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Urine as a Diagnostic Tool

A long time ago, disgusting as it may be, people used to actually taste and drink urine in order to try and diagnose a patient's disease! I'm not even kidding you. Thankfully, modern-day doctors do not have to resort to such disgusting and even dangerous methods.

One of the reasons the doctor barbers of yesteryear used to drink their patient's urine was to see if it had a sweet taste, often indicative of diabetes mellitus. Finding the sweet-tasting glucose in the urine was covered in detail in another lesson, so we'll focus on other important measurements here instead.

Interpreting Urine pH

One value that can be measured in the urine is known as urine pH. pH is a measure of the acidity or alkalinity of a substance. If the pH is low, then it is acidic. If the pH is high, then it is basic, or alkaline.

To remember which is which, I'll give you a little trick that has worked for me. If you grew up watching cartoons, you probably saw some comical ones where cartoonish robbers poured acid on the roof of a bank vault and waited while the acid ate its way downward into the vault, so the robbers could get down there to steal all the cash. If you can recall that acid likes to eat its way downward into things, then you'll remember that acidic substances go down the pH scale. That is to say, their pH numbers are lower than basic substances.

Normal urine pH is roughly 4.6-8, with an average of 6. Urine pH can increase, meaning it will become more basic, or alkaline, due to:

A urinary tract infection

Kidney failure

The administration of certain drugs such as sodium bicarbonate

Vegetarian diets

On the flip side, causes for a decreased, or acidic, urine pH, include:

Metabolic or respiratory acidosis

Diabetic ketoacidosis, a complication of diabetes mellitus

Diarrhea

Starvation

High-protein diets

Interpreting Urine Ketones

Other than urine pH, another important value in a urinalysis, a test measuring the levels of different substances in urine, is ketones. Ketones, or ketone bodies, are molecules produced by the body when fat is broken down in order to be used as a source of energy.

If you are happy and healthy and get enough nutrients, then your body breaks down carbohydrates as a source of fuel. But in conditions when you aren't getting enough carbohydrates, when you've used them up, or when they cannot be used as a source of energy (as in the case of diabetes mellitus), then the body begins to break down fat stores in order to provide you with energy, resulting in ketone bodies that are used as a source of energy instead.

As a familiar example of the same deal, if you own a hybrid car, then you know that the car can run on battery power for only so long. If you don't charge the car, the battery is used up, or it malfunctions, then the hybrid car switches to another energy source, gasoline. The ketones are essentially a backup source of fuel in times of great need or disease.

Normally, there should be no ketones in the urine. If ketones are found in the urine, called ketonuria, they may be indicative of:

Extreme exercise, as in the case of ultra-marathoners, depleting normal energy sources

Starvation, leading to inadequate carbohydrate intake

Uncontrolled diabetes or diabetic ketoacidosis

Alcoholic ketoacidosis as a result of alcohol abuse

Pregnancy

Vomiting

Interpreting Urine Protein

Another thing that can be tested for in the urine is proteins. Normally, a test called a urine dipstick test is used as a routine scan for protein in the urine. This is the test that has all those pretty colored squares on a strip of paper. I'm sure you've seen it before. A typical urine dipstick test will not detect any normal amounts of protein in the urine, normally less than 150 mg/day. Foamy-looking urine is often indicative of abnormal amounts of protein in the urine, called proteinuria, which will be detected by the urine dipstick.

But the problem with a urine dipstick test is that it has several faults. Normally it only measures only one kind of protein, called albumin, and is much less sensitive to globulins and Bence-Jones proteins. Furthermore, the test strip indicators may sometimes be fooled by varying levels of urine concentration and may therefore give false results. Therefore, a more accurate test for proteinuria is known as the 'sulfosalicylic acid test.' Both of these tests give results with a series of plus signs indicating ever-increasing concentrations of proteins in the urine. Because the sulfosalicylic acid test is more accurate, we'll focus on interpreting its results in this lesson:

A negative or 0 result indicates no proteinuria

Trace indicates slight proteinuria of about 20 mg/dL

1+ (or just +) indicates 50 mg/dL

2+ (++) indicates 200 mg/dL

3+ (+++) means the proteinuria is at a 500 mg/dL level

4+ (++++) is telling us that the proteinuria is equal to or more than 1000 mg/dL

Protienuria itself may be a result of many different problems, including;

Heart conditions, such as congestive heart failure

Glomerulonephritis, a condition causing the kidney's glomerulus, the structure that filters blood, to become more porous and leak proteins into the urine

Renal tubulointerstitial disease, where the kidneys can't reabsorb adequate amounts of protein filtered by the glomerulus

Cancer, such as multiple myeloma, which produce large amounts of proteins to the point that even normally functioning kidneys can't reabsorb enough of them before they reach the bladder

Renal amyloidosis, a condition where insoluble proteins are deposited in the kidneys

Diabetes mellitus

As a general rule, the larger the amount of proteinuria, the more likely the disease is one that affects the glomerulus.

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and cells - video & lesson transcript | study.com

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Urine Test Types: pH, Ketones, Proteins, and Cells - Video & Lesson Transcript | Study.com

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A long time ago, disgusting as it may be, people used to actually taste and drink urine in order to try and diagnose a patient's disease! I'm not even kidding you. Thankfully, modern-day doctors do not have to resort to such disgusting and even dangerous methods.

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Iâ€™ll be demonstrating how chemical dipsticks are used to analyze urine specimens in order to provide a rapid diagnosis for various conditions including diabetes, bladder infections, kidney or liver disorders amongst others.

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What do the characteristics of urine tell us?

The elimination of urine is very important for different bodily functions. It regulates the balance of water in the body, for example, and also gets rid of substances that are produced during metabolic processes and are no longer needed by the body. These include toxic substances in food or medicines. Urine tests can help detect diseases of the urinary system as well as metabolic diseases like diabetes or liver disease.

The color, odor and amount of urine can already indicate whether something is wrong. If, for instance, someone passes only a little very dark urine, it could be a sign that they have not had enough to drink - or that their kidneys are no longer working properly. Cloudy or flaky urine could be a sign of a urinary tract infection. If the urine is reddish in color, there might be blood in it. To find out more, the urine needs to be tested using a test strip or in a lab.

How do you give a urine sample?

Urine can easily be contaminated by bacteria, cells and other substances so it is a good idea to cleanse the genital area with water - but not soap - before giving a sample. To get an accurate result and avoid bacterial contamination, "clean" midstream urine is used. You take a sample of midstream urine by interrupting the flow of urine after a few seconds and then collecting this middle portion of the urine in a cup. Your doctor will let you know if there is anything else you should pay attention to for your specific test.

Five standard urine tests can be used to examine the different components of urine. Two of them can also be done at home, whereas the other three can only be done in a lab.

Rapid urine test

What is a rapid urine test?

A rapid urine test is the quickest way to test urine. This involves dipping a test strip with small square colored fields on it into the urine sample for a few seconds. After that you have to wait a little for the result to appear. Depending on the concentration of the particular substance you are testing for, the fields on the test strip change color. Then the resulting colors of the fields are compared with a color table. The color table can be found on the urine test package. It shows which colors indicate normal and abnormal values.

Rapid urine tests are usually done as part of routine examinations - for example at a family doctor's office, during antenatal visits, when being admitted to the hospital, or before surgery. They are also used in people who have acute symptoms like lower abdominal pain, stomach ache or back pain, frequent painful urination, or blood in their urine. Some people who have diabetes use this test to check their sugar levels.

Rapid urine tests can be done at doctor's offices, in hospital, or at home. The test strips are available without a prescription at the pharmacy or on the internet. But they are not intended for self- diagnosis purposes, and should be used in consultation with a doctor.

What substances can a rapid urine test detect?

Many substances are usually found only in certain amounts in urine, so higher or lower levels indicate a deviation from the norm. The following substances can be checked using a rapid urine test:

pH value (measure of the acidity of the urine. Normal values, depending on diet, range from about 5 to 7, where values under 5 are too acidic, and values over 7 are not acidic enough)

Ketone (a metabolic product, not usually found in urine)

What do the results tell us?

You can determine whether the results are within the normal range by using the package insert or the color chart on the package. The pH value, for example, can be used to find out whether there is an increased risk of developing urinary stones. This is the case if the pH is too acidic (if the value is below 5). A pH value over 7 may be a sign of a bacterial urinary tract infection. Tests measuring other things can help detect other problems:

If the test results are abnormal, you need to see a doctor. As with all tests, the results of rapid urine tests are not always reliable. For this reason, it might be a good idea to have a more detailed test done in a lab.

Urinalysis

What does urinalysis test for?

In addition to the substances that can be detected using a rapid test, urinalysis can also test for the following:

What do the results tell us?

With the help of these values, laboratories can also use urinalysis to detect signs of other problems:

Abnormal results can be discussed with a doctor and may be followed by more precise tests, such as a blood test.

Urine culture

What is a urine culture?

What can urine cultures test for?

Urine cultures can be done to test whether there are bacteria or fungi in urine. If this is the case, you can often already see what type of bacteria or fungi they are, based on the size, form and color of the colonies.

What do the results tell us?

24-hour urine collection

What is 24-hour urine collection?

What can be tested with a 24-hour urine sample?

24-hour urine samples can be used to find out what amounts of certain substances (such as proteins, hormones, salts and metabolic products) are excreted from the body.

Pregnancy tests

What is a pregnancy test?

If your menstrual period is late, there are different tests available to find out whether you are pregnant. But they are not absolutely reliable. Most tests can already determine whether a woman is pregnant eight to ten days after her period was due. They are usually done like rapid urine tests, using a urine sample in the morning after getting up. You can find exact instructions in the package insert. Pregnancy tests can be bought in pharmacies, drugstores, department stores and on the internet.

What can be checked with a pregnancy test?

What do the results tell us?

Many women who would like to find out whether they are pregnant will first do a pregnancy test. The results might be false if a woman does the test too soon, is taking medicine or drinks a lot of fluids before doing the test. Only a doctor can say for sure whether you are pregnant or not.

Other urine tests

Drugs can also be detected in urine for a while after being used. Depending on the type of test, cannabis can be detected up to several weeks after being consumed. Drugs like cocaine, ecstasy or heroin can show up in test results for up to five days. Various types of tests can be used here too: Rapid tests help give police fast results on site, while other drug tests need to be sent to a laboratory. Urine samples can also be used to test athletes for banned performance-enhancing substances (doping).

Sources

Andreae S. Lexikon der Krankheiten und Untersuchungen. Stuttgart: Thieme; 2008.

Bundesausschuss der Ärzte und Krankenkassen. Richtlinien über die ärztliche Betreuung während der Schwangerschaft und nach der Entbindung („Mutterschafts-Richtlinien"). Bundesanzeiger 2011; 72: 1787.

Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Urine and blood glucose self-measurement in diabetes mellitus type 2. Final report A05-08. Version 1.0. Cologne: IQWiG. October 2009.

Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. Harrison's Principles of internal medicine. New York: McGraw-Hill Companies. 18th ed; 2011.

Pschyrembel W. Klinisches Wörterbuch. Berlin: De Gruyter; 2014.

Thomas L. Labor und Diagnose. Marburg: Die Medizinische Verlagsgesellschaft. 7th ed. 2007.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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national center for biotechnology information

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united states national library of medicine

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Understanding urine tests - PubMed Health - National Library of Medicine - PubMed Health

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Most people will have already given a urine sample at some point in their lives. Urine samples are needed for urine tests, which are used for things like testing for particular diseases or monitoring their progress. For instance, urine test strips can be used to indicate whether you have a urinary tract infection.

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Urinalysis - Urinary System Tests - HealthCommunities.com

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Urinalysis, also called a routine urine test, is used to check for abnormalities in the urine. Urinalysis may be performed as part of a regular physical examination to screen for early signs of disease such as diabetes and kidney disease and to detect urinary tract infection and blood in the urine.