Why is this not a standard test?

[GoodHealthIsAJourney]

I've had protein in my urine, and am now tested every three months. What I don't understand is, why don't they routinely order a urinalysis when they do the urine albumin test? I told my PCP today that I wanted a specific gravity test done at the same time so I KNOW if I'm dehydrated or overhydrated.

I guess I don't understand - because it's such a cheap and simple test - why they don't automatically run it at the same time? This would eliminate the "well, you could be dehydrated" answers. I told my PCP that I want to know my REAL results - not something artificially inflated by being dehydrated, or artificially lower by being overhydrated.

Does anyone else's PCP/Neph run a UA as standard practice?

[RoxanneKidney]

No. Today I was wondering why we even needed a doctor to order test. It is not like they pay for them. And we know what we need.

[GoodHealthIsAJourney in reply to RoxanneKidney]

Right???

[GoodHealthIsAJourney in reply to GoodHealthIsAJourney]

I guess I should add that I do understand why we can't. Many of us know what we need, but so many more don't, and don't care to educate themselves (or are unable). Insurance companies would go broke (as opposed to profiting billions!) paying for potentially unnecessary tests from those who don't know what they need. I insist on a partnership with my PCP, and she asks me every appointment what tests I would like done, in addition to what she orders. I guess I just don't understand why a UA wouldn't be standard for those of us with CKD?

[Sarah_402 in reply to GoodHealthIsAJourney]

Wow, my doctor never does what I want.

[TaffyTwoshoes27 in reply to RoxanneKidney]

It’s a way to control costs.

[Sarah_402]

So, I went for testing yesterday. My nephrologist for the first time didn’t order a urinalysis or urine albumin. I wasn’t happy and I was wondering the same thing as you…Don’t I need one every time, why am I not getting one?

I know you can order your own labs online and pay for them but one of the problems is what are you suppose to do then? Tell your doctor here I ordered these labs myself and you need to see these results. I have wanted to order a cystatin C myself.

I don’t know but I thought I’ve heard others say their doctors order urine tests every time. I read another member got a 24 urine test every time.

[GoodHealthIsAJourney in reply to Sarah_402]

Have you tried directly telling your doctor what you want? What was their response? 😞 To be honest, it took me a while to find someone who agreed to partner with me. I was committed to "interviewing" practitioners until I found someone who was on the same page. It's my body, my health, my life. And that's how I approach it. I'm paying them for a service. I want someone who will work with me. I understand not everyone has options (insurance issues, etc), but that's what I do.

I did the whole "order and pay for my labs myself", but it wasn't financially feasible for me. Especially not when I pay for insurance.

If your doctor won't listen to you, and you have the option of changing doctors, I would look into it. You deserve to have more control over your health care!

[Sarah_402 in reply to GoodHealthIsAJourney]

He usually downplays things, and tells me I don’t need them or it’s not that bad. I’ve been dragging my feet because he is also a specialist of another condition I have. So I need 2 physicians to replace him. But your completely right.

[jodaer]

I usually get a urine test each time. Although this last time it was w/o the creatinine and usually it is with. I don't know if it was a mistake or some reason. My doctor didn't mention much at all. It was my last visit with him as I'm relocating in a couple of weeks and will find a new doctor.

[GoodHealthIsAJourney in reply to jodaer]

So you get a routine UA done with specific gravity? That's great! I hope you find a great new doctor, and love your new home!

[jodaer in reply to GoodHealthIsAJourney]

Thanks I hope I do too. I was looking up UAs and think maybe I don't always get one. I do get a urine test though but rarely do they need a lot of it. I've had CKD for a few years now but stayed steady at 3a but in the last year it's started to decrease. I need to study up

[GoodHealthIsAJourney in reply to jodaer]

The UA doesn't tell them too much (if you have an infection, color, clarity, etc), but what is does specifically tell them is how well hydrated you are (or aren't). That way, when they test for albumin and creatinine, they know if the result is true (normal hydration), or artificial (dehydrated, overhydrated). I just don't understand why it's not automatically run!

[jodaer]

I just checked and the tests i get are creatinine random urine so guess it isn't a UA after all.

[WYOAnne NKF Ambassador]

it's unfortunate, but the more you educate yourself the more respect you get from doctors. Seems like knowledge is power.! You are so right about being your own advocate.

I feel like I have the ideal situation with a great PCP and Nephrologist.I have had a transplant, so I see my nephrologist every 3 months. And yes, besides my renal labs, I also have a urinalysis that does include specific gravity. I always prepare for my appt. by writing down questions and concerns ahead of time. He listens to me and we discuss my options,

Many doctors send out surveys now, so easy to look them up on-line and see how they rate.

I feel that if you can't freely talk with your doctor - it's time to find a new doctor! It is your body and your life!!

[RoxanneKidney]

Not when you live in rural America. Not much to choose from. I recently asked the local clinic if they could draw blood and do a kidney panel etc. and the 24 hr urine. They said that they would need my Mayo doctor to order it; otherwise, the local doctor, whom I have seen in the past, would "have to start from scratch"---even though they have access to my Mayo records. What a bunch of B.S. Of course, in the end I got the order from Mayo, but I am traveling 60 miles to another town to have it all done.

[Sophiebun11]

Your blood test shows if you are dehydrated or not. If you are having a CBC , hemoglobin on a metabolic blood panel your dehydration is tested by blood; a specific gravity urine test is a waste of time and money, which is why lay people aren't allow to order tests. Buy the little test strips over the counter at any pharmacy to test your specific gravity in urine for under $20, but it's a waste of time and not as accurate as blood test in the cells.

[GoodHealthIsAJourney in reply to Sophiebun11]

I'm glad my doctor readily agreed with me to order a UA. I didn't demand the test - I asked her opinion. It is my understanding that a hemoglobin test checks for red blood cells, and will only be high if someone is acutely dehydrated. A UA is a cheap test - at least where I live - and the urine is already being collected for another test. So for me, cheap and easy is not a waste of time and money.

I also understand why lay people aren't allowed to order tests. But I also believe that some lay people can have a good understanding of their bodies and can be well educated about their particular conditions. That's why I believe it so important to work in partnership with my doctor, with mutual respect. I have a vested interest in the outcome! 🙂

[Sophiebun11 in reply to GoodHealthIsAJourney]

I have a medical background and don't share your concern about needing a spec. gravity. There is no point in ordering one. If you have a Dr. who will placate your wish, then great.

Good luck.

[Gotroot in reply to Sophiebun11]

But doesn't specific gravity also indicate the kidneys ability to concentrate urine? If there is some damage to the distal tubules then the kidneys can no longer concentrate urine resulting in diluted urine (low specific gravity). Please correct me if I am wrong, I am not a medical professional.

[Darlenia in reply to Gotroot]

I hope Sophiebun responds. She made some great statements in her posts above. As a big picture gal, I don't think it really matters.

It's my experience that kidneys become really unstable as disease progresses so doctors turn away from urine tests to blood tests for a clearer and more reliable picture of health. They want to know what the disease is doing throughout the body... so blood, not urine, presents that data. Interestingly, as kidneys fail, peeing can become erratic and urine production less and less. People on dialysis often have no urine function left - dialysis takes over that job. When my hubby went on emergency dialysis, the nephrologists constantly drew blood over those days to check the levels of creatinine, bun, etc. I think it's safe to say that most can expect to see more blood tests and fewer, if any, urine tests, as time goes on.

[WYOAnne NKF Ambassador]

When you have blood work drawn, your BUN results will show if you are dehydrated or not. Normal BUN from my lab is 7 - 17 mg/dl. Last labs for me my BUN was 25, so I knew I was low on fluids. Being dehydrated can also raise your creatinine.

[GoodHealthIsAJourney in reply to WYOAnne]

It's my understanding that a BUN tests for several things in addition to dehydration - CHF, liver damage, poor circulation, etc. It helps in the process of elimination, as it doesn't specifically diagnose one thing. My doctor told me in order to lower BUN, I had to decrease protein. I think every doctor has their own preferred way of doing things! 🙂

[TaffyTwoshoes27]

You may want to check with your insurance carrier or ask the person at your PCP who checks on insurance coverage to see if your insurance benefits allow you to have that particular urinalysis once a month? It may not.

[GoodHealthIsAJourney in reply to TaffyTwoshoes27]

I am extremely fortunate in that my insurance pays for unlimited lab work. I checked with them myself. I have my labs done every 3 months - 4 times a year - and they pay for it all. Yes, I know how lucky I am!

[Marvin8]

Did you seriously write that?