[Eric Hofacket]

24-urine test - what results indicate serious problems?

by Eric Hofacket on Mon Apr 27, 2015 2:37 pm

I just saw the results of my 24-hour urine test, which I had not done in about 3 years. I have been relapsing and my kappa light chain numbers have really escalated over the last few months. I will be starting a Kyprolis trial soon, so hopefully it will get my numbers back under control soon.

While I believe it is no surprise that I have urine protein, is there a range our threshold when these numbers could indicate a problem that needs to be addressed immediately?

I found lots of information on the normal ranges for urine protein, but none indicating when it indicates a serious problem or damage is being done now and action should be taken.

Are 24 hour urine test results by themselves ever a primary indicator of a problem or needed for immediate action or concern? My labs are below:

Specimen Volume 24 HR Urine: 2600

Test My Value Normal Range

Protein, Urine, QN 17 mg/dL High ≤ 11 mg/dL
Protein 24 HR Urine 442 mg/24hrs High ≤ 149 mg/24 hrs

Other Labs of interest:

Test My Value Normal Range

Bilirubin, Total 1.5 mg/dL High ≤ 1.0 mg/dL
GFR 71
Creatinine 1.1 mg/dL ≤ 1.30 mg/dL
BUN 18 mg/dL ≤ 18 mg/dL
Albumin 4.3 g/dL 3.3-4.8 g/dL
ALT 16 U/L ≤ 63 U/L
AST 15 U/L ≤ 34 U/L

My thinking is that things are OK for the moment. I will be seeing my oncologist on May 12, but that is still two weeks away, and from past experience with kidney problems three years ago, I know I can feel just fine one day and the next day things can suddenly go bad quickly.

Any comments or feedback would be appreciated.

[goldmine848]

Re: 24-urine test - what results indicate serious problems?

by goldmine848 on Mon Apr 27, 2015 8:24 pm

Eric,

I have no answers to your questions, but I will be interested in the responses. I have never had a 24-hour urine test and I have been meaning to ask my doctor why he does not order them for his patients.

[Cheryl G]

Re: 24-urine test - what results indicate serious problems?

by Cheryl G on Mon Apr 27, 2015 8:33 pm

Hi Eric,

Like Andrew, I don't have any answers to your questions at this time, although I will give it some more thought. Andrew's posting, however, reminded me that I've been wanting to share an article that I recently found when looking for some information related to another posting someone made in the forum.

I initially noticed the article because it addressed a question that comes up often here in the forum. Namely, is it really that important to have 24-hour urine tests done? I think the prevailing wisdom is that the tests are not really that important now that serum free light chain (SFLC) testing is done so regularly.

Well, this short article argues that free light chain testing doesn't completely eliminate the need for 24-hour urine testing:

S Singhal et al, "The serum-free light chain assay cannot replace 24-hour urine protein estimation in patients with plasma cell dyscrasias," Blood, April 15, 2007 (full text of article)

See, in particular, the concluding paragraph:

Our data show that a normal SFLC ratio cannot rule out significant total proteinuria, that SFLC is not 100% sensitive in detecting monoclonal proteinuria, and the extent of proteinuria but not the SFLC ratio correlates with renal function. The SFLC assay cannot replace 24-hour urine protein estimation from a clinical standpoint. Any recommendation to the contrary runs the risk of suboptimal patient management."

[Multibilly]

Re: 24-urine test - what results indicate serious problems?

by Multibilly on Mon Apr 27, 2015 8:52 pm

Hi Eric,

I also have no experience with 24-hour UPEPs. But I think it is a good sign that you have a normal creatinine and GFR level in this lab report. If these values were elevated, they would be signaling potential kidney damage.

[blair77]

Re: 24-urine test - what results indicate serious problems?

by blair77 on Mon Apr 27, 2015 11:40 pm

Can you forward these labs to your oncologist? My husband's doctor @ UCSF has a "send a message" portal on "mychart" and he addresses concerns like this within 24 hours.

[Tracy J]

Re: 24-urine test - what results indicate serious problems?

by Tracy J on Tue Apr 28, 2015 10:48 am

Generally speaking, protein in the urine crosses a threshold when it exceeds 3 grams over 24 hours. Then it's called nephrotic-range proteinuria. Your number is far below this, at 442 mg / 24 hours, or 0.442 grams - almost half a gram.

For comparison, when I was diagnosed with AL amyloidosis (primarily affecting my kidneys) in 2012, the first symptoms I had were those related to nephrotic syndrome. My 24-hour urine showed 11 grams in 24 hours. My 24-urine peaked at 13 grams in 24 hours. No wonder I felt horrible - I was peeing all my protein into the toilet!

Now, having had an auto stem cell for amyloid (and having myeloma, which does not yet affect my kidneys), my 24-hour urine is down to a couple hundred mg in 24 hours - close to yours. In this range, my nephrotic symptoms are gone. I don't notice that level of protein loss at all.

Here's a quote from Medscape about nephrotic syndrome:

Nephrotic syndrome is kidney disease with proteinuria, hypoalbuminemia, and edema. Nephrotic-range proteinuria is 3 grams per day or more. On a single spot urine collection, it is 2 g of protein per gram of urine creatinine.

There are many specific causes of nephrotic syndrome. These include kidney diseases such as minimal-change nephropathy, focal glomerulosclerosis, and membranous nephropathy. Nephrotic syndrome can also result from systemic diseases that affect other organs in addition to the kidneys, such as diabetes, amyloidosis, and lupus erythematosus."

Source: http://emedicine.medscape.com/article/244631-overview  

Hope this helps.

[Eric Hofacket]

Re: 24-urine test - what results indicate serious problems?

by Eric Hofacket on Tue Apr 28, 2015 2:09 pm

Thanks everyone for your comments and feedback. This has been really helpful and confirmed my suspicion that the results of this 24-hour urine test are nothing to be surprised about and nothing to get concerned about.

I will be seeing my oncologist on 12 May and will go over all of this with him then.

[Barbarah]

Re: 24-urine test - what results indicate serious problems?

by Barbarah on Tue Apr 28, 2015 8:11 pm

It appears every multiple myeloma doctor has a different approach to the 24 hour urine test! I have been a patient of a Mayo Clinic Rochester multiple myeloma specialist since 2006, with as few as two appointments a year to as many as 4 appointments a year. I also had an autologous stem cell transplant (ASCT) there in 2011. Every single time I have seen him, I have had to produce a 24-hour urine sample, including next week! I have become an expert in this process, if any of you are interested. (In my opinion, the key for women is a "hat," which is essential to my mental health.)

[Multibilly]

Re: 24-urine test - what results indicate serious problems?

by Multibilly on Wed Apr 29, 2015 12:16 am

24 hour UPEPs are actually an evil joke that some doctors dreamt up at a bar late one night back in the 60's. If you stick around the lab after you've delivered your jug of pee, you will notice that the technician just immediately pours the jug's contents into a toilet while all the other lab technicians bust out with uncontrolled laughter. The resulting numbers you see on your UPEP lab reports are just all randomly generated by the lab's computer.

Since I go to the same church as my oncologist, my oncologist took pity on me and clued me in on this big, long running joke

[Nancy Shamanna]

Re: 24-urine test - what results indicate serious problems?

by Nancy Shamanna on Wed Apr 29, 2015 8:37 am

I had several of the UPEP tests done, but not recently. They were around the time of diagnosis, and during the stem cell transplant time. Nothing makes you feel more like a patient than having to take a large jug into a hospital in a tote bag!

Probably UPEPS are used more now for specific reasons, such as if one does have kidney problems? I think that the SFLC and other blood tests have replaced the need for that in my case.