From the Guidelines
When urinalysis shows trace proteins and ketones in a non-diabetic patient, the patient should undergo further evaluation with a spot urine protein/creatinine ratio and a renal ultrasound, as recommended by the HIV Medicine Association of the Infectious Diseases Society of America 1. This approach is crucial for determining the underlying cause of the proteinuria and ketones, which could be indicative of an underlying kidney issue or other metabolic disorder. Key steps in the evaluation process include:
- Evaluating proteinuria further with a spot urine protein/creatinine ratio to quantify the amount of protein in the urine
- Performing a renal ultrasound to assess the structure and function of the kidneys
- Considering referral to a nephrologist for further evaluation and potentially a biopsy, depending on the results of the initial tests It is essential to note that trace proteins and ketones can be transient and may result from various factors such as dehydration, intense exercise, or fasting. However, in the absence of diabetes, it is crucial to investigate these findings further to rule out any underlying conditions that may impact the patient's morbidity, mortality, and quality of life. The patient's nutritional status and dietary habits should also be evaluated, particularly if they are following a very low-carbohydrate diet, which can lead to the presence of ketones in the urine 1. By prioritizing a thorough evaluation and taking a proactive approach, healthcare providers can ensure the best possible outcomes for patients with trace proteins and ketones in their urine.
From the Research
Urinalysis Results
- Trace proteins and ketones in a non-diabetic patient's urinalysis results may indicate an underlying condition that requires further evaluation 2, 3.
- Proteinuria, or the presence of excess proteins in the urine, can be a sign of kidney damage or disease, and an accurate assessment of proteinuria is important for evaluation and management of chronic kidney disease (CKD) 2.
- The presence of ketones in the urine can be a sign of ketoacidosis, a potentially life-threatening metabolic disorder that can occur in non-diabetic individuals, such as those with alcoholic or starvation ketoacidosis 4, 5.
Possible Causes
- Non-diabetic ketoacidosis, which can be caused by factors such as starvation, alcoholism, or other metabolic disorders, may be overlooked due to relative unawareness among clinicians, leading to misdiagnosis and inappropriate management 5.
- Kidney disease, such as CKD, can cause proteinuria and may be a possible underlying condition in a non-diabetic patient with trace proteins in their urinalysis results 2, 3.
Next Steps
- Further evaluation, such as blood tests and imaging studies, may be necessary to determine the underlying cause of the trace proteins and ketones in the urinalysis results 2, 4.
- A healthcare provider may recommend a spot urine protein- or albumin-to-creatinine ratio test to assess proteinuria and albuminuria, which can help diagnose and manage CKD 2, 3.
- Point-of-care blood testing for ketones may be used to diagnose and manage ketoacidosis, particularly in non-diabetic patients 4.