Hi Mohammad

 

The urine is a conventional void and I am not aware of any UTI.

 

I have arranged for a fresh sample today and have a very kind mass spectrometrist on stand bye to measure creatinine and creatine.

 

Another clever colleague also suggested some spiking experiments in urine to see whether any possible interferent/contaminants affect a donor urine sample in a similar way to the patients’.

 

Thank you everyone for your interest – I will let you all know what the outcome is in due course.

 

Best wishes

 

Ian

 

 

The urine creatinine is probably truly low for some reason as both Jaffe & enzymatic couldn’t record a result.

 

Is the urine from an ileal urinary diversion? This could lead to contamination with creatinine splitting bacteria?

Similarly, is there UTI due to such bacteria.

Is there microbiology study of such urine?

 

Experiment: do dilution studies of serum creatinine using the patient’s urine as diluent, you may need to keep the diluted samples overnight before analysis.

 

Regards,

 

 

Mohammad

 

 

 

 

It could well be and I have already received an offer from a mass spectrometrist to check creatinine and creatine!

 

The mailbase is just great!!

 

Thank you for all your interest!

 

Ian

 

 

Is it worth seeing if you can get creatine measured?

 

 

Yes the urine is recent. We have had 4 such samples- all with low urine creat over the past year. I suspect it is assay interference – which could be a contaminant at sampling – I am pursuing this angle at present.

 

She is type 2 diabetic and had her Alb/Creat ratio checked.

 

Ian

 

 

Apology Ian! Is the urine test recent?  How recent and why it was requested in the first place?

 

 

Hi Ali

 

I don’t know what her urine volume is and I don’t know what her height is.

 

Her last bloods were done in June last year:-

 

Sodium = 146 mmol/L

Potassium = 4.0 mmol/L

Urea = 6.2 mmol/L

 

Osmo and bicarb were not requested.

 

Thank you for your interest

 

Kind regards

 

Ian

 

 

Apology meant likelihood of SIADH??

 

 

Very concentrated urine! What is her 24 hour urine volume?? What is her serum urea/Na/K/HCO3/Osmolal and height please? What is the likelihood of DI???

 

Kind regards

Ali

 

 

Kind Regards

ALi

Dr Ali Al-bahrani  MBCh.B MSc.Chem Path.  EuClin.chem. CSci. FRCPath.
Lead Pathologist for Blood Sciences
Consultant Chemical Pathologist and metabolic medicine and HOD of Blood Sciences
St Mary's Hospital
Newport
Isle of Wight
PO30 5TG
United Kingdom
Te: 01983 534859/534917

 

 

 

 

 

 

Dear collective,

 

We have a very unusual urine creatinine result - which has been confirmed by both enzymatic and Jaffe assays, and confirmed on 3 previous occasions.

 

The female patient is a reasonably well 72 years old. She is not taking any medication of note (and not taking any “internet potions”), her BMI is 40 and she does not have a myopathy. Her serum creatinine (enzymatic assay) is 76umol/L.

 

Urine results are as follows:-

 

Urine sodium = 173 mmol/L

Urine potassium = 34 mmol/L

Urine urea = 292 mmol/L

Urine creatinine = <0.1 mmol/L

Urine osmolality = 781 mosm/kg.

 

Any ideas?

 

Kind regards

 

Ian Barlow

Consultant Biochemist

Chemical Pathology Clinical Director

 

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