From the Guidelines
A urinalysis showing trace ketones and trace blood requires immediate medical evaluation to rule out potential underlying conditions such as diabetes, urinary tract infection, or kidney stones. Trace ketones suggest that the body is breaking down fat for energy, which can occur during fasting, low-carbohydrate diets, intense exercise, or in conditions like diabetes 1. Trace blood (hematuria) may indicate urinary tract infection, kidney stones, glomerulonephritis, or trauma to the urinary tract 1.
While these trace findings might be temporary or benign, they warrant follow-up with a healthcare provider, especially if symptoms like pain during urination, increased urinary frequency, back pain, or unexplained weight loss are present. The healthcare provider may recommend additional tests such as a complete urinalysis, blood tests, or imaging studies to determine the cause. It is essential to stay hydrated while awaiting medical evaluation, and if diabetes is present, to check blood glucose levels regularly 1.
The presence of urine ketones is highly sensitive for diabetic ketoacidosis (DKA) or significant ketosis, with a high negative predictive value, suggesting utility in ruling out DKA 1. Therefore, it is crucial to seek medical advice if urine or blood ketones are increased, especially in individuals prone to ketosis, such as those with type 1 diabetes or a history of DKA. By prioritizing medical evaluation and potential further testing, individuals can ensure prompt identification and management of any underlying conditions, ultimately reducing the risk of morbidity, mortality, and improving quality of life.
From the Research
Urinalysis Results
- Trace ketones and trace blood in urinalysis may indicate several conditions, including diabetic ketoacidosis (DKA) 2, 3
- The presence of ketones in the urine can be a sign of insulin deficiency, and the type of ketone present can vary depending on the stage of DKA 2
- Blood in the urine can be a sign of kidney stones, urinary tract infections, or other conditions 4, 5
Possible Causes
- Diabetic ketoacidosis (DKA) is a possible cause of trace ketones in the urine, and it can be associated with insulin deficiency 2, 3
- Kidney stones can also cause blood in the urine, and patients with a history of kidney stones may be more likely to have antibiotic-resistant infections 5
- Other conditions, such as urinary tract infections or kidney disease, can also cause blood in the urine 4, 6
Measurement and Interpretation
- Ketone measurements can be done using point-of-care tests, which can measure beta-hydroxybutyrate and acetoacetate in blood or urine 2, 3
- Urine ketone tests may not always be accurate, as the type of ketone present can vary depending on the stage of DKA 2
- Blood ketone measurements are generally more accurate than urine ketone measurements, but they may not always be available 3
Relationship to Kidney Stones
- Patients with a history of kidney stones may be more likely to have antibiotic-resistant infections, and may require alternative antibiotic therapies 5
- Diabetes medications and glycemic control can affect the risk of kidney stones, with insulin therapy associated with a higher urine pH than oral antihyperglycemic agents 6