General Laboratory: Urinalysis: Clinical Significance Online Training
Performing a chemical analysis of urine using urinalysis strips allows laboratories to perform a single test and obtain results for a number of different analytes.
Describe the clinical significance of test results that yield abnormal values Explain normal versus abnormal values for several test results Identify medical conditions and diseases and describe how they can be detected by analyzing the combined results of tests included on urinalysis strips Welcome to the Clinical Significance of Urinalysis course. After completing this course, you’ll be able to: Select Next to continue. Performing a chemical analysis of urine using urinalysis strips allows laboratories to perform a single test and obtain results for a number of different analytes. Download and print a chart of average normal values for routine and non-routine tests performed during a urinalysis. Download and print a list of some important proteins, along with medical conditions in which they may be found. UA Test Results and Clinical Significance I Learn about specific gravity, pH, osmolality, protein, and albumin test results. Select each tab to learn about specific gravity, pH, osmolality, protein and albumin results.TitleTextSpecific GravityTab TitleTextTest ResultsUrine specific gravity ranges from 1.003 to 1.030, but usually falls between 1.010 and 1.025. Specific gravity is highest in the first-morning specimen, with levels typically greater than 1.020 A specific gravity of 1.025 or above in any random urine specimen indicates normal concentrating ability Note: Water has a specific gravity of 1.000. Since urine is a solution of minerals, salts, and organic compounds in water, the specific gravity of normal urine is greater than 1.000.Clinical SignificanceLow Specific Gravity: Diabetes insipidus is a disease characterized by large volumes of urine with low specific gravity between 1.001 and 1.003. Low specific gravity may also occur in people with glomerulonephritis, pyelonephritis, and various kidney anomalies. In these cases, tubular damage renders the kidney incapable of concentrating urine. High Specific Gravity: Specific gravity is high in people with adrenal insufficiency, hepatic disease, and congestive cardiac failure. It is also elevated in cases where there has been excessive loss of water, as with sweating, fever, vomiting, and diarrhea. Fixed Specific Gravity: Urine with a fixed low specific gravity (approximately 1.010), which varies little from specimen to specimen, is known as isosthenuric. This condition is indicative of severe kidney damage with disturbance of both the concentrating and diluting abilities of the kidney.Other FactsIf test results are questionable or inconsistent with expected results, perform creatinine and osmolality tests. Note: Abnormally high amounts of some of the urinary constituents such as glucose, or the presence of X-ray contrast media may increase the specific gravity as measured by some procedures, such as the Total Solids (TS) Meter and the urinometer. However, the colorimetric strip test is not affected by such materials and thus gives a more clinically relevant specific gravity.pHTab TitleTextTest Results Urine pH is a measure of its hydrogen ion concentration. A pH below 7 indicates acidic urine A pH above 7 indicates alkaline urine Normal kidneys are capable of producing urine that can vary from a pH of 4.5 to slightly higher than 8.0. Freshly voided urine from people not on special diets is acidic and has a pH of about 6.0. Clinical SignificanceSecretion of an acidic urine or alkaline urine by the kidneys is one of the most important mechanisms the body uses to maintain the body’s normal acid-base balance. Refer to the Glossary to learn about situations that can cause the following conditions: Acidic Urine Kidney Tubular Acidosis Alkaline Urine Kidney Stones Other FactsIf test results are questionable or inconsistent with expected results, measure the urine pH using a pH meter for confirmation.OsmolalityTab TitleTextTest ResultsNormal urine osmolality ranges between 50-1400 mOsm/kg water, and averages about 500-800 mOsm/kg. A random urine osmolality should average between 300-900 mOsm/kg.Clinical Significance A higher-than-normal result may indicate inappropriate ADH secretion, dehydration, glycosuria, adrenal insufficiency, or high protein diet A lower-than-normal result may indicate diabetes insipidus, excess hydration, acute renal insufficiency, or glomerulonephritis Other FactsN/AProteinsTab TitleTextTest ResultsThe protein results on urinalysis test strips are reported when using the Plus system of results as negative (yellow color), trace, or 1+ to 4+ positive range. Trace readings may detect 15 to 30 mg/dL of protein Plus (+) readings approximate protein concentrations of 30, 100, 300, and over 2,000 mg/dL, respectively These readings are reliable indicators of increasingly severe proteinuria. Albumin reacts with the indicator more strongly than do the other proteins. Highly buffered, alkaline urine may give false positives when the buffer system in the reagent area is overcome. Normally, between 40 and 80 mg of protein are excreted daily, but as much as 100 to 150 mg per day may be considered normal. Since the average daily urine volume may range from 1,000 to 1,500 mL, the average normal concentration of protein in the urine varies from 2 to 8 mg/dL. This wide range of normal values is the result of biological variations and differences in the methods used for the determination of protein.Clinical SignificanceProteinuria refers to an increased amount of protein in the urine and is one of the most important indicators of kidney disease. Detection of protein in the urine, combined with the microscopic examination of the urinary sediment, forms the basis of the differential laboratory diagnosis of kidney disorders. Proteinuria may, at times, reflect urinary tract or physiological conditions rather than intrinsic kidney disorders. The types of proteins excreted in disease states are typically related to serum proteins. In fact, in severe cases, they are the serum proteins. Smaller proteins, such as albumin and alpha-1 globulin, are excreted more readily than larger proteins. Albumin constitutes between 60% and 90% of protein excreted in most disease states. Certain diseases are characterized by the excretion of specific globulins rather than by a diffuse proteinuria. The urine of people with multiple myeloma contains increased amounts of a low molecular weight globulin (Bence Jones protein). Proteinuria depends on the precise nature of the clinical and pathological disorder and upon the severity of the specific disease. Some examples are: Transient proteinuria Minimal proteinuria Marked proteinuria Postural proteinuria Moderate proteinuria Functional proteinuria Other FactsIf test results are questionable or inconsistent with expected results, run a quantitative urine protein for confirmation.AlbuminTab TitleTextTest ResultsAlbuminuria and microalbuminuria both refer to the presence of albumin in the urine. The difference between the two is in the quantity of albumin detected. Albuminuria is indicated at 20 mg/dL albumin and may be detected in people with kidney damage either early or late in the course of the disease Microalbuminuria is indicated at 20-200 mg/L albumin per urine sample. It describes the very low levels of albumin found in the urine in the absence of other clinical signs or symptoms of kidney damage, and is a good indicator of early kidney damage, especially in people with diabetes Clinical SignificanceMicroalbuminuria is an accepted early marker for kidney damage in groups such as those with diabetes. Microalbuminuria constitutes the critical factor in the routine test for glomerular kidney damage, especially in the case of diabetes. If the microalbuminuria test is positive, it is recommended that the test be repeated within six to eight weeks. A positive test result should be defined as two out of the three tests being positive to assure persistent rather than intermittent positive results.Other FactsIf test results are questionable or inconsistent with expected results, run a quantitative urine albumin for confirmation. When complete, select the X in the upper-right corner to close the window and continue. UA Test Results and Clinical Significance II Learn about creatinine, P:C ratio, A:C ratio, glucose, and ketones test results. Select each tab to learn about creatinine, P:C and A:C ratios, glucose and ketone results.TitleTextCreatinineTab TitleTextTest ResultsTest Results The normal creatinine concentration in adults is 0.6 to 2.0 g of creatinine per day (strip results of approximately 50 to 200 mg/dL), with men having higher values than women due to muscle mass. Random urines may have strip results that vary from 10 to 300 mg/dL Concentrated urines from dehydrated individuals, or first-morning specimens, will typically have elevated concentrations (strip results of >200 mg/dL) Diuresis will typically result in lower concentrations (strip results of <50 mg/dL) Clinical SignificanceClinical Significance The value of the creatinine test is that it can be used to calculate P:C and/or A:C ratios that correct for varying urine concentrations. It provides meaningful results from random samples and minimizes the need for inconvenient timed or 24-hour urine samples. Creatinine is reported as a separate result for quality control purposes.Other FactsOther Facts If test results are questionable or inconsistent with expected results, run a quantitative urine creatinine for confirmation.P:C RatioTab TitleTextTest ResultsTest Results A "normal" P:C ratio result indicates that the P:C ratio of the sample is below the cutoff A "normal dilute" P:C ratio result indicates that the sample may be too dilute to reliably detect protein. If a "normal dilute" result is obtained, consider recollecting the sample, preferably a first-morning collection to obtain a more concentrated sample A P:C ratio of 150 mg/g is considered abnormal and should prompt the physician to evaluate the patient for early kidney disease. Values >300 mg/g are indicative of clinical proteinuria. Clinical proteinuria is indicated at a P:C ratio result of >300 mg/g or SI units of 33.0 mg/mmol Clinical SignificanceClinical Significance The P:C ratio result is adjusted for varying urine concentration; therefore, an abnormal P:C ratio is an indicator of kidney disease. The patient should be tested with a quantitative method and if the abnormal result is confirmed, a nephrologist or other specialist should be consulted. The P:C ratio differs from the A:C ratio in its sensitivity to urine proteins. The P:C ratio test detects higher levels of protein than the A:C ratio, and is therefore more appropriately used with a broader population The A:C ratio detects very low levels of albuminuria (microalbuminuria), and is therefore most appropriate for testing people with diabetes Other FactsOther Facts If test results are questionable or inconsistent with expected results, run a quantitative urine protein and a urine creatinine for confirmation.A:C RatioTab TitleTextTest ResultsTest Results An A:C ratio of 30-300 mg/g (SI units = 3.4-33.9 mg/mmol) is abnormal, and defined as microalbuminuria. An A:C ratio of >300 mg/g (SI units >33.9 mg/mmol) is defined as albuminuria.Clinical SignificanceClinical Significance The A:C ratio detects very low levels of albumin (microalbuminuria), and is therefore most appropriate for testing people with diabetes.Other FactsOther Facts If test results are questionable or inconsistent with expected results, run a quantitative urine protein and a urine creatinine for confirmation.GlucoseTab TitleTextTest ResultsTest Results Small amounts of glucose are normally excreted into the urine. This level is normally below the sensitivity of the test, but on occasion may produce a color that is between the negative color block and 100 mg/dL color block. Certain individuals have a reduced kidney threshold that results in glucose being excreted into the urine when the blood glucose level has not reached the "normal" kidney threshold level of approximately 180 mg/dL. In these cases, physiologically normal blood glucose levels can result in glucose being found in the urine.Clinical SignificanceClinical Significance The presence of detectable amounts of glucose in urine is known as glycosuria. Glycosuria occurs whenever the blood glucose level exceeds the reabsorption capacity of the kidney tubules (kidney threshold); that is, when the glomerular filtrate contains more glucose than the tubules can reabsorb. The condition may be either benign or pathological; the physician must distinguish between the two types. Diabetes mellitus, a pathological state, is the chief cause of glycosuria. This condition is associated with a marked elevation of blood glucose and usually an increase in urine volume. The glucose content of diabetic urine may reach as high as 10% (10,000 mg/dL), though 2-5% (2,000-5,000 mg/dL) is more common. Kidney glycosuria occurs with normal blood glucose levels when tubular reabsorption of glucose is below normal, thus permitting some glucose to spill into the urine. This is a benign condition, as is the occurrence of glycosuria after eating a heavy meal or in conjunction with emotional stress.Other FactsOther Facts If test results are questionable or inconsistent with expected results, run a serum glucose test for confirmation.KetonesTab TitleTextTest ResultsTest Results Detectable levels of ketones may occur in urine during physiological stress conditions such as fasting, pregnancy, and frequent strenuous exercise. In ketoacidosis, starvation, or with other abnormalities of carbohydrate or lipid metabolism, ketones may appear in urine in large amounts before serum levels are elevated. High protein/low carbohydrate diets are also known to produce ketones in the urine.Clinical SignificanceClinical Significance Diabetes mellitus is the most important disorder in which ketonuria occurs. Ketonuria also accompanies the restricted carbohydrate intake that occurs in association with fevers, anorexia, gastrointestinal disturbances, fasting, starvation, cyclic vomiting, pernicious vomiting of pregnancy, and cachexia. It also occurs following anesthesia and as a result of certain neurological disorders. When diabetes is untreated or inadequately treated, excessive amounts of fatty acids are metabolized, resulting in the accumulation of ketone bodies in the blood (ketosis), which are excreted in urine (ketonuria). Ketone bodies are excreted in combination with normal basic ions, leading to a reduction in the carbon dioxide-combining power and causing systemic acidosis. Progressive diabetic ketosis is the cause of diabetic acidosis, which can eventually lead to coma and even death. (The term ketoacidosis is frequently used to designate the combined ketosis and acidosis of diabetes.)Other FactsOther Facts If test results are questionable or inconsistent with expected results, run serum B-hydroxybutyric acid and electrolytes for confirmation. When complete, select the X in the upper-right corner to close the window and continue. UA Test Results and Clinical Significance III Learn about bilirubin, blood, nitrites, leukocyte esterase, and urobilinogen test results. Select each tab to learn about bilirubin, blood, nitrites, leukocyte esterase and urobilinogen results.TitleTextBilirubinTab TitleTextTest ResultsBilirubin appears in the urine at a concentration of approximately 0.02 mg/dL, reflecting the normally low blood levels of conjugated bilirubin. This amount is not detected by routine qualitative or semi-quantitative techniques. Urinalysis test strip results are reported when using the Plus system of results as negative or small (+), moderate (++), or large (+++) amounts of bilirubin. The test has a sensitivity of 0.4 to 0.8 mg/dL bilirubin.Clinical SignificanceBilirubin excretion in the urine will reach significant levels in any disease process that increases the amount of conjugated bilirubin in the bloodstream. In some liver diseases due to infectious or hepatotoxic agents, liver cells are unable to excrete all of the conjugated bilirubin into the bile. Therefore, sufficient amounts are returned to the blood to elevate blood levels and cause significant bilirubinuria. In obstructive biliary tract disease, biliary stasis interferes with the normal excretion of conjugated bilirubin via the intestinal tract. This causes a buildup in the bloodstream with resulting bilirubinuria. Bilirubin may appear in the urine before other signs of liver dysfunction (jaundice, clinical illness) are apparent. An increase in the amount of unconjugated bilirubin in the circulation will not change the amount of bilirubin excreted in the urine. This increase of unconjugated bilirubin in the circulation occurs in hemolytic anemias because the greater release of hemoglobin leads to greater production of albumin-bound bilirubin. However, a normal, non-diseased liver can conjugate all the excess bilirubin and excrete the entire amount into the biliary tract.Other Facts Bilirubin is an unstable compound that disappears from urine on standing, especially if exposed to light. It is very important that urine be tested for bilirubin as soon after excretion as possible. The instability and reactivity of bilirubin and its derivatives are shown in the table. If test results are questionable or inconsistent with expected results, use the Ictotest Reagent Tablet plus run serum bilirubin and liver enzymes for confirmation. BloodTab TitleTextTest ResultsNormally, there is no detectable amount of occult blood present in urine, even with very sensitive chemical methods.Clinical SignificanceThe presence of blood in urine, as indicated by a positive test for occult blood, most likely indicates bleeding in the urinary tract. This may occur in a variety of kidney disorders, infectious disease, neoplasms, or trauma affecting any part of the urinary tract. Hemoglobinuria is likely to be found in any of the above disorders as well as transfusion reaction, hemolytic anemia, or paroxysmal hemoglobinuria. It may also appear in various poisonings, or following severe burns A positive chemical test without the presence of red blood cells may indicate myoglobinuria as a result of traumatic muscle injury Other Facts If test results are questionable or inconsistent with expected results, perform a standard microscopic examination. NitriteTab TitleTextTest Results Positive results: The combination of positive reactions for both nitrite and leukocyte esterase indicates the need to perform a microscopic examination of the urine sediment for White Blood Cells (WBCs) and bacteria, or directly confirm bacteriuria and Urinary Tract Infection (UTI) by microbiological culture testing. Positive tests for nitrite and leukocyte esterase on any random urine specimen generally indicates bacteriuria and often prompts the physician to immediately initiate therapy. Negative results: A negative test result should never be interpreted as an absence of bacteriuria. There are several reasons for this: First-morning urine, or urine that has remained in the bladder for four hours or more, is more likely to yield a positive nitrite test result in the presence of significant bacteriuria than a random urine sample that may have been in the bladder only a short time In the latter type of specimen, there may have been insufficient time for the conversion of nitrate to nitrite by the infecting bacteria. Some strains of urinary pathogens do not produce the enzyme necessary to reduce nitrate to nitrite, but these organisms are the least common pathogens (see table to the right) A negative test result may occur if dietary nitrates are absent Clinical Significance Bacteriuria is considered significant when microbiological laboratory findings show the presence of 100,000 (105) or more bacteria per mL in three separate urine specimens. If bacteria from an external source contaminates an otherwise "sterile specimen," the count may be as low as 10,000 (104) or even 1,000 (103) or less per mL. When the count is between 103 and 105, the possibility of an incipient urinary tract infection is suggested and the physician may request that another clean-voided midstream urine specimen be obtained for repeat testing. Significant urinary tract infections may be present in people experiencing no symptoms. Despite an absence of symptoms, these infections are serious because they have the potential for causing severe kidney damage before the person is aware of them. This condition is known as significant asymptomatic bacteriuria. The availability of simple, inexpensive, semi-quantitative methods for detecting bacteriuria makes it easy for physicians to test high-risk patients with and without symptoms for bacteriuria. High-risk patients include pregnant women, school children (especially girls), people who are pregnant or elderly, or people who have diabetes or a previous history of urinary tract infections. Gram-negative bacteria of the types normally present in the large intestine are the organisms most commonly identified in urinary tract infections. Other Facts If test results are questionable or inconsistent with expected results, perform a standardized microscopic examination and a urine culture for confirmation. Leukocyte EsteraseTab TitleTextTest ResultsLeukocyte esterase test results when using the Plus system of reporting range from negative, trace, small (+), moderate (++), and large (+++). The test may detect levels as low as 5-15 cells/µL in clinical urines.Clinical SignificanceLike the nitrite test, the leukocyte esterase test is useful in detecting urinary tract infections. This is because normal urine does not contain large numbers of white blood cells, but infected urine does. Leukocyte esterase is often used in conjunction with the nitrite test when the clinician suspects infection.Other Facts If test results are questionable or inconsistent with expected results, perform a standardized microscopic examination and a urine culture for confirmation. UrobilinogenTab TitleTextTest ResultsNormally, between 1 and 4 mg (1 to 4 Ehrlich units) of urobilinogen is excreted in urine in a 24-hour period. The concentration of urobilinogen in a random normal urine is 0.1 to 1.0 Ehrlich unit/dL (1 EU/dL-1 mg/dL).Clinical Significance Urinary urobilinogen is increased by any condition that causes an increase in the production of bilirubin and by any disease that prevents the liver from normally removing the re-absorbed urobilinogen from the portal circulation. It is also increased whenever there is excessive destruction of red blood cells, as in hemolytic anemias, pernicious anemia, and malaria, as well as with infectious hepatitis, toxic hepatitis, portal cirrhosis, or congestive heart failure. Urinary urobilinogen is increased by any condition that causes an increase in the production of bilirubin and by any disease that prevents the liver from normally removing the re-absorbed urobilinogen from the portal circulation. It is also increased whenever there is excessive destruction of red blood cells, as in hemolytic anemias, pernicious anemia, and malaria, as well as with infectious hepatitis, toxic hepatitis, portal cirrhosis, or congestive heart failure. More comprehensive information is obtained when the physician can correlate test results for both bilirubinuria and urobilinogenuria. As indicated in this table, the two findings, considered together, provide more helpful information for differential diagnosis than either finding alone. Other FactsIf test results are questionable or inconsistent with expected results, repeat the test using a fresh sample for confirmation. When complete, select the X in the upper-right corner to close the window and continue. A new troubleshooting feature has been added to the Process Errors screen. Using this feature, operators can resolve many process errors minimizing down time. Physicians can obtain clinically relevant information to help diagnose as well as rule out many medical conditions and diseases related to carbohydrate metabolism, urinary tract health, kidney and liver function, or acid-base balance by analyzing the combined results of certain test parameters available on urinalysis test strips. Note: As with all laboratory tests, definitive diagnostic or therapeutic decisions should not be based on any single result or method. Medical Conditions and Diseases I Learn which tests aid in the diagnosis of UTIs, kidney stones, kidney and liver disease. Select each tab to learn about tests that aid in the diagnosis of UTIs, kidney stones, kidney and liver disease.TitleTextUTIsTab TitleTextOverviewUrinary Tract Infection (UTI) Overview UTIs are among the most common medical problem encountered in primary care practice. 40-50% of women will have at least one UTI diagnosed in their lifetime 25% of all identified infections among the elderly population are UTIs. These represent the second most common form of infection 30% of infections recur in 3 months, 60% recur within 1 year, and 80% recur within 2 years 6.7 million physician office visits result in a UTI diagnosis and 2.6 million ER visits result in a UTI diagnosis Diagnostic TestsDiagnostic Tests In combination, the following tests were found to be a better predictor of the presence or absence of UTIs, than any one parameter alone: Nitrite - Detects nitrate-reducing, gram-negative bacteria Leukocyte - Detects leukocyte esterase found in white blood cells Blood - May indicate damage to the urinary tract pH - Typically high or alkaline if UTI is present Urinalysis test strips are an effective "rule-out" tool for people with suspected UTI. A key advantage of combining the results of leukocyte and nitrite is that if both tests are negative, very few UTIs will be missed. Other FactsOther Facts Some urinary tract infections do not produce symptoms and, if undetected for a long time, can cause damage to the kidneys or urinary system. This situation, called asymptomatic bacteriuria, is most common in young women, pregnant women, and people with diabetes.Kidney DiseaseTab TitleTextOverview Kidney Disease Overview Kidney disease is recognized as a public health problem. In the United States: 1 in 9 adults (or 20 million persons) have chronic kidney disease More than 20 million adults are at increased risk and may be unaware Incidence of end-stage renal disease (ESRD) is increasing by 6% per year The presence of continuous proteinuria, and/or the presence of cellular casts observed by microscopic examination of the urine sediment, may indicate that a patient's kidneys are not functioning properly. In addition, if blood is also found in the urine, this may give further clues regarding compromised kidney function. Diagnostic TestsDiagnostic Tests The following tests provide useful information regarding kidney disease: Protein - Detects the presence of proteinuria which may be caused by kidney malfunction Albumin - A common type of urine protein Leukocyte - Indicates urinary tract infections that can lead to kidney disorders Blood - Detects blood in urine, which may indicate damage to the kidney P:C Ratio & A:C Ratio - Correct for varying urine concentration, which improves the accuracy of result interpretation, without a timed or 24-hour urine collection Other FactsOther Facts A single urinalysis test strip can measure both the protein and creatinine or both the albumin and creatinine, at the same time, to correct for varying urine concentration. The P:C and/or A:C ratios in a first-morning or random, untimed "spot" urine specimen are effective for the clinical evaluation of people at an increased risk of developing chronic kidney disease. The P:C and A:C ratios are recognized by the National Kidney Foundation and the American Diabetes Association as diagnostic indicators of the presence of kidney disease. These tests, along with testing for the presence of blood and leukocytes, help physicians detect early stages of kidney disease in people who are at risk for kidney damage, enabling fast initiation of therapy to slow or stop the progression of kidney damage.Kidney StonesTab TitleTextOverviewKidney Stones Overview There are over 1 million cases of kidney stones reported in the U.S. annually. Kidney stone formation depends significantly on the pH of urine. Phosphate and calcium carbonate stones develop in alkaline urine Uric acid, cystine, and calcium oxalate stones precipitate in acid urine Diagnostic TestsDiagnostic Tests The following tests provide useful information regarding kidney stones: Blood - May indicate damage to the kidney pH - Used to determine type of stone Specific Gravity and/or Creatinine - Provides a relative indication of urine concentration or dilution Other FactsOther Facts N/ALiver DiseaseTab TitleTextOverviewLiver Disease or Damage Overview In the U.S., 400,000 persons have chronic liver disease, which is the seventh leading disease-related cause of death.Diagnostic TestsDiagnostic Tests The following tests, when analyzed in combination, provide more useful information regarding liver function than any one test finding alone. Bilirubin - May indicate abnormalities affecting the liver or biliary system Urobilinogen - Serves as an aid in detecting and differentiating liver disease, hemolytic disease, and biliary obstruction Specific Gravity - Provides a relative indication of whether other test results are affected by urine concentration or dilution Other FactsOther Facts Urinary bilirubin reaches significant levels in disease processes that increase the amount of conjugated bilirubin in the bloodstream. This can occur before other signs of liver dysfunction (jaundice, clinical illness) are apparent. Urinary urobilinogen can also indicate liver problems, as well as certain types of anemia. Consequently, when urobilinogen and bilirubin results are considered together, they provide more helpful information for differential diagnosis than either finding alone. When complete, select the X in the upper-right corner to close the window and continue. Medical Conditions and Diseases II Learn which tests aid in the diagnosis of diabetes, pregnancy-related and eating disorders. Select each tab to learn about tests that aid in the diagnosis of diabetes, pregnancy-related and eating disorders.TitleTextDiabetesTab TitleTextOverviewDiabetes Overview In the United States: 18.2 million people (6.3% of the population) have diabetes An additional 20 million Americans have pre-diabetes 5.2 million people are unaware that they have the disease 5-10% of Americans have type 1 diabetes Diagnostic TestsDiagnostic Tests The following tests provide useful information regarding diabetes when performing a routine examination and/or managing people with confirmed diabetes. Glucose - May detect unsuspected diabetes Ketones - May detect early ketoacidosis in confirmed diabetics A:C Ratio (Microalbuminuria) - May detect early kidney damage associated with diabetes Nitrite - Detects nitrate-reducing (usually gram-negative) bacteria Leukocyte - Detects leukocyte esterase found in white blood cells Other FactsOther Facts The ketone test helps assess the severity of diabetes and avoid progressive diabetic ketosis, which can eventually lead to coma and even death. The American Diabetes Association recommends the annual measurement of microalbuminuria in all people with type 2 diabetes, and in people with type 1 diabetes with at least 5 years disease duration to aid in the early detection of kidney disease. Nitrite and leukocyte tests help detect urinary tract infections, which are relatively common complications of diabetes.Pregnancy DisordersTab TitleTextOverview Pregnancy-Related Disorders Overview Urinary testing for glycosuria during pregnancy is routinely performed to diagnose gestational diabetes, which accounts for 33% of all pregnancy-related diabetes. Urinary protein tests are done to aid in the diagnosis of pre-eclampsia, a condition of hypertension and proteinuria that occurs in pregnancy and affects about 4% of all pregnancies (mother and unborn), and may advance rapidly with few other symptoms. Diagnostic TestsDiagnostic Tests The following tests may be useful in managing women during pregnancy: Glucose - May indicate gestational diabetes Protein - May indicate pre-eclampsia during pregnancy Other FactsOther Facts N/AEating DisordersTab TitleTextOverview Eating Disorders Overview Eating disorders represent the highest mortality rate than any other mental illness. In the U.S., 8 million persons have an eating disorder and 90% are women. 1 in 20 women suffer from anorexia 2 in 100 women suffer from bulimia Diagnostic TestsDiagnostic Tests The following tests, when analyzed in combination, provide useful information regarding proper hydration that may be compromised for people diagnosed with eating disorders, such as anorexia nervosa and bulimia nervosa. Ketones - Detect the presence of ketones in urine that may indicate starvation or vomiting Specific Gravity - A high value may indicate excessive vomiting Other FactsOther Facts N/A