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.

Protein in urine: The causes and what you can do

Protein in Urine
When a doctor asks to test for protein in your urine, it’s because, in normal conditions, you should not have protein in your urine. Your Doctor is using this test to gain insight into potential health issues. If Protein is present in your Urine it could indicate a number of different conditions which will likely need medical treatment and monitoring. In this article we investigate the importance of Protein appearing, or better, not appearing in your Urine. 

How the Kidney manages Protein

Your kidneys filter waste products from your blood allowing a clean and filtered supply to continue to flow through your body. Your kidneys ensure the blood re-entering your veins contains exactly what your body needs.

Specifically, the kidney maintains the balance of water, electrolytes and acid-base in addition to removing toxins, and producing various hormones that our bodies need.

The kidney deals with 2 basic types of Proteins: small proteins and large proteins.

Smaller proteins are absorbed as they pass through the kidney, broken down into amino acids and returned to the blood whereas large protein molecules, like Albumin, are retained in the blood due to their size.

An Albumin molecule is a flexible ellipsoid molecule about 3.6 nanometres in diameter and 15nm long. It encounters the kidney’s filter slit which is about 3.5nm wide. During blood filtration most albumin molecules do not pass through the kidney’s filter due to its physical properties, however, some will pass through due to their ellipsoid shape and their flexible nature somehow slipping through the filtration slit.

There are estimates that the kidney reabsorbs about 9.6 g per day of low weight protein molecules per day and filters and retains about 3.2g per day of Albumin per day.

Protein is important for the functioning of your body as it is in every cell in the body and is used to build and repair tissue, make enzymes, hormones, and other chemicals as well as being an important building block of bones, muscles, cartilage, skin, and blood.

What causes Protein in Urine?

As mentioned above, some protein will appear in your urine as part of the normal functioning of the body. There are healthy reasons why this base level of protein may increase, and unhealthy reasons which may indicate the presence of a condition that requires medical treatment.

Normal stresses such as exercise, dehydration, emotional stress, fever and pregnancy can lead to temporary increased protein excretion in the urine. This is not permanent and protein excretion will return to normal once the stress to the body has been removed.

If there is presence of protein in urine in the absence of the above stresses, and, or it appears over a longer period of time, this can be an important indicator of renal disease.

Kidney disease is insidious as it can develop undetected in the body until it is in a very late stage and it is too late to intervene to avoid serious health issues. Detecting Protein in Urine is important as it may be the first sign of a serious problem and may appear long before other clinical symptoms.

Before jumping to the most serious conclusions, it is important to understand some factors, temporary conditions or existing diagnosed diseases that can lead to increased protein in urine.

If you having any of the above conditions and have protein in urine, you are at high risk of developing further complications and should work with your Doctor to diagnose and manage any problems. Every time you protein appears in your urine it means protein has breached your kidney filters.

It’s, therefore, important to:

Protein in Urine and Kidney Damage

When the presence of protein in urine is persistently high, this may indicate a serious kidney injury. It means that large amounts of protein are passing through your kidney filters and it is likely that your Kidney is permanently damaged. If you experience high levels of protein in your urine it is highly recommended to consult your doctor. Through advanced diagnosis they can diagnose the cause which could be due to:

What you can do

In any of the situations described in this article you can act proactively and better understand your condition by routinely checking, monitoring your urine, follow your disease evolution and share your results with your doctor.

The existence of low cost and widely available urine tests are a handy tool to help you do this. By testing Urine at home you can track the levels of protein in your urine, identify a potential urinary tract infection and other conditions and enable you to take action before the presence of other physical symptoms.

Urinalysis Test Strips: how they work, which to buy

Urinalysis Test Strips - The Basics

Urinalysis test strips are useful diagnostics for the detection and monitoring of various diseases & health 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.

Article summary

Urinalysis test strip
The results of home urinalysis testing is done by comparing the reacted test strip to the color matrix on the product's packaging.

The importance of urine

Urine is a waste product of the body produced by the Kidney. The kidney filters blood by removing waste and balancing water, minerals and salts. Clean filtered blood is exits the kidney and circulates through the body. 

Excess water, waste products and excess mineral and salts leave the kidney via the urinary tract, are stored in the bladder and then evacuated via the urethra.

By analyzing urine it is possible to understand the state of the body. The presence or absence of certain molecules, and the measurement of other properties can 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.

Urinalysis test strips

Urinalysis test strips are pieces of plastic or waterproofed paper that have a number of absorbent pads soaked with different chemical reagents. 

When a urinalysis test strip is dipped into a urine sample the chemically impregnated pads react with the urine. Dependent on the result of the chemical reaction certain interpretations about the properties of the urine can be interpreted. 

Each pad on the urinalysis test strip has a different chemical reagent. 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.

Some of the tests available for home urinalysis testing include:

Reading results

The results of a urinalysis test strip are based upon the color change of the chemical pads after they have reacted with the urine. These chemical reaction produce color changes in the reagent pads. 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 experience.

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

Protein in urine can be a sign of wider health issues. In this article we explain how to test for protein in urine at home and what to do if you the result is positive.

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Test your protein in urine knowledge

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A home urine test can identify the existence of protein in urine?

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Testing for protein in urine at home is very difficult and very expensive?

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A urine test result can be measured before the reaction time has passed?

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Protein in urine can be a sign of chronic kidney disease?

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A clean urine sample is not important for home urine testing?

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Protein in urine home test

Protein in urine is a symptom of chronic kidney disease (CKD).  Protein in urine may be the first sign of kidney damage and is useful in the early diagnosis of this condition. Patients already diagnosed with CKD can test for protein in urine at home to monitor their treatment and disease progression in addition to laboratory results. If you want to test for protein in urine at home it is easy and inexpensive. In this article we will show you how to test for protein in urine at home. We will take you through the steps to conduct this home urine test and give you some good tips for understanding your results.

Urine in protein test instructions

Step 1 - select a urine test strip

To conduct the protein in urine test at home you need to purchase a urine test strip that tests for protein. The following products include a protein assay and can be bought inexpensively in a pharmacy or online: 

Your local pharmacist or doctor can also recommend a urine test strip that tests for protein in urine or you can consult our guide on our website by clicking here or our article on how to select a urine test dipstick by clicking here.

Step 2 - Collect a urine sample

To collect a urine sample you will need a disposable urine collection cup.

Taking a sample from your first urination in the morning is recommended by many experts. Before collecting your 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 your 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.

Step 3 - Conduct the test

Have your urine sample, your urine test strip and a stopwatch or the PURI urinalysis app ready with the template for your urine strip ready.

Dip your urine strip into the urine sample at the same time as you start the timer. Ensure all the reagent pads are submerged in the urine and are submerged for as long as your manufacturer recommends, usually 1 to 2 seconds.

On removing the strip wipe it on the side of the cup to remove any excess urine.

Wait until the correct reaction time has passed before reading your strip. PURI will indicate this by unlocking the template so you can enter results.

When the reaction time has passed follow the manufacturer’s instructions and compare the color of the reagent pads on the strip to the colored grid on the manufacturer’s packaging.

Step 4 - Record your protein in urine results

Once you have identified the test result record the results in PURI or write them on a piece of paper or type them into an excel spreadsheet. If recording your results manually ensure you record the date and time as well as the result of your test.

If you use PURI you can save 2 photos with your test results. We recommend taking a photo of your urine sample and of the test result. This information can be useful when test results are reviewed by your doctor.

Step 5 - Review 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 series of results over time is much more reliable than a single result and we recommend you repeat the tests over a number of days to confirm the negative result.

If you received a positive result then for protein in urine for the first time we recommend you visit your doctor for his opinion. Your doctor can carry out laboratory tests to diagnose the underlying cause. Until you doctors appointment we recommend you continue testing so you have more data to share with your doctor during your appointment.

For patients with an already diagnosed condition please work with your medical carer to manage the underlying condition(s) that may cause protein in urine to appear. 

For users of PURI you can share your results via email or with other users in the app at a touch of a button.