learn about your tests in plain-English

It can feel awkward to hand over a jar of your bodily waste to a collector. You may think to yourself, why can’t they just take a blood sample? But urine tests can tell us a lot about our health that blood can’t.

(Also – don’t feel awkward, your collector is a trained health professional and they’re not fazed by a bit of urine.)

What are urine tests used for?

Urine tests can be used for a whole range of diagnoses. From confirming a pregnancy to diagnosing an infection such as a UTI or an STI, checking kidney function, monitoring diseases such as diabetes and bladder cancer or monitoring drug use (for legal purposes or a pre-employment screening).

Urine is produced in your kidneys and passed through the urinary tract (ureters, bladder and urethra) before being expelled from the body. It’s mostly water (about 99%) but the remaining 1% is made up of urea, uric acid, ammonia, hormones, dead blood cells, proteins, salts and minerals, and toxins. It’s a waste product – your body getting rid of chemicals it doesn’t need. And that’s why urine tests are so useful; in many cases we can learn as much about a person’s health from what the body expels as what it holds onto.

A person with kidney disease, for example, will have both urine tests and blood tests to monitor their condition. The urine is tested for albumin, a type of protein. Your body needs protein, so having high levels in your urine may mean that your kidneys are not filtering your blood well enough. The blood is tested for creatinine, which comes from muscle tissue. It’s a waste product but when the kidneys are damaged, they have trouble removing creatinine from your blood.

Collection

Generally, it doesn’t matter what time of day you collect a urine sample, but there are occasional exceptions. Your doctor may, for example, request a first morning sample because the urine is more concentrated and therefore it is more likely to show up any abnormalities.  Or if the doctor is looking for glucose in the urine they may ask you to collect a sample after a meal.

You will probably be asked for a “mid-stream” sample. Urine is naturally sterile so if a test shows up bacteria this can be a sign of infection. By taking a sample from the middle of the stream you are reducing the likelihood of contamination from bacteria and cells from the surrounding skin. This is important – contamination due to improper collection can mean having to provide a second sample or even result in unnecessary treatment.

What happens to your urine once it’s in the lab?

Luckily for lab staff technology has improved a lot over the years when it comes to urine testing. In Medieval Europe doctors would observe the smell, consistency and even taste of urine to diagnose their patients.

These days analysis is a bit more scientific. For a UTI, for example, the first step usually involves your doctor carrying out a point of care test, whereby they dip a specially treated strip into a urine sample.

The strip will change colour depending on the diagnosis. If it detects white blood cells, blood or chemicals called nitrites, infection is likely. The sample is then sent to a lab for further testing. In the lab a scientist analyses the sample to confirm the presence of white blood cells and bacteria. They can also test it to work out which antibiotic is most likely to be effective (an important step in combating antibiotic resistance).

And whilst your lab technician isn’t tasting your sample, the Medieval doctors weren’t entirely wrong. A strong odour, for example, could be a sign of a urinary tract infection whilst a sweet smell could indicate diabetes. Cloudy urine could be a result of infection whilst pinkish coloured urine may mean there’s blood present.

The post Everything you need to know about urine tests first appeared on Know Pathology Know Healthcare.

With an El Nino event forecast for summer 2015, it seems Australian pathology staff will be kept on their toes ensuring STIs are treated quickly.

A new study¹ released by the Melbourne Sexual Health Centre reviewed their clients over nine years and found seasonal variations in the rates of STIs – with the highest rates falling smack bang in summer.

The study also found that both male and female patients reported a greater number of partners during the spring and summer months.

The findings could help public health officials improve targeting of safe sex messages, and suggests that the onset of warmer weather signals the best time to launch campaigns.

But until prevention messages are heeded by all Australians, staff working in microbiology departments will be kept busy diagnosing and advising on treatment for STIs.

Microbiology is the study of infectious diseases, including STIs. Trained scientific staff diagnose these conditions from blood/fluid samples and swabs.

The wee beasties responsible for STIs are found using a variety of techniques – even genetic tests. For chlamydia and gonnorhoea for example, a common test involves ‘amplifying’ the DNA of the bacteria from a urine sample. ‘Amplifying’ simply means copying the bacteria’s DNA thousands or even millions of times so that there are so many copies it’s easily detectable on a machine. Using modern pathology techniques, this test can be done overnight.

HIV is a blood-borne virus that can be spread via unsafe sex among other risky behaviours. Rather than directly testing the virus’s DNA, the most common test for HIV measures the body’s response to the virus. If a blood sample is found to contain antibodies to the HIV virus, the sample must be positive for the virus. No antibodies, no virus.

Knowing which tests to use and how to perform them is all part of the extensive scientific training medical scientists, technicians and pathologists all undergo.

References:

1. Sex Transm Infect 2015

The post It’s getting hot in here…. first appeared on Know Pathology Know Healthcare.

Men’s Health Week takes place in June each year; it was started in the US in 1994 to increase awareness of preventable health problems and encourage early detection and treatment of disease among men and boys.

This month we take a look at the broad role pathology plays in some conditions affecting men.

Heart disease

The biggest killer of men in Australia is heart disease. The Heart Foundation says 98 Australian men have a heart attack every day with 1 in 7 dying. Heart disease has a number of risk factors that are modifiable and pathology can help to identify risk and measure improvement by use of cholesterol testing.

Total cholesterol testing measures levels of high density lipoproteins (HDL or ‘good’) cholesterol, low density lipoproteins (LDL or ‘bad’) cholesterol and triglycerides in the blood.

A person’s total cholesterol score will show whether they are at greater risk of developing heart disease and having a heart attack. High ‘bad’ cholesterol and triglycerides can cause the arteries to harden and narrow. Having a blood test to find out cholesterol levels is highly recommended, particularly for men over 45. Changes in diet can help lower ‘bad’ cholesterol and reduce risk and follow-up pathology results can monitor improvement.

Although younger men may be less likely to worry about heart health, cholesterol testing is also advisable for those under 45 who are in high risk groups. Men with heart disease in their family, who are overweight or have diabetes are all at increased risk and recent research has also drawn a link between mental health and heart disease.

Melanoma

Men are more likely to suffer from melanoma than women and more likely to die from the disease.

Research suggests that, as well as other biological differences, men develop melanoma more on their backs and chests, whereas it is more common on the arms and legs in women. Back and chest areas are harder to see meaning the cancer may go unnoticed longer in men. It is also more difficult for someone to apply sunscreen to their own back when it is exposed to the sun. As men may be less likely to seek help with sunscreen application, this places them at further risk.

Pathology is crucial for melanoma diagnosis which is done via a biopsy of a lesion removed from the skin.

Testicular cancer

The most common cancer in men aged 18-39 is testicular cancer, according to Cancer Council. Diagnosis of testicular cancer starts with a physical examination and may then include laboratory tests for tumour markers, such as AFP (alpha-fetoprotein), hCG (human chorionic gonadotropin) and LDH (lactate dehydrogenase). An ultrasound may also be used to distinguish between cancer and other possibilities such as infection.

Should these tests indicate testicular cancer is likely, diagnosis is confirmed by removing the testicle, which is then biopsied.

A biopsy performed while the testicle is still in situ risks spreading the cancer so the testicle is removed in cases where cancer is strongly suspected. This also acts as the first stage of treatment and further treatment may not be needed if the cancer is detected early.

Once testicular cancer is diagnosed, blood tests to monitor tumour markers can also help doctors to assess the patient’s response to treatment.

Sexually transmitted infections

With research showing that sexually transmitted infection (STIs) rates continue to rise, STI screening is an essential part of men’s health.

In terms of everyday human activities, sex is one of the easiest ways to spread infection and although many men feel that they are in a low risk category for STIs, screening is important to rule out ‘silent’ infections and protect sexual partners.

Chlamydia has raised concern recently as rates are high amongst Australians on the dating scene, including over 50s. Around 50% of chlamydia cases in men have no symptoms and diagnosis can only be made using pathology testing of either a urine sample or a cell sample collected from the urethra (or the cervix in women).

The infection is easily spread and when left untreated can damage fertility in women and can even lead to men becoming sterile in some cases.

Other infections which can be passed on through sex, such as herpes, can increase the risk of contracting more serious diseases like HIV. A sexual health check can help identify any suspect lesions which can then be swabbed to collect a cell sample for pathology testing.

The post Men’s health: much more than ‘man flu’ first appeared on Know Pathology Know Healthcare.