From the Guidelines
The presence of trace ketones and trace blood in urine requires immediate further evaluation to determine the underlying cause, with a focus on ruling out diabetic ketoacidosis (DKA) and urinary tract malignancies, as these conditions can significantly impact morbidity, mortality, and quality of life. For trace ketones, consider dietary factors (low-carbohydrate diets, fasting), pregnancy, or metabolic conditions like diabetes, and check blood glucose levels using a glucometer or formal laboratory testing, as recommended by the guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus 1. If diabetes is suspected, obtain an HbA1c test. For trace blood (hematuria), evaluate for urinary tract infection with a urine culture, and consider renal imaging such as ultrasound if persistent, following the guidelines for hematuria evaluation 1. In patients over 35 with risk factors, consider cystoscopy to rule out bladder cancer, as the risk of malignancy increases with age and the presence of hematuria 1.
Some key points to consider in the evaluation of trace ketones and trace blood in urine include:
- The importance of confirming the presence of ketones and blood in the urine through repeat urinalysis, as transient abnormalities can occur
- The need to evaluate for underlying metabolic conditions, such as diabetes, and to assess for the presence of DKA, a potentially life-threatening condition
- The consideration of urinary tract infection, kidney stones, glomerular disease, or medication effects as potential causes of hematuria
- The recommendation for increased fluid intake to help manage both ketones and blood in the urine
- The importance of follow-up testing within 2-4 weeks to monitor resolution or progression of these findings, and to adjust the management plan as needed, based on the guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus 1.
Overall, the evaluation and management of trace ketones and trace blood in urine require a comprehensive approach, taking into account the potential underlying causes and the need to rule out serious conditions such as DKA and urinary tract malignancies, with the goal of improving morbidity, mortality, and quality of life outcomes.
From the Research
Trace Ketones and Trace Blood in Urine Workup
- The presence of trace ketones and trace blood in urine can be an indicator of various health issues, including diabetic ketoacidosis (DKA) and kidney disease 2, 3.
- A study published in 2007 found that urine ketones and capillary blood ketones can be used to exclude ketosis, but capillary blood ketones are more accurate for confirming ketoacidosis 2.
- Another study from 1994 suggested that confirmatory testing for ketonuria is only necessary for trace ketonuria, and that higher levels of ketonuria do not require confirmation 4.
- The measurement and interpretation of blood ketones can be useful in the management of DKA, with recent guidelines shifting the focus from glucose-centered to ketone-centered management 5.
- A 2021 study found that slightly elevated circulating levels of ketone bodies are not beneficial for renal function in patients with type 2 diabetes mellitus, and that a ketone body concentration lower than 0.09 mmol/L can be used as a threshold for low risk of renal function damage 3.
Key Findings
- Urine ketones and capillary blood ketones can be correlated, but the correlation is poor for high values 2.
- Trace ketonuria can be confirmed using Acetest, but higher levels of ketonuria do not require confirmation 4.
- Blood ketone measurements can be useful in the management of DKA, particularly with the use of hand-held, point-of-care ketone meters 5.
- Ketone body concentration can be used as an indicator of renal function in patients with type 2 diabetes mellitus 3.