InforMed Centers offers Kidney Health Testing
Kidney Health Comprehensive
Includes: Urinalysis Complete, Blood Urea Nitrogen (BUN) Creatinine and BUN/Creatinine ratio
Blood Urea Nitrogen (BUN)
The major breakdown product of bodily protein (e.g., in that hamburger you had for lunch) is urea, which is first formed in the liver. Urea contains nitrogen and together, in excess quantity, they are both toxic to the body and must be removed. Kidneys normally do an excellent job of removing urea, but when they start to fail, the blood concentration of urea begins to rise. The reference range (or range within which most normal people’s test values fall) for BUN is 10-20 mg/dL. Other circumstances, such as blood in the intestinal tract, a big meal of cooked meat, simple dehydration (too little water in the tissues), or any condition which decreases blood flow to the kidneys, can cause the concentration of blood urea to rise and suggest there is something wrong in kidney function. Therefore, a second blood test is done at the same time.
Creatinine
Creatinine is a normal blood chemical that is a breakdown product of muscle metabolism. Kidneys are normally very efficient filters of creatinine. Unlike urea, the blood creatinine concentration is much less sensitive to the degree of bodily hydration, blood or meat in the intestinal tract. The reference range for blood creatinine is 0.3-1.5 mg/dL.
Considered together, the BUN, blood creatinine and their ratio give very good evidence of the filtering function of the kidneys and also, a measure of the degree of bodily hydration. The ratio of BUN: creatinine is normally 10:1. With dehydration, the ratio can increase to 20:1 or even higher. An increased BUN: creatinine ratio may also be due to certain types of kidney disease, breakdown of blood in the intestinal tract, increased dietary protein, or any clinical circumstance in which insufficient blood is flowing through the blood vessels to the kidneys (such as heart failure or kidney artery disease). The BUN: creatinine ratio is decreased in certain types of kidney disease, liver disease, malnutrition and in a condition known as Sickle Cell Anemia.
Normally functioning kidneys (at least one) are necessary for a healthy life. The kidney performs essential functions for the body in removing waste chemicals from metabolism of our tissue cells in producing energy, chemicals that have been detoxified by the liver (such as drugs, toxins and hemoglobin breakdown products), and has major roles in maintaining the right amount of bodily water and salts, and in regulating our blood pressure.
The kidneys can be damaged as a result of disease processes occurring elsewhere in the body, such as diabetes, infections, blood vessel diseases, high (or low) blood pressure, diseases of the blood, cancer, immune diseases such as lupus, trauma, etc. The kidneys can also have diseases of their own such as infections, structural abnormalities from birth that bring about abnormal function, cancer, and can cause high blood pressure. Kidneys are incredibly resilient in functioning sufficiently well to keep the body alive even after great or continuing damage. When the kidneys begin to fail, the first signs are usually chemical, in the blood and urine. Consequently, periodic checking of the kidneys’ functioning, along with checking other bodily functioning, can be very beneficial in identifying problems early, when many are curable or controllable. Metabolism of both fat and sugar eventually produces CO2, which exits the body mainly through the lungs and a small amount through the skin. However, the metabolic breakdown product of proteins, after conversion in the liver into a substance called urea, is chemically such that it must be excreted in water. Likewise, creatine in muscle is metabolized into a chemical called creatinine, which is also excreted in water. If the kidneys are not functioning properly, the concentrations of these chemicals will rise in the blood. The laboratory uses the blood urea nitrogen (BUN) and creatinine to assess kidney function, and the urinalysis to measure kidney output function and health of the collecting system (lower portion of kidney, ureters and bladder).
BUN/Creatinine Ratio
The ratio of BUN/Creatinine is normally 10:1. With dehydration, the ratio can increase to 20:1 or even higher.
An increased BUN/Creatinine ratio may also be due to certain types of kidney disease, breakdown of blood in the intestinal tract, increased dietary protein, or any clinical circumstance in which insufficient blood is flowing through the blood vessels to the kidneys (such as heart failure or kidney artery disease).
The BUN/Creatinine ratio is decreased in certain types of kidney disease, liver disease, malnutrition and in a condition known as Sickle Cell Anemia.
Urinalysis
Color
Normal urine usually ranges from a light yellow to a dark amber color that may vary according to the concentration and the type of food and drugs that are ingested. The color of urine is attributed to its chief pigment, “urochrome”. Changes in urine may be due to disease, but can also be caused by food and drugs ingested.
Transparency
Freshly voided urine is usually clear. Samples exposed to room temperature for more than an hour or two may become cloudy bur to bacterial growth or precipitation of phosphates or urates. Possible transparency are the presence of kidney stones, bacteria, sperm, yeasts, or stool contamination.
Odor
The odor of a fresh urine sample is normally Aromatic. The odor, when unusual (Ammonia-like sweet and fruity), may be due to a urinary tract infection, or the presence of ketone bodies as in Diabetes, starvation, strenuous exercise, vomiting, diarrhea, malnutrition; or may be due to the ingestion of certain food or to the contamination of the urine container.
Specific Gravity
The specific gravity of urine depends on the gravity and number of molecules dissolved in solution of the urine sample. The normal urinary specific gravity may range from 1.002 to 1.030. Most of the molecules dissolved in the urine are made of Sodium Chloride and Urea. Urine is usually More concentrated in the morning which, is a normal phenomenon. Abnormally diluted urine may be present in kidney disease whereas very concentrated urine with high specific gravity may be present in diabetes, vomiting, diarrhea, and fever.
Leukocytes
Leukocytes are one of the white (Leuko) cells (Cytes) present in blood stream which defend the body from bacterial invasion. When present in the urine may suggest the presence of an underlying mild urinary tract infection. A repeated presence of leukocytes indicate the needs for further testing such as cultures or blood test.
Nitrates
The presence of nitrates in the urine is due to the conversion of nitrates in food by the action of the bacteria. Therefore, a positive nitrate test is a good indicator for the presence of a significant amount of bacteria in urine. This may be associated with a urinary tract infection of a bladder or urethral the tube which connects the bladder to the outside) infection. Significant bacteriuria is estimated to affect 1%-2% of young girls,5%-10% of pregnant women and is also associated with diabetes, hypertension, herniation of the urinary bladder, Prostate problems and the use of a catheter for drawing certain anatomic abnormalities.
Ph
Normally freshly voided urine is acid. Therefore, the PH which is a measure of acidity may range from 4.0-7.0. People who eat high protein diets produce a more acid urine than those that consume mostly fruits and vegetables. Increased urinary acidity (lower PH) may also be present in diabetes, fever, pulmonary emphysema, diarrhea and dehydration. Alkaline PH (Higher PH) may also be noted in chronic inflammation of the urinary bladder, acute or chronic kidney failure, or for intoxication of salicylate ( such as aspirin) or other drugs.
Proteins
The presence of proteins in the urine is called “Proteinuria” and is an important sign of renal disease. Proteinuria can be due to an increased permeability of the walls of the filtering components of the kidneys (The glomerulus). Proteins may be present in a number of kidney diseases. However a small amount of proteins, mostly albumin, may appear in the urine in response to excessive muscular exertion, exposure to colds, or with extra ingestion of proteins with food. In some people the presence of proteins in the urine may occur upon arising from a sitting position. This is called ” Orthostatic Proteinuria”. Proteinuria may also be present in acute inflammation of the kidneys as acute nephritis, or in the presence of malignant hypertension, heart failure and diabetes.
Ketones
Ketones are called “Ketone bodies” and include acetone, diacetic acid and beta hydrobutyric acid and and appear in normal urine of patients on a carbohydrate-deficent diet. When the body can not find sufficient sugar for its metabolism it turns to its fat stores for energy which in turn are reduced to ketone bodies. Ketone bodies appear in urine before they increase significantly in blood and this is called “Ketonuria”. The presence of ketones in the urine may occur in uncontrolled diabetes and hyperthyroidism.
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