Employers are Not the Only Ones Who Ask You to “Pee in the Cup.”

We’re not quite done with the urine tests.  Chances are, while you might not have gotten to NYC’s Broadway to see “Urinetown,” you’ve been asked to “pee in the cup” by more than one prospective employer. That’s also part of the urine test for CKD patients.

The Random Urine Tests

When you read random urine test, think, “pee in the cup.” You’ll be asked to do this, as well as give blood, when you bring your 24 hour urine collection to your lab. Oddly enough, in this case random refers to a special time of the day, namely the time of day you’re producing a urine sample. While these are not as accurate as the 24 hour urine collection tests we discussed on Friday, they do allow your doctor to see how much of each element is being secreted when you urinate.

To illustrate the importance of this test, one summer I’d suffered infection after infection for a total of five.  This necessitated quite a few random urine tests to watch the white blood count.  When that count was elevated, an infection was present.  When it wasn’t, the antibiotics had accomplished their task and I was finally infection free.  Here are explanations of some of the specific tests.

2498 deals with the creatinine that is voided in the urine at one specific time. In other words, this test measures the creatinine in one urine sample rather than during the entire 24 hour collection period.

209245 Immunofixation, Urine, Random is used to assess the state of your immune system. (Notice this was also tested in the blood.)

9929 Microalbumin, Ur, Random, Normal tests for micro, or very small amounts, of albumin in the urine. Ur stands for urine. Albumin is a form of protein that is water soluble. Urine is a liquid, a form of water, so the albumin should have been dissolved. Protein in the urine may be an indication of kidney disease.

209198 Protein, Electrophoresis, Urine serves the same purpose as the blood test for this. It separates the different components of protein in your urine, rather than in the blood.

209245 Immunofixation, Urine, Random identifies the proteins found in the test explained above.

2482 Protein, Urine Random, Normalized is similar to 2043 (Protein, Urine Timed). The difference is that this measures the protein in one sample of your urine, rather than the entire 24 hour collection period’s urine.

And then, there’s 203405 Urinalysis, Complete which can’t be part of the 24 hour collection due to the additives used to preserve the specimen.  It is complete in another way. The urine is visually examined for color, transparency and odor.  This is what you usually hear about as the urine test for drugs, but this also may catch signs of different diseases.

Food and drugs can change the color of urine, but so can concentration or dilution of the urine. CKD patients are instructed to drink 64 ounces of liquid a day.  Too much will make the color of your urine very light. Not enough will cause your urine to become a deep yellow.

Cloudiness, rather than transparency, could mean kidney stones or the beginning of a phosphate or urate which may indicate a  problem. Urate is a salt of the uric acid whose presence could indicate gout. The presence of either element could also mean that the sample has been unrefrigerated for too long or that a bacterial growth is present. Either way, it’s an indication that more testing is needed.

While unusual urine odor could be due to a plain, old, ordinary urinary tract infection, it might also be caused by ketone bodies in the urine. When the kidneys or liver break down fatty acids for energy, these are the by products which are used by the heart and brain for energy. There could be any number of causes for their presence, but the important part is that diabetes may be one of them.

Just a little bit more of this. The second part of the Complete Urinalysis deals with specific gravity of the urine which has been tested since abnormally diluted urine may indicate kidney disease. High specific gravity may indicate diabetes, which is one of the primary causes of CKD. My reaction to this was a big question mark about just what gravity was in the first place. It turned out to be the concentration of particles in the urine. Evaluating this helps evaluate your body’s water balance and urine concentration.

The biochemical part of the urinalysis tests leukocytes, nitrates, Ph, proteins, ketones, urobilinogen, glucose, bilirubin, blood, and hemoglobin. To be as succinct as possible: leukocytes are one of the white blood cells that fights bacterial infection; nitrates present in the urine indicate bacteria and possibly diabetes; high Ph may point to an over consumption of protein (I’m limited to five ounces a day) or CKD while low Ph may point to diabetes or dehydration.

Protein in the urine, or proteinuria, is one of the signs of kidney disease. Ketone presence might be caused by uncontrolled diabetes. High urogilinogen levels could be an indication of anemia. High glucose levels might be the result of diabetes. Bilirubin in the urine could be the result of liver failure. Blood in the urine may indicate some kind of kidney disorder.

Hemoglobin in the blood may be a result of the breakdown of red cells. Hemoglobin in the red blood cells is what carries the oxygen through your body. These are not the only causes for finding these elements in the urine. Should you decide you’d like to know more, try one of the online medical dictionaries.

The final part of the urinalysis is microscopy and sediment. The sediment part refers to the particles that settle to the bottom when urine is allowed to stand for several hours and then examined under a microscope.

Albumin, stagnant urine, cellular debris and low urine filtration rate can cause a protein cast in the urinary sediment. Proteinuria can indicate kidney disease – as you probably remember.

Urinary sediment doesn’t usually contain crystals unless alkalization is present. As mentioned before, high Ph – or alkalization – may indicate kidney disease. But, then again, it may indicate not enough water intake or high water elimination.

There should be no micro-organisms in the urine sediment, but their presence may indicate a urinary tract infection – which is bacteria based – or kidney infection – which is yeast based. Other micro-organisms that may be detected are parasites, spermatozoa and mucus.

Now that the explanations of the tests are complete, you’re probably aware of how many times I wrote may indicate and can cause. Understanding your blood and urine results is a more precise science than can be explained with a boiler plate list of what causes which problem or what each test may mean.  Your doctor will be able to understand how the results of one test – or even one part of one test – implicate the other tests. The tests produce the pieces of your evaluation.

It’s almost like a thousand piece jigsaw puzzle; some people are good at putting those together, others aren’t.  Your doctor is the one who’s good at it, although it doesn’t hurt to have a passing knowledge of just what is happening in what flows through your body.

That’s enough for now.  All those numbers are making my head hurt.

Until Friday,

Keep loving your life!

Published in: on November 9, 2010 at 7:40 pm  Leave a Comment  

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