established reference ranges for Provoked testing other than those established by the testing companies.

Second, a test can be done for differing lengths of time.

A Random Collection is from a single urination; the results will have greater variability due to factors such as time of day, recent food or liquid intake, etc.

A 24-hour collection provides the most consistent results as it reduces the factors that can lead to variability in a single collection.

A 6-hour collection is often done for a provoked test since the time-effectiveness of the provoking agents is generally a couple hours, and the results would be lower if the collection was done for 24 hours.

Third, the units of measurement used in the test must always be understood.

Test results are normally expressed as either mcg Gd/sample (micrograms of Gadolinium per urine sampling period) or mcg Gd/g Creatinine .  Both of these measures will be reasonably consistent for an individual.  However these two different units cannot be compared with each other.  Comparing a result of 0.6 mcg Gd/24-hours with a result of 0.9 mcg Gd/g Creatinine would be like comparing the statement “I used 60 gallons of gas on my 24-hour trip to Boston” with “I got 23 miles per gallon while on my trip to Boston”.  We do not know which car gets greater fuel efficiency.

For these reasons, we recommend an unprovoked 24-hour collection if you want to compare the results with others or track your levels over an extended time period.

Getting a random or 24-hour unprovoked test for Gadolinium is not exactly straightforward, but it can be done.  Your doctor can order the 24-hour test from Mayo Clinic Medical Laboratories through testing agencies like Quest Diagnostics and others.  But he or she will likely not be familiar with this test as it is not regularly prescribed.  You may need to request the test.

A wellness doctor or a naturopathic doctor will be the best source for having urine testing conducted by Genova Diagnostics or Doctor’s Data independent clinical laboratories.  These labs do their testing for Gadolinium as part of a toxic metals panel that is typically used by the doctor to determine if Chelation might benefit the patient.  More about Chelation can be found in the Treatments subsection.  Since many doctors performing Chelation routinely only do 6-hour provoked urine testing, we want to repeat the suggestion that you periodically have a 24-hour unprovoked urine test to enable tracking of your urine Gadolinium when not under the influence of a provoking or chelating agent.  You might want to check the Chelation Category in our Viewpoints section where individual Chelation results are discussed.

The Genova Diagnostics urine test for Gadolinium is also available through several online services. The collection and testing process is exactly the same as if done through a local doctor except that the report is sent directly to the patient.  Genova Diagnostics has two test panels that include the Gadolinium test.  You should get either the Toxic Elements Clearance Profile or the Comprehensive Urine Element Panel.  Make sure you check out the online sample reports that also include interpretive comments for any tests that are out of range.  Please note that we have no connection of any sort with Genova Diagnostics and we do not make any statement about their validity for any particular purpose.  One of the authors has used Genova Diagnostics many times, but we only provide these links as an information service.  A patient cannot purchase these tests directly from Genova Diagnostics.  The online services we have found where these tests can be purchased include Health RemediesForrest Health, and likely others.  If you are outside the United States you may need to find a local testing source.  For example, Healthscope Pathology in Australia can arrange for testing through Genova Diagnostics.

Blood Testing

Blood Testing (also called Serum Testing) for Gadolinium is also available through Mayo Clinic Medical Laboratories.  However, the plasma half-life of Gadolinium is approximately 90 minutes.  Mayo states that elevated Gadolinium in serum drawn more than four days after GBCA administration is not typical of most patients with normal renal function.  Our experience is that blood tests often report undetectable levels when urine tests indicate elevated levels of Gadolinium.  We will not cover blood testing in any additional detail.

Biopsy Testing

Biopsy Testing is a more complex topic including two different types of tests – dermal biopsies for histological features similar to those found in NSF patients, and testing of tissue for the presence of Gadolinium.

We want to be clear that in our view, Gadolinium Toxicity is not the same as NSF, but likely shares some similarities with NSF due to retention of Gadolinium. Nonetheless, we understand that some patients will want to be tested for NSF.

There is no biopsy or laboratory test that can be used as a gold standard to diagnose NSF. However, the current clinicopathological criteria focus heavily on clinical and histologic findings that involve the skin and underlying tissues. Finding evidence of Gadolinium in tissue is not a criteria used in the diagnosis of NSF. For the most part, the histopathological criteria for NSF are based on what was found in patients with severe renal impairment after exposure to Gadolinium-based Contrast Agents. In other words, it is based on what was seen in patients who likely retained large amounts of toxic Gadolinium due to their poor renal clearance of the contrast agent.

Most dermatopathology labs can test dermal biopsies for the histopathological features seen in NSF; however, most patients with normal kidney function do not present with the same, severe skin manifestations after Gadolinium retention. If you have skin changes and plan to have dermal tissue tested for NSF, it should be taken from an area with skin changes that are similar to what has been seen with NSF. Before you have a biopsy, be sure your dermatologist and his or her lab are familiar with the biopsy specimen requirements and the histopathological evaluation that is required to make an NSF diagnosis. It is very important that the biopsy be deep enough, have enough volume, and be taken from affected skin.

If you have NSF-like dermal changes, you can also have a biopsy specimen tested for the presence of Gadolinium at Mayo Medical Laboratories.   Note that providing evidence of Gadolinium in your dermal tissue is not required to get an NSF diagnosis.   Mayo Clinic’s testing has been set up in relation to people contracting NSF (Nephrogenic Systemic Fibrosis).  The most important thing to note is that even in patients diagnosed with NSF, higher concentrations of Gadolinium are usually found in tissue taken from an “affected” area rather than in tissue taken from an “unaffected” area.   Most of the people who have been participants in our research do not have skin changes consistent with what would be considered NSF-like “affected” tissue.

Even though many participants in our Symptom Survey identified Dermal Issues as one of their symptoms, we are not aware of any positive dermal biopsy results for these individuals – either for the histological features of NSF or for the presence of Gadolinium.

During the course of your medical care, a biopsy or removal of other body tissue might be medically warranted. That tissue can also be tested for the presence of Gadolinium; however, to our knowledge, that testing is not available for purchase at any lab. Testing would have to be arranged with a researcher who may be willing to test tissue specimens for evidence of Gadolinium. There is no guarantee that anyone will be willing to do the testing, and any cost involved might not be covered by insurance. Contact us if you would like additional information on searching for researchers who might be willing to help you. Also note that even if Gadolinium were discovered in tissue, the medical community has no reference levels or other ways to evaluate what the presence of Gadolinium might mean.

Many of the symptoms we describe as being related to Gadolinium Toxicity are not visible on the skin or related to the skin.  Therefore the dermal test is not relevant for things like muscle pain, paresthesias, cognitive issues, or ocular and ENT symptoms.  The current Gadolinium-related diagnostic criteria are based solely on what has been seen in patients with severe renal impairment who developed NSF, and that is based primarily on dermal changes and joint contractures. There are no tests to evaluate the effects of Gadolinium Toxicity on internal organs and body tissues.

We would like the Testing story to be a better one, but it is not.  We should all continue our advocacy efforts to drive for recognition of Gadolinium Toxicity and the development of relevant diagnostic tests.

 

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7 Comments

  1. sansea says:

    My level is 190. This was a provoked test and a few weeks after a contrast brain MRI. Does this indicate a typical response or should it never be that high?

    • Hubbs G says:

      You need to pay attention to the units with the test, as some are reported as mcg Gd/24hr and some are reported as mcg Gd/g creatinine. These are not interchangeable. We have seen other with test results in that time frame that are around the level of your result, if your result is mcg Gd/24hr. I suggest that you go to the Research Section on the website and go to the Our Research page. Read the report we did on Group Self-Study of Gadolinium Retention from Contrast MRIs. It will explain how the results are coming down very quickly that early after your contrast MRI.

  2. Lawrence Jones DDS says:

    Thank you for your work…

  3. Tracy Williams says:

    Don’t know if questions are asked on this site but I was wondering what the test costs?

    • Hubbs G says:

      The unprovoked urine test for Gadolinium that we describe on this page from labs other than Mayo typically cost between $125 and $250 depending on where you buy them. For Mayo, most people who have the Mayo test done have it covered by their insurance.

  4. Shari G. says:

    So is a provoked test completely invalid? I had a 24-hour provoked Toxic Elements test through Genova Diagnostics. The reference range shows
    <= 0.019. My level was 2.980 – 156 times that. Truly alarming! I had a few others metals very slightly outside the reference ranges but nothing like gadolinium! I would like some more clarity on the two methods and reasoning behind. Also, has anyone proving such high levels that is ill been able to get insurance to pay for IV chelation treatment? I did see that Gena Norris, who suffered from GAD toxicity was able to chelate her levels down to zero in a little over 2 years with almost a complete resolution of symptoms. I'm cautiously optimistic! Thanks in advance.

    • Hubbs G says:

      Shari –
      Testing for Gadolinium in urine, especially provoked testing has some challenges. If you understand the different aspects, you can put your results in perspective. First, about the range. Genova uses 0.019 mcg Gd/24hr. Mayo Labs uses a range of less than 0.7 mcg Gd/24hr collection. Big difference. There is no agency that sets ranges, each lab sets their own. Secondly, you need to make sure you got your test results in mcg Gd/24hr. This is not the same as mcg Gd/g Creatinine. Third, there are many different types of provoking agents that doctors may use as well as differences of oral chelators versus IV chelators. So without knowing all those parameters, you cannot compare your provoked results with anyone. Lastly, both Doctors Data and Genova use ranges based on unprovoked testing but doctors often use these labs for testing while the patient is under the effects of chelation (provocation). What we have seen is that if the patient receives an EDTA IV of 3 grams, and does a 24hour urine collection, that the result will be somewhere around 20 times higher that their unprovoked level. But this certainly varies.

      If we used 20, and IF you received a 3 gram EDTA IV, and IF you did a 23hr collection and IF the results were reported in mcg Gd/24hr, then that would indicate that your unprovoked result could be something like 0.13 mcg Gd/24hr. So that would certainly be within the Mayo range. However we think that any amount of Gd will have some level of toxicity, so less is always better.

      Sorry it is so complex, but that is the state of things in the world of Gadolinium Toxicity.

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