All About Kidneys

Kidneys

Here at PURI we believe Kidneys are the unappreciated body organs. We here allot about the heart, but rarely about the kidneys. The PURI urinalysis app helps patients with Kidney problems to monitor their Urine to help them understand their Kidney Health. In this article we explain some key facts about the kidneys.

Where are the Kidneys?

You have two kidneys that are located each side of the spinal cord just below the rib cage and rest against the back muscles. Given the liver sits on the right hand side of the body, the right hand kidney sits a little lower down than the left hand kidney. 

As the kidneys are located towards the back and below the rib cage the kidneys are not well protected. The kidneys can be damaged due to impacts to the back. This can happen during falls, sports or vehicle accidents. Given the location in the lower back kidney pain can be confused with back pain.

What is the function of the Kidneys?

The kidneys main function is to filter the blood and remove waste products and excess water from the blood supply. They also have a very important function in maintaining the balance of proteins and other molecules which are important for the health of the body.

Urinalysis Test Strips: how they work, which to buy

Urinalysis Test Strips - The Basics

Urinalysis Test Strips are very important for detecting and monitoring diseases such as Diabetes, Hypertension and Chronic Kidney Disease. Many users of Urinalysis Test Strips are first introduced to them by their Doctor as a method to assist in the diagnosis and monitoring of various medical conditions.

In this article we will take you through the basics of Urinalysis Test Strips and give you some advice on which strips the first time user should buy.

Why Test Urine?

Urine is a waste product of the body produced by the Kidney. The Kidney works as the blood purification plant in our body and filters incoming blood by removing waste and excess water and allowing clean filtered blood to continue to circulate through the body. The waste product of the Kidneys’ pass to the Urinary Tract for evacuation via Urination.

Analyzing our Urine to understand which molecules are present gives us a valuable insight into our health. The presence and absence of certain molecules indicate potential health issues in the Kidney, Urinary Tract or elsewhere in the body.

Urinalysis is the 2nd most used diagnostic in the world. While there are many types of Urinalysis in existence in this article we are focusing on home urine tests done via a chemical dipstick. These urine dipsticks are useful because they are cheap, fast and effective.

What is a Urine Dipstick?

A Urine Dipstick is a piece of plastic or waterproofed paper which has a number of absorbent pads soaked with different chemical reagents. This strip is dipped into a Urine Sample and removed. The chemically impregnated pads react with specific compounds in the Urine. If these reactive molecules are not present then they do not react which indicates the absence of the compound.

The rule for Urine Dipsticks is that each pad has a specific chemical which reacts with one compound and therefore one pad tests for one molecule. It is possible to buy Urinalysis Dipsticks with only one reagent pad or to buy one with up to 12 reagent pads. The more pads there are, the more molecules or properties are being tested.

How to determine a result?

Determining results is based upon the color change in the chemical pads. When the chemicals react with compounds in the Urine the chemical reaction produces a color change in the pad. This color change is visible to the human eye and a test result is determined by comparing the color of the reacted pad to a colored matrix on the Urine Strip packaging. Once the color on the dipstick has been matched to one in the matrix, the result is simply read off the packaging. The procedure is therefore to fully dip and submerge the test strip in your urine sample, removed it and leave for the appropriate amount of time so a full reaction can occur. Once this has happened the colors can be compared to the colored matrix on the packaging and the results determined.

What measurements will I find?

The results of home urine tests fall into two categories: Qualitative and Semi-Quantitative.

A qualitative result is non-numerical and will generally show a “negative result”, meaning the compound is not present, “Trace” result, meaning there might be a low concentration of the molecule present, or a “Positive” result, meaning the compound is present.

Positive results are often shown on a scale of “+”’s such as +, ++, +++ etc. with each additional + indicating a higher concentration of the molecule.

A semi-quantitative result means a numerical value is given with its unit of measure. It is semi-quantitative because it is not a precise result  but one with a range of error. Semi-quantitative results in Urinalysis Test Strips will often have more than one unit of measure given. This type of test shows the presence or absence of certain compounds and typically the compounds concentration.

Finally, some results such as Acid-Base balance or Specific Gravity give a result that measures this chemical property on a scale. For example Acid-Base balance uses the pH scale which runs from 1 to 14. A low result from 1 to 6 means the sample is acidic, 7, the sample is neutral, and a result greater than 7 the sample is basic (the term alkaline can also be used).

Another example is the specific gravity measure which is given as a ratio of the density of the urine sample versus the density of water. For example, a ratio of one (1) means the density of the Urine sample is the same as water, results above 1 means the sample is more dense than water, and vice versa for a sample less than 1. (see our article on using specific gravity to determine hydration here).

What does this all mean?

Doctors are trained to understand these results, the average patient not. For first time buyer and user of Urine Dipsticks it can be difficult to know what these results mean. We have also found that most first time users it is difficult to know which strip to buy. People using strips for the first time most often accept the recommendation from their doctor or their pharmacist, which is always a good place to start. That said, we have found that not all manufacturers make their strips easy to use for the average patient.

Some of the issues we have found with Urine Test Strips are that the majority are aimed at Doctors and trained medical professionals. This means that after completing a Urine Test that there is no information available to assist the user in interpreting the results. For a patient under the care of a medical professional, this is less of a problem as at the next visit the doctor can interpret the results for them. For patients with chronic conditions they will learn over time. For the first time user it will most likely require some internet research and an eventual visit to the doctor.

Those products which are aimed at patients are beneficial due to the diagnostic nature of the tests. Products like the Atlas Medical Home Test Kits allow users to obtain a diagnostic which is very useful. There are other kits, which we will not name, which do the same, but at a a very hefty price. The worst we have seen is a kit which sells two urine test strips for nearly 29 US dollars! This is nearly 100 times the price per strip if bought elsewhere. Clearly information asymmetry can lead to being ripped off.

How do I choose a strip?

We recommend that users start with a strip which has most, if not all, testing parameters available. Products like the Roche Combur 9 or Combur 10, and the Siemens Multistix 10SG, are perfect for this purpose. These strips have up to 10 assays that cover the vast majority of tests that can be done with a Urine Dipstick. By testing all these parameters and you can identify quickly if you have presence of any compounds that could indicate health problems and acts as a general health screen.

Another Consumer friendly test is the Roche Combur 5. We like this test as it has an easy to interpret 3 step qualitative scale starting with “0” for no presence and a 2 step “positive” scale with “+” and “++” results. The 5 parameters covered by the Combur 5 test cover the most usually tested parameters and can give insight into kidney and urinary tract health.

For users with an existing diagnosis using a Urine Dipstick with a wide range of assays can be beneficial as in addition to monitoring your known condition you can also monitor your general health and identify early onset of other issues which is an additional benefit if you are testing regularly anyhow.

Strips for Chronic Conditions

Patients with chronic conditions such as with Diabetes or Chronic Kidney Disease (CKD) may benefit from regular urine testing. The key parameters that need to be tested will depend on their diagnosed condition. For both Diabetes and Chronic Kidney Disease it is useful to test for Proteins and Glucose in the urine. For CKD patients, this is because it is one of the indicators of damage to the Kidney’s filter and tracking these results over time can indicate improvements or deterioration in the filter. For Diabetes patients one of the long term risks is the development of CKD. So in addition to measuring blood sugar for day to day Diabetes management, monitoring Glucose and Protein in the Urine can indicate potential Kidney problems and may assist in early intervention. For the CKD patient a product like the Roche Diagnostics Combur 3 test strips which measures pH, Protein and Glucose may be the suitable choice. Products such as the Ascencia Diabete’s Care Keto-Diastix which measures Glucose and Ketones may be more suitable for the Diabetic patient. We think if you are testing, the more you parameters you test for the better data you will get, however we do understand that it can be slightly more time consuming to test for 10 parameters versus, say, two. The good news for patients with chronic conditions that there are well trained medical professionals to guide you, a range of products and plenty of information available.

Strips for Periodic Conditions

Periodic Conditions like Urinary Tract Infection & Kidney Stones can benefit from regular Urine Testing to identify potential onset of the condition or identification of an attack. If we look at patients who have suffered from Urinary Tract Infection,  it is estimated that up to 70% of patients who have experienced a Urinary Tract infection at least once will suffer recurring infections during their lifetime. Given these statistics UTI sufferers have a choice: they can wait until the painful symptoms of a new infection arrive and then seek treatment, or they can monitor their urine and identify and treat the onset of an infection before the painful symptoms start. The two key test parameters for UTI are Leukocytes and Nitrites. If you find presence of one or both of these in your Urine then it is likely that there exists an infection and action can be taken. One product we really like to test for UTI are the AZO Test Strips. These strips have both Leukocytes and Nitrites which make them easy to use and to understand. The important parameter for Kidney Stones is the pH measure. This is only useful, however, if you understand what acidity your previous kidney stone was. If you previously had a stone containing calcium or phosphate then a urine sample with a high pH may indicate you have a risk of a kidney stone recurring. Alternatively if you had a stone containing uric acid or cystine, then a low pH may mean there is a risk of recurrence. For both UTI and Kidney Stones, regular urine testing can be beneficial as a way to avoid the repetition of painful conditions.

Conclusion

Urinalysis Test Strips are incredible useful to screen, manage and prevent for a variety of health conditions however a new user of Urinalysis Test Strips can have a difficult time to select and then understand their results.

With some research and learning home urine testing can be mastered and can form an important part of your health record. Strips which offer no diagnosis to home urine test users are often cheaper but require more knowledge by the user. Strips which offer a diagnosis can be more expensive, but they do provide the peace of mind that comes with a clear diagnosis.

The Urinalysis Test Strip has been with us for decades now and will continue to be a useful tool. They are cheap, so if you haven’t already go to your local pharmacy and buy some. It will be a worthwhile experieince.

Why save your Home Urine Test results?

Saving Home Urine Test Results just seems like a good idea. Here at PURI we get asked by friends and acquaintances why we have invested so much time into such a simple idea. Even though saving home urine test reults is a simple idea we had not seen a handy mobile application which addressed the problem.

In this article we cover why we have created PURI and why we think you will benefit from using it.

1. Home Urine Testing is Useful

The first reason we created PURI is that thanks to the humble Urine Test Strip, Urinalysis is a widely used diagnostic. Urinalysis can be done at home and in a clinical setting. By using a Urine Dipstick we can gain insight into the health of different parts of the body and an indication of how advanced certain diseases are.

Here are two simple examples about what Home Urine Testing can tell us:

1) Protein should not appear in Urine. If Protein does appear in Urine this may indicate problems with the filter in the Kidney. You see, a protein molecule is too large to pass through a healthy and properly functioning kidney. If Protein does appear in your Urine it may indicate Kidney damage. Conducting a Home Urine Test can identify the presence and approximate concentration of Protein in your Urine. If Protein is found via a home urine test, you can then consult a doctor to gain a professional diagnosis of the cause.

2) The presence of blood cells in your Urine is considered serious and may indicate problems in the urinary tract. Causes of blood in urine could be anything from kidney stones to cancer. Identifying blood in your urine early through regular Urine testing may lead to an early diagnosis of bigger issues.

It is the simplicity of a home urine test plus the usefulness of the results that makes Urinalysis one of the most performed diagnostics.

2. Most home tests end up in the bin

When doing our research for PURI we found many people do not save their home urine test results. That is, they are throwing away an important part of their health record.

We found this odd especially given the value in keeping home urine test results, especially in the context of an increasing number of apps designed to save medical data.

As a comparison lets look at Blood Glucose. If you search on the internet, ask your local pharmacist, or as we did recently, visit a medical device conference,  you will find many Blood Glucose monitors available. Allot of these devices send data directly to a smart phone and instantly capture and save the user’s results. The storing of data makes these devices very valuable. With instant, present time results, patients can take action on the immediate measurement, while saved data can be used for identifying trends and effectiveness of treatment over a longer period.

While blood measurements are largely digitized, urine measurements seem to have remained somewhat in the analog age. The majority of home urine test results are read manually by comparing the strip to the manufacturer’s colored grid on their packaging. We have seen an increase in start ups using mobile apps with color recognition to automatically read strips and determine results, but so far none of these are universally available, they are expensive, and they limit the patient to using only the proprietary strip with the manufacturer’s app.

The other issue with these color recognition apps seems to be that some require the strip to be placed on a color comparison grid which, to us at least, does not seem to speed up the process nor the hygiene of the testing. We will see where these products end up, as they are the future, but as of today there is no great solution for digitizing urine test results at home.

So until technology catches up to make the storing of home urine test results automatic, it seems that allot of tests will be read, understood and then thrown away, unless that is… people start using PURI!

3. Saving results must be made easy

In researching PURI  we think that the lack of an easy way to capture home urine test data is the key factor why home urine test data is not saved. 

Today to save your results there is always a pen and paper or an excel spreadsheet that will do the job. You can also use a universal health app which captures many different types of health data. The issue with these methods is they have not been designed for fast, easy and intuitive input which sometimes makes the effort of entering data more trouble than it is worth.

We have tried to fix this problem by making it easy to enter results into PURI. Our goal is to allow users to store results from any urine test strip and to be able to enter data in the most simple and fastest manner possible. We are working to achieve this goal by building an extensive database of strips. Once complete, the library of test strips will mean that patients all over the world can continue to use the strips they know, and even change to different strips with out losing their existing data.

PURI’s entry interface replicates the color matrix on the Urinalysis strips packaging. This color matrix in PURI is not be used to identify the reagent color on the test strip (you must always follow your manufacturer’s instructions), but it is used to easily identify and input your results. With this simple interface storing Urine Test is fast and easy with PURI.

4. Accurate Results at Home

There are a few factors to think about to achieve accurate home test results. Prior to the home urine test there you must not consume anything that may effect the results (e.g. orange juice),  genitals must be clean, the “catch” of the urine must be done correctly, the catch container must be uncontaminated and the time from the “dip” to the measure must be correct. The first four items are well known and there is plenty of good advice on line on how to do a Home Urine Test.

Where PURI makes it easy to gain accurate results is with PURI’s timer functionality. The measurement readings must be taken at the correct time after dipping the Test Strip into the Urine sample. This is important as reading too early, or too late may deliver a false result.

At PURI we wanted to help improve accuracy by creating a built in timer. PURI allows you to “Dip and Click”, that is simultaneously dip your Test Strip in your Urine Sample and click the start timer button in PURI on your smart phone. You can see our full instructions on how to use PURI  on our website.  

When the timer is used the test input cells are locked until the time recommended by the manufacturer has elapsed. Once the correct reaction time has passed the row for the assay that can be measured will unlock. For example, if Protein needs a reaction time of 60 seconds then the Protein row is locked for 60 seconds. Once it is unlocked you can take your measurement and then input the result into PURI.

This simplifies input as it frees up your hands, the timer is built into the test template meaning you don’t need an extra stop watch, and there is no risk that you will enter the data too early which should all lead to better results. 

5. More Home Urine Test Data is a good thing.

Aside from the Urine Test Strip Results, you can gain insight into your health by viewing the physical properties of the Urine Sample. Is the color light or very dark? Is it clear or cloudy? Is there foam in the sample? At home it is not just strip data that is being thrown away, but also the important color and physical appearance of the urine sample. When the urine sample is flushed down the toilet this is health data that is being lost.

PURI allows users to capture up to two images for each test. The first image should be of the test strip, and the second image should be of the urine sample. In this way when you go back and review your results if you want to double check what was happening that day you have a photographic record. And this leads us onto the next topic of why we built PURI… the ability to Share Results

6. Sharing Results

We hope by now you have downloaded and started using PURI. If you have, this means you will have some test data and some photos saved. So now imagine you have a result that you are not happy with such as positive Leukocyte and Nitrites in your Urine which may indicate the onset of a Urinary Tract Infection (UTI). By having this data saved in PURI it gives you further options about what you can do.

PURI has the option to share results two ways 1) within PURI or 2) via email.

So you suspect you have a UTI but you want to be sure. With PURI you can email your test results to your Doctor at the same time you ask for an appointment. Before you arrive in the surgery, the doctor can review your results and be prepared for an appointment.

And another example, you have a child with Diabetes and they are old enough to do their own Ketone tests, but as a parent you want to make sure they are actually being done by your child and you want to have access to their results to make sure everything is OK. In PURI you have the ability to view other user’s results (once they have given you permission) and also the option to enter results on their behalf (again after permission is received).

The second option of entering results on behalf of another person can be very helpful for a home nurse, a parent or someone who has taken on a carer role for an elderly parent.

With the digitising of Urinalysis results the benefits of the internet age become instantly available.

7. Tracking Results

And finally we have tracking. Building up a good data set can help identify trends in results which is useful for chronic conditions. For periodic conditions such as UTI, having urine results stored can help keep a track of the how often the infections are occurring. 

We built into PURI two views of results. The first is one that simply highlights when a positive result occurred. The second view is trend data. 

PURI also has the ability to filter data so you can select which results you want to see, e.g. you may want to look exclusively at the Protein in Urine results.

With the combination of two different data views and the ability to filter and focus on your test results you gain great visibility into your health data.

We hope you like it

This is the first version of PURI and we have much more planned. We have started with addressing a need that patients who regularly test their Urine at home might have. We hope you find PURI useful and we are always happy to hear from you.

Protein test in Urine at Home: Easier than you think

How to test for protein in Urine FI

Each month there are over 100 thousand searches for the term “Protein in Urine” in Google.  If you add other related search terms and other Search Engines, then the real figure is likely much higher. You might have found this article from a search engine result!

Many people want to know if they have Protein in their Urine as this may be the first sign of Kidney Disease.  Others may have already been diagnosed with Chronic Kidney Disease and want to monitor their disease progression. Finding out if you have Protein in your urine, or tracking your results is easier than you may think.

In this article we will show you how to test for Protein in Urine at home. We will take you through 5 steps to conducting the appropriate Home Urine Test and give you some good tips for understanding your results. These results can be used to track and manage the condition that is causing the Protein to appear in your Urine.

How to test for Protein in Urine at Home

Protein in Urine can be a cause for concern and may indicate serious health problems. If you have reason to suspect you have Protein in your Urine then it is important you understand what this means for your health.

A common cause for Protein in Urine is the break-down of the filter in the Kidney. Protein should never appear in Urine as the molecule are too large to pass through the Kidney’s filter. If Protein is appearing in your urine this could signify the onset of Chronic Kidney Disease (CKD).

Causes for CKD may include old age, a family history of CKD or as a side effect of Diabetes and/or Hypertension. Another reason could be as a side effect of UTI.

Urine Test Strips

Urine Test Strips allow you to test your Urine Protein levels at home cheaply and effectively. They have been around for a long time and can be found in your local pharmacy or purchased on line inexpensively.

A Urine Test Strip is a strip of paper or plastic with reagent soaked pads on top. Each pad contains a different reagent that changes color when it comes into contact with certain compounds and proteins that may be found in our urine.

To gain a urine test result, the test strip is dipped into a Urine Sample and the chemical in the pads react with molecules in the urine sample. The pads will change color dependent on what molecules are in the sample and in what concentration.

To get a result, the reacted strip compared to the color of the chemical pads to a colored reference grid on the manufacturer’s packaging. As a patient you need to match the color on your test strip to the color on the grid. Once the color has been identified the patient’s result is known.

Urine Test Strip Results

A Urine Test Strip is a Semi-Quantitative test which means that the results give you a range of values for your Protein levels not an exact value. This Semi-Quantitative method is generally enough to indicate if you have a problem or not.

The best tests for consumers have a simple qualitative scale, usually based on a range starting from “Negative” & “Trace” followed by a series of plus symbols starting at “+” and going to “+++” to indicate a range from a small concentration to a high concentration of Protein in your Urine.

With the availability and ease of use of these test strips, nearly everyone in every part of the world has access to home based testing for Protein in their Urine.

So this leads us to the first step in how to test for Protein in Urine at home:

Step 1 - Select a Urine Test Strip

There are many urine test strips to choose from and the first time purchasing your test strip can be a confusing experience.

The simplest way to identify if you have Protein in your Urine is to purchase a urine test strip which measures Protein such as the Siemens Albustix or the Siemens Uristix which also measures Glucose. In this way you can very quickly identify if you have any presence of Protein and if you need to take further action. There are other tests which test for more factors, but if this is your first time testing there are benefits to keep your test simple and focused on only Protein.

Your local pharmacist or doctor can also recommend for a Urine Test Strip that tests for Protein or you can consult this guide on our website by clicking here. You can also consult our article on how to select a urine test dipstick by clicking here.

Another approach to choosing a test strip is to know exactly why you are doing the test. Are you a Diabetic and worried about long term kidney damage? Have you already been diagnosed with Chronic Kidney Disease (CKD) and want to monitor your progress? Do you have a family history of CKD and want to identify the early onset of symptoms of the disease?

For these situations their are specific home tests that not only tell you at what concentration Protein appears, but also will be able to give you a diagnosis by combining the Protein Result with other results. A Kidney Function Home test is a good example of this such as Atlas Medical’s Home Kidney Function Test.

Step 2 - Do your Protein in Urine Test

To do the test you will need a disposable Urine Sample Collection Cup, a stopwatch and your Urine Strips. For those people who want to save their results, they should have the PURI application installed and opened on their phone.

Taking a sample from the first urination in the morning is good. Before taking the sample men should make sure their penis is clean and women should ensure that the area between the labia are clean to ensure there is no contamination.

To collect the sample have your urine collection cup on hand and urinate a small amount into the toilet bowl then stop. Place the collection cup in the appropriate area and pee into the cup, stopping before it overflows. You are now ready to use your Urine Sample to do your Urine Test.

Start the timer and dip your urine test strip into the Urine at the same time (see instructions for how to use PURI here). Allow your strip to remain in the urine for as long as your manufacturer recommends, usually 1 to 2 seconds, and on removing the strip, wipe it on the side of the cup to remove any excess urine.

Wait until the correct time has passed to read your strip and then compare to the coloured grid provided in the manufacturer’s packaging.

We will take you through these steps briefly here, but if you want to see a great guide you can visit this article or you can visit the instructions on our website.

You have now completed your Urine Test.

Step 3 - Record your Protein in Urine Results

Many Urine test results end up in the rubbish bin. By saving your Urine Test Results you are saving an important part of your health record. You can also provide to your doctor good information about your results that will give them more information when assessing your health.

A simple way to record results is to write them on a piece of paper, or type them into an excel spreadsheet, recording the date and time and the result of your test.

A better way is to download for free the PURI Urinalysis App from the Google Play Store or the iTunes app store. PURI safely stores your data, has a simple input screen making it easy to save your results.

PURI has other features such as a built in timer (as discussed above)  and the ability to store two photos of your results.

Step 4 - Record a Photo of Your Results

Photos are can be viewed at a later date to confirm certain aspects of your test. Particularly useful is taking a photo of your Urine. Much can be interpreted from the colour and the physical properties. Your doctor may find these photos useful in reviewing your your test results.

The other advantage of saving your test results in PURI is that you can share your results at a touch of a button. By clicking the share icon on your test results you can share your results with a contact within the app or send to anyone via email. The share function will share your test results and also the photos you have added to this test.

Another benefit of recording your results in PURI is that you can view graphs of the result which will allow you see trends. Is your Protein in Urine getting better or getting worse? Storing your data electronically and having it on hand makes this type of analysis easier.

So now you have your results stored in a safe place the next step is to understand your results.

Step 5 - Understand your results

If you had a negative result then you can either stop testing, or if you wish, continue testing at regular intervals to be 100% sure of the result. A single result is a good indicator, but a series of results is much more reliable. You will have purchased more than 1 test strip so you might as well use them all.

If you received a positive result then it is time to understand your results better. Again, you might want to do a number of tests to double check your single result, for example, by testing every day for at least 3 days. That way you can gain confidence in your result and have more data to share with your doctor.

Armed with your test results you can seek a clear diagnosis of why you have Protein in your Urine. Some online research is always good as it will prepare you to understand the possible causes. That said, the best and most accurate way is to book an appointment with your Doctor. Your Doctor is trained to interpret your results and can initiate more detailed tests to arrive at a conclusive diagnosis. If your diagnosis requires special treatment, your Doctor can refer you to a specialist. The most important for you is that you understand what is causing the Protein in your Urine and begin a treatment program.

If you have saved your results in PURI you can easily share your results with a Doctor or Pharmacist at the click of a button. In that way, if your health provider offers remote service, they can view your results and advise you via email or the phone. You can also share your result with the PURI Pharmacist free of charge for an initial opinion.

Step 6 - Manage your condition

Hopefully you have a negative result, in which case their is not much more to do. A regime of ongoing screening can be helpful to pick up on symptoms early, but for now there is no condition to manage.

For patients whose test results have resulted in a diagnosis then it is important that you follow your Doctor’s advice. There are plenty of online resources for CKD; Diabetes and Hypertension, and in fact for most things that cause Protein in Urine.

We hope you have found this article on how to test for Protein in Urine at home useful, if you have any comments, feedback or questions then please let us know by filling out the contact form.