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13 Part 4: Biological Matrices Table 4. Components of Urine Specimen Validity Testing Characteristic Description Creatinine Creatinine is the product of muscle metabolism and is produced at a fairly constant rate by the body. Creatinine is used clinically as an indicator of renal health, with very high or very low concentrations indicating abnormal kidney function as in Diabetes Insipidus. Creatinine will be very low if an individual has over-hydrated, and very high concentrations can result from the use of some adulterants. SAMHSA has set criteria for normal creatinine concentrations in urine, with <20 mg/dL indicating a dilute sample. is limit is meant to screen out probable instances of attempted tampering among the general workplace population. Creatinine concentrations can be used to normalize drug concentrations if practitioners want to continue with definitive testing of a dilute sample. Specific gravity Specific gravity is a measure of the concentration of dissolved particles in a liquid by comparing its density to the density of water. e specific gravity of normal human urine is between 1.003 and 1.030. While a urine specific gravity of 1.000 is essentially water and suggest dilution, higher specific gravity values can indicate that an adulterant has been added to a sample. Most sources recommend that specific gravity need only be checked if creatinine is <20 mg/dL. pH pH is a measure of acid-base status and ranges between 4.5 and 8.0 in urine. It greatly affects the concentration and stability of some drug and drug metabolites in urine and therefore the likelihood that they will be detected. e pH of the sample may influence the enzymatic action and performance of immunoassay screens. Abnormal pH can indicate that a sample is dilute or adulterated. Bleach, acid, soap, detergent and vinegar all alter pH to outside the normal human range. Abnormal pH can also be the result of a kidney or urinary tract infection as well as diets extremely high in protein or low in carbohydrates. Immunoglobulin (IgG) IgG is the most common antibody in the bloodstream. Concentrations <0.5 µg/mL suggest that a sample was substituted with synthetic or animal urine. While IgG is discussed in the literature and is available as part of a specimen validity test at many lab facilities, the expert panel had mixed opinions regarding the appropriateness of its inclusion in specimen validity testing, with some commenting that it was not commonly used in their practice. Adulterants Testing for the presence of adulterants such as glutaraldehyde, pyridium chlorochromate and nitrites can be done on-site or in a laboratory. However, not all adulterants can be detected in standard adulterant test, including Visine eye drops and newer adulterants such as Urine Luck, UrinAid, Klear, and Whizzies.