I remember my provider explained to me that the work of a urologist is like the work of a plumber for the human body, which didn’t make the most sense until I realized that the urinary system it is often overlooked and often unappreciated until something no longer works. Working at a urology clinic, I came across many unusual findings, most of them began with a simple urine test. A urine test can reveal surprising information about what is happening in your body and may also indicate underlying complications.
Many factors can affect your urine, its color and appearance can provide clues about one’s diet, hydration, and overall health. In physiology, we learn about homeostasis, the kidneys play a key role in their contributions to maintaining homeostasis by regulating fluid balance, electrolytes, and the removal of waste products.
From my experience working at this clinic, I have learned that the results of a urine sample are only a piece of the puzzle. For example, a patient may come to the clinic with symptoms of difficulty urinating, a weak stream, or feeling they cannot empty their bladder. The urinalysis detects specific substance in the urine, such as blood, proteins, and glucose, among other things. Next, a post-void residual test was used to measure urine remaining in the bladder. In men, a possible cause is benign prostatic hyperplasia (BPH), which is the enlargement of the prostate that begins interfering with normal urinary flow.
Diagnosis of urinary retention can have additional consequences, including an increased risk of infection due to the bladder harboring bacteria, creating a harsh environment that can be evident in the presences of leukocytes and nitrites emerging in the urine. This is why something as simple as performing a urinalysis can provide crucial and valuable information to doctors on what can be happening in our body.
My provider was a great mentor, knowing what I know now about ethics, I see how well he exhibited these principles, ensuring all patients received the same care and respected their right to choose treatment. He demonstrated nonmaleficence by avoiding unnecessary antibiotics when cultures did not show growth of an infection or indicated that a particular antibiotic would be ineffective, preventing unnecessary harm and guiding patients toward alternative forms of treatment.
Works Cited
National Institutes of Health- https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-retention/diagnosis
Johns Hopkins Medicine - https://www.hopkinsmedicine.org/health/wellness-and-prevention/anatomy-of-the-urinary-system
Mayo Clinic - https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/symptoms-causes/syc-20370087
It’s interesting that so many of the unusual findings you saw started with just a urine test. Was there one case that stood out to you the most? I'd love to hear what the results showed and how it led the provider to figure out what was going on.
ReplyDeleteWhen thinking about what to look for in the urine when completing a urinalysis, it is also important to consider the physiological functions of the renal system and why it is abnormal to see organic molecules such as protein and glucose in the urine when we expect them to be reabsorbed back into the blood in the renal tubule. Organic molecules are first filtered in the kidneys by the glomerulus and reabsorbed in the proximal tubule of the juxtaglomerular nephrons in order to reclaim the nutrients and maintain homeostasis (Hall, 2025; Vallon & Nakagawa, 2023).
ReplyDeleteThis isn't always the case, as you've stated; the urinalysis whihc led to the diagnosis of benign prostatic hyperplasia (BPH) showed increase levels of protein and glucose in the urine, where it doesn’t belong this can potentially be because the glomerulus, which is essential in filtration, could be damaged, and the barrier would allow more protein to enter from the blood into the filtrate of the renal tubule and therefore will be more difficult for the proximal tubule to reabsorb the protein (Toblli et al., 2012). As for glucose, glucosuria can be the cause of high levels of glucose seen in the urine because there is more sugar than normal; therefore, glucose will rise and remain in the filtrate to be excreted in the urine (Shepard & Pluznick, 2017).
The point is that glucose and proteins can be lost in the filtrate for different reasons, and it's important to think about the other possible diagnoses when you understand why we may see glucose and proteins in the urinalysis.
Refereneces
Hall, A. M. (2025). Protein handling in kidney tubules. Nature Reviews Nephrology. https://doi.org/10.1038/s41581-024-00914-1
Shepard, B. D., & Pluznick, J. L. (2017). Saving the sweetness: renal glucose handling in health and disease. American Journal of Physiology-Renal Physiology, 313(1), F55–F61. https://doi.org/10.1152/ajprenal.00046.2017
Toblli, J. E., Bevione, P., Di Gennaro, F., Madalena, L., Cao, G., & Angerosa, M. (2012). Understanding the Mechanisms of Proteinuria: Therapeutic Implications. International Journal of Nephrology, 2012. https://doi.org/10.1155/2012/546039
Vallon, V., & Nakagawa, T. (2021). Renal Tubular Handling of Glucose and Fructose in Health and Disease. Comprehensive Physiology, 2995–3044. https://doi.org/10.1002/cphy.c210030
Super interesting read! BPH perfectly illustrates urological mechanisms: hyperplasia in the prostate's transition zone physically compresses the prostatic urethra, increasing bladder outflow resistance. Stagnant urine then allows Gram-negative bacteria using nitrate reductase to convert urinary nitrates into nitrites. Your highlight on antibiotic stewardship cleanly ties into nonmalfeasance and justice, avoiding unnecessary prescriptions prevents adverse drug reactions while mitigating population-wide antibiotic resistance. From your clinic experience, did sharing these urinalysis results help empower patients' treatment autonomy?
ReplyDeleteAs vitally informational as a urinary analysis is, many find the practice to be both uncomfortable and humiliating. Components include the general aversion to letting someone else view this discharge, the vulnerability of the situation, and the complicated and dehumanizing connotation of urinary analysis as a component in many drug raids and prison settings. Many feel horrified by the idea of handing over a sample of their urine.(Ehrenreich, 1996) Have you experienced any of this discomfort in your patients in your time at the lab? How have you seen your mentor deal with these situations? Should there be any educational practices put into place to encourage a shift in the perspectives of the broader public? Perhaps a move away from shame and disgust in order to fully appreciate urine as an important biomarker.
ReplyDeleteReferences:
Ehrenreich, B. (2007). Nickel and Dimed: On (Not) Getting By in America.