Urinalysis?

Question

Suppose a urine sample revealed abnormal results, such as protein in the urine. If there is a result differing from the norm (color, pH, subtances present), should the physician always make an immediate diagnosis of a disorder? Why or why not?

Answer 1

Hello There!
Here is your answer.
A Doctor could not give an immediate diagnosis, as the cause of the protein in the urine must be determined first
I hope all goes well for you! :)

What is proteinuria?
Proteinuria is leakage of protein from the blood into the urine. This page explains what protein is, how it gets into the urine and what doctors can do to deal with any problems caused by proteinuria.

What is protein, and how does it get into the urine?
Protein is one of the three main types of chemical that make up our body (the others are fats and sugars). Protein is an important part of diet, and is contained in most types of food. Meat and fish contain large amounts of protein. After you eat protein, it is dissolved in the stomach and absorbed into the body. The protein is then modified and distributed throughout the body in the blood. Protein is an important part of the plasma (watery part) of the blood, and the body does not want to lose protein. Therefore, when the body eliminates waste through the kidneys, protein should be kept in the blood stream.

The kidneys make urine by filtering the blood. Normally no protein passes into the urine when the blood is filtered, because protein in the blood is too large to pass through the tiny holes in the kidney filters. However, the filter can be damaged in kidney disease, so that protein can pass into the urine. The filter in the kidney is called a glomerulus, and many of the kidney diseases that cause nephrotic syndrome are called glomerulonephritis.

What are the symptoms of proteinuria?
Normally there are no symptoms, but protein is detected by a routine urine test. The simple test with a dipstick (small plastic strip with a indicator paper attached) can detect very small amounts of protein, so that a positive test may not mean there is any serious problem with the kidneys.

If the amount of protein in the urine is very high, a condition called nephrotic syndrome may develop. Nephrotic syndrome causes water to build up in the body. The extra water can cause ankle swelling, or swelling in the hand (rings go tight on fingers) or around the eyes. Severe swelling can develop all the way up the legs and around the back. There may be swelling of the tummy or breathlessness due to water around the lungs. Click here for more detail on nephrotic syndrome.

What are the causes of proteinuria?
Protein in the urine can be a marker of almost any type of kidney disease, so tests are always needed if the cause of proteinuria is to be confirmed. These are the most common (click on a disease for more information):-

High blood pressure
Infection
Reflux nephropathy
Diabetes
Glomerulonephritis
Minimal change nephritis

How is the cause of proteinuria diagnosed?
Further tests may be necessary after protein has been detected by a simple 'dipstick' test on a small urine sample. This dipstick test is very sensitive, but cannot measure exactly how much protein is in the urine. To get an exact measurement, some urine needs to go to the laboratory. This can be done with a single small urine specimen, in which the laboratory measures the levels of protein and creatinine ('protein-creatinine ratio' or PCR for short). A collection of a whole days urine output (24 hour collection) into a container was the standard method for measuring protein in the urine for many years, but is now being replaced by the far more convenient PCR test.

A PCR of less than 2 mg/mmol is normal. Levels of up to 50 usually do not indicate serious kidney disease, so long as the kidney function (measured by blood creatinine level or eGFR) is normal. However, a PCR of 20-50 in someone who has diabetes will require further action, especially to reduce the blood pressure, improve the control of diabetes and check the blood cholesterol level (Click here for more information on 'diabetes and the kidneys').

A PCR of 50-300 usually requires some further testing, see the section on chronic kidney disease (Click here). A PCR of greater than 300 may mean that nephrotic syndrome is present (Click here for more information on this syndrome).

If a 24 hour collection of urine has been performed, the protein level is given as grammes/24 hours. This result roughly equates to the PCR divided by 100; i.e. a PCR of 2 is 0.02 g/24hr; a PCR of 50 is 0.5 g/24hr; and a PCR of 300 is roughly 3 g/24hr.

The doctor will also take a full history, and check there is no-one else in the family with kidney disease. Several blood tests will be done, and your blood pressure will be measured. The size and shape of the kidneys will be measured in the X-ray department with an ultrasound (sound wave) scan, or an IVU (X-rays of the kidneys after an injection).

Sometimes, to make a firm diagnosis of the cause of proteinuria, it is necessary to perform a kidney biopsy. This is the removal of a small fragment of kidney using a needle, so that the kidney can be examined under a microscope. Click here for more information on kidney biopsy.

What are the complications of proteinuria?
Many people with proteinuria turn out to have minor kidney disease with no problems in the long term, but some kidney disease can progress to kidney failure. Complications depend on the exact cause of proteinuria in each case, so read the information on the condition you have.

There are some problems which are common in all types of kidney disease with protein in the urine:-

1) High blood pressure - Kidney disease commonly causes high blood pressure. This increases the risk of further kidney disease, and also the risk of heart attack and stroke. Drugs may be needed to control the blood pressure

2) High cholesterol - In nephrotic syndrome (very high protein levels in the urine, click here for more details), high levels of cholesterol (a type of fat) may be found in the blood. If the cholesterol level is high over a period of years there is an increased risk of a heart attack. If the nephrotic syndrome is cured quickly, the cholesterol level will go down on its own. However, in some cases where a rapid cure is not possible, drugs to reduce the cholesterol may be needed.

What is the treatment of proteinuria?
The underlying kidney disease may be treatable with drugs. The type of treatment depends on the cause. Information is contained in the sections on each individual disease (see above for the types of kidney diseases).

Water retention can be treated by reducing the amount of salt and water taken in your diet each day. Some cases also require drugs to make the kidneys produce more urine.

High blood pressure can be treated by reducing salt in your diet, and often with drugs to take each day. A high cholesterol level may be treated with dietary control (eating less fat) and, in some cases, with cholesterol lowering drugs.

Answer 2

1

Answer 3

Never. because the sample may have broken a chain of custody, been contaminated etc. It should be treated as a possibility or a springboard for further testing to confirm. Most doctors are smarter then that and most have a decent "bedside manner" I have early onset Parkinson's and I lost 2 years of my life messing with I think you have this I think you have that. I spent 2 years in depression and although today I still dislike what my body has turned into, I just take my meds and slowly trudge on.

My first Neurologist is the head of a movement disorder department at a major university research center. I am on my 4th and best Neurologist now. Anyway my first Neurologist said to me on my 2nd visit that HE set 6 months after my initial visit "Why did you come back? I have taken you as far as we can go. There is nothing more I can do for you.

So a medical professional should not cause any unnecessary concern or fear just on a urinalysis. It should be approached with respect and dignity for both the patient and families sake.

Answer 4

No, a physician should know better. You need to verify any concerns with blood work or other diagnostic tests. One thing alone is not a signifier of an illness.