What Urinalysis Tests Are Used to Check for Various Illnesses?
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In this program:
Urinalysis tests are used to gauge levels of glucose, protein, urine pH, ketones, bilirubin, red blood cells, and others in the urine. Watch as medical laboratory scientist Dr. Kyle Riding explains visual signs checked in urinalysis, the reasons for checking specific levels, and how to advocate for yourself if you notice changes in your test results.
Transcript
Leo Hesse:
Can you speak to a specific urinalysis test that may be performed to check for issues? Now, let's say you have a red blood cell urine test, or a glucose urine test, or a protein urine test, or urine pH level test, ketones urine test, bilirubin urine test, urine-specific gravity test, I hope everyone was listening, Dr. Riding does a phenomenal job at breaking down the sciences, so we understand it all and act on it. Can you just speak a little bit on the urine tests that I just mentioned?
Dr. Kyle Riding:
Absolutely, so I think before we get into those specific components, let's talk about the steps involved in an urinalysis, and I'm going to make all of you little medical laboratory scientists today. The first step that you can all do at home is what we call a macroscopic evaluation, meaning you look at it without any magnifying glass or any microscope, we simply look at the color of the urine and the clarity of the urine, and a normal healthy urine should be some shade of yellow and should be clear, there shouldn't be any cloudiness or haziness to it, all right? So if you see a color that is not a shade of yellow, or you see a haziness or a turbidity or cloudiness to the urine, you should seek medical advice without even having a laboratory test done. Because guess what, the first thing we do in the lab is actually report out what that color and clarity is, because it is as important as the fine-tuned details of the test we're going to talk about now. The second step is we take a dipstick, a little thin film with all of these little chemical pads on them, and on these chemical pads, there are dry chemicals on them, that as soon as the urine touches it, it starts chemical reactions. So we can detect if red blood cells are present, we can detect the pH of the urine, and we can also identify if there are white blood cells or protein present just by visually looking at the color that those little chemical paths turn.
And so let's talk about the specific chemical pads, and the ones that you mentioned, the first was red blood cells, and you may see this referred to in our analysis report as blood as blood present and that's just saying our red blood cells present and what will happen is when those chemical pads get put into the urine, if there's hemoglobin, that protein found in red blood cells present in the urine, we're going to have that chemical pad change in color, and we'll be able to detect that color change and report it out as positive for blood, which truly means red blood cells. The next one was glucose, which again is blood sugar. In a healthy individual who doesn't have high blood sugar levels, your kidneys should be able to reclaim, re-absorb any blood sugar that made it through those little filters in your kidneys. However, in patients that have, let's say diabetes, they have excessively high blood glucose levels, and so the kidneys, they can't reclaim or re-absorb all of that blood sugar like they want to, so some of it spills over into the urine, and we end up with glucose in the urine, and again, we absolutely dip the pad, in and it will change color for glucose, fun little fact that's really gross to think about.
The first laboratory test was actually for urine in glucose, and it was a taste test, this was way back in ancient Greece, when medicine was first training a foothold as a true field of inquiry. I am so glad I am not living in ancient Greece as a lab professional these days, I will tell you that much. The next one you mentioned is protein, and as I mentioned earlier, protein should not get into your urine. But if it does, that chemical pas will alert us to the presence of that protein, which could mean there's an inflammatory issue, or there's some type of damage to the kidneys or protein is spilling into the urine, it's able to get through those filters and into the urine when it should not be able to. Ketones, we've all heard of the ketosis diet. Ketones are little molecules your body makes when you're breaking down fats really quickly, okay? So when we're breaking down fats really quickly, it usually means we're doing that to be able to make glucose, because we can actually take fats and your body, your liver can convert it into sugar, convert it into glucose, it's the coolest thing our bodies are so neat that they're able to take that and turn it into sugar.
As part of that process, we generate these compounds called ketones. Now, if you're on a ketosis diet, you probably test for ketones in your urine to see if it's effective. For the general members of the public who are on a ketosis diet or feel perfectly healthy, ketones being in your urine is just a consequence of you burning fats at a very high rate. However, there are certain conditions such as diabetic ketoacidosis that are type 1 diabetics are prone to where we're having a pathological breakdown, an inappropriate and metabolically unacceptable breakdown of fats, and we can detect those ketone bodies in the urine and monitor it that way. The next was bilirubin and bilirubin again, is really a test and gives us a good sense of how the liver is processing that breakdown product where red cells die, they make bilirubin, but if our liver is not working correctly, that direct form of bilirubin builds up in our blood to a point where, hey, it can't get out through our stool. So our kidneys do the job of getting rid of it, so you can actually see bilirubin in your urine if you have some form of liver issue that's causing bilirubin to build up in your blood.
And finally your in specific gravity is a fancy way of saying how many dissolved particles are in this or how many dissolved the little chemicals are in this urine right now. And that's actually an important test, it's a numeric result that's usually between 1.003 to 1.035. Okay, it's kind of these weird numbers that you see in the lab report there, but the reason that we measure it and the reason it's important is your kidneys are responsible for re-absorbing dissolved things when it filters the blood, and it's also responsible for secreting things into the urine that the filters may have missed, and so that specific gravity gives us a sense of how good a job are your kidneys doing at that process of re-absorbing things or secreting things into the urine to maintain electrolyte balance and water balance.
Leo Hesse:
Thank you for that, Dr. Riding. Wow. Very well broken down. Now, should we be concerned if we get back an urinalysis test and you do not get a level of attention you pay to detail and your breakout just now should you be concerned at all? As someone mentioned to me last week, I had my blood and my urine test just sent to me in an email and that was it. Should we...should we really be talking and asking more questions if that happens?
Dr. Kyle Riding:
So for test like the urinalysis that are great, screening tests, the best thing I can give, the best advice I can give, if there is just a lab report sent to your electronic medical record with no context from your provider, the best thing to do is to simply just: a) Look to see if there's anything outside of the reference range, any flags that say this is low, high, abnormal, unexpected, if there are, talk to your physician, send a note, make a phone call and feel free to ask them. The other item is if you have prior laboratory results from your analysis or from, say, your liver function test or your CBC or your basic metabolic panel, you as a living system, you as a biological entity exist in this dynamic state of equilibrium, there's always balance going on inside of us, but we tend to keep a balance within very tight margins. So if you see alterations and trends that are changing in your lab results, even if they’re within the reference range, within that normal range, talk to your provider about, because we should not be seeing long-term trends over the course of several months in results, our bodies are fairly consistent for the most part.
And remember, physicians are deeply compassionate people, they're hard working people, and they care about their patients. But think about all of the data in your lab report, and think about how many lab reports at a general physician's office they're getting on a day-to-day basis. They may not remember your last lab values, and they see that you're in the healthy range, they may say, “Oh, they're good. So I don't need to let them know about anything.” But be your own advocate and ask those questions, because even if the physician through their due diligence and hard work misses a change and a trend in your lab results, you being a health advocate is not going to insult them, it's not going to hurt their feelings, and they're probably going to be grateful to you for having your own back and working with them as a member of your own care team and working with them as a team player.
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