From the Guidelines
The presence of ketones, bilirubin, protein, and urobilinogen in a urinalysis is a significant finding that requires immediate medical attention to rule out underlying conditions such as liver dysfunction, kidney issues, or metabolic abnormalities. These findings can indicate a range of potential health issues, including diabetes, liver disease, kidney damage, or hemolytic conditions. For ketones, this may reflect a state of increased fat metabolism due to diabetes, starvation, or high-protein diets, as suggested by recent guidelines for laboratory analysis in the diagnosis and management of diabetes mellitus 1. Bilirubin in urine suggests liver disease or bile duct obstruction, while protein indicates possible kidney damage or inflammation, which can be further evaluated using the albumin–creatinine ratio or total protein-creatinine ratio, as recommended by the national kidney foundation practice guidelines for chronic kidney disease 1. Elevated urobilinogen typically points to liver dysfunction or hemolytic conditions.
Key Considerations
- The presence of ketones in urine or blood is a significant finding that requires medical attention, especially in individuals prone to ketosis, such as those with type 1 diabetes or a history of diabetic ketoacidosis 1.
- Proteinuria is a key indicator of kidney damage or inflammation, and further evaluation is necessary to determine the underlying cause, as suggested by the national kidney foundation practice guidelines for chronic kidney disease 1.
- Bilirubin and urobilinogen in urine can indicate liver dysfunction or hemolytic conditions, and additional testing is necessary to determine the underlying cause.
Recommendations
- Immediate follow-up with a healthcare provider is recommended for comprehensive evaluation, including additional blood tests to assess liver and kidney function.
- While waiting for the appointment, maintain good hydration, follow a balanced diet low in salt and protein, avoid alcohol and non-prescribed medications that could stress the liver, and monitor for symptoms like jaundice, dark urine, swelling, or abdominal pain.
- Individuals with a history of diabetes or those prone to ketosis should measure ketones in urine or blood if they have unexplained hyperglycemia or symptoms of ketosis, and implement sick-day rules and/or seek medical advice if urine or blood ketones are increased, as recommended by recent guidelines for laboratory analysis in the diagnosis and management of diabetes mellitus 1.
From the Research
Urine Test Components
- Bilirubin: a yellow compound that occurs in the normal catabolic pathway that breaks down heme in red blood cells 2, 3, 4, 5
- Protein: can be an indicator of kidney damage or disease 4, 5
- Urobilinogen: a colorless by-product of bilirubin reduction 4, 5
- Ketones: can be an indicator of diabetic ketoacidosis, a condition characterized by a serum glucose level greater than 250 mg per dL, a pH less than 7.3, and an elevated serum ketone level 6, 4, 5
Relationship Between Components
- The presence of bilirubin in the urine can indicate conjugated hyperbilirubinemia, which can be caused by a variety of disorders, including liver disease and biliary tract obstruction 2, 3
- The presence of protein in the urine can indicate kidney damage or disease, which can be caused by a variety of disorders, including diabetes and hypertension 4, 5
- The presence of urobilinogen in the urine can indicate hemolysis or liver disease 4, 5
- The presence of ketones in the urine can indicate diabetic ketoacidosis, which can be caused by a variety of factors, including insulin deficiency and infection 6, 4, 5
Diagnostic Value
- Urine tests can be used to diagnose a variety of disorders, including liver disease, kidney disease, and diabetic ketoacidosis 6, 2, 3, 4, 5
- The combination of physical characteristics, biochemical parameters, and microscopic sediment evaluation can provide a comprehensive understanding of the underlying condition 4, 5