From the Guidelines
The presence of ketones, bilirubin, protein, urobilinogen, and leukocytes in the urinalysis results indicates multiple potential abnormalities that require further evaluation, and I recommend prompt follow-up with a healthcare provider for a complete assessment. The findings could suggest several underlying conditions, including diabetes, liver dysfunction, kidney disease, or urinary tract infection. Ketones in urine may indicate a state of fat metabolism due to diabetes, starvation, or high-protein diets, as noted in the guidelines for laboratory analysis in the diagnosis and management of diabetes mellitus 1. Bilirubin and urobilinogen suggest possible liver dysfunction or hemolysis, which can be further evaluated using guidelines on the management of abnormal liver blood tests 1. Protein in urine could indicate kidney disease, while leukocytes point to a possible urinary tract infection.
Some key points to consider in the evaluation of these findings include:
- The presence of urine ketones is highly sensitive for diabetic ketoacidosis (DKA) or significant ketosis, with high negative predictive value suggesting utility in ruling out DKA 1.
- The measurement of β-hydroxybutyrate in blood is recommended for the diagnosis of DKA and may be used for monitoring during treatment of DKA 1.
- Individuals with diabetes who are 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 1.
- The combination of findings requires comprehensive evaluation, including blood tests, additional urine studies, and possibly imaging to determine the underlying cause and appropriate treatment.
No immediate medication can be recommended without clinical context, but if infection symptoms are present (burning urination, frequency, urgency), increased fluid intake is advisable while awaiting medical evaluation, as suggested by the position paper on urinary extracellular vesicles 1. These abnormalities often occur together in conditions like hepatorenal syndrome, systemic infections, or metabolic disorders.
From the Research
Laboratory Tests
- The question mentions several laboratory test results, including ketones, bilirubin, protein, urobilinogen, and leuks, but the provided studies do not directly address these specific test results 2, 3.
Ketones
- One study mentions urine ketone assays, which can be confusing during conditions altering the mitochondrial redox potential and are prone to interference from medications 2.
Interference with Laboratory Tests
- The studies suggest that various factors can interfere with laboratory test results, such as pre-analytic variables, hematocrit, oxygen tension, and pH 2, as well as the release of protons and changes in extracellular pH 3.