What Is a Urine Sodium Test?
A urine sodium test checks the amount of sodium in a sample of your pee to see whether it’s at a normal level.

Having too much or too little sodium can mean there’s an issue with your kidneys or perhaps another health matter. You may be asked to take a urine sodium test after you’ve already taken a sodium blood test and gotten results that are not normal.

Sodium is an important electrolyte (a mineral in your blood and other bodily fluids) that helps your body and cells function. It helps your body regulate how much fluid it retains.

Sodium is in almost everything you eat -- from chips and bread to even some medicine. When you eat too much sodium, your kidneys have the job of clearing it from your body. But if your kidneys are damaged, the organs can’t remove sodium efficiently.

The urine sodium test helps to figure out whether your kidneys are working as they should to remove sodium.

How Do I Prepare for the Test?
The urine sodium test poses no risks.

Before your test, you should tell your doctor what medicine and supplements you’re taking. Some drugs could affect your test results, so he may ask you to stop taking certain ones before giving a urine sample. These include:

Corticosteroids. These are used to treat many conditions, from rashes to arthritis to asthma. They helps lower inflammation in the body.

Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications are used to reduce inflammation and include aspirin (Bayer, Bufferin, Excedrin), ibuprofen (Motrin, Advil), and Naproxen sodium (Aleve).

Prostaglandins. These medicines are used to treat glaucoma or stomach ulcers.

Water pills. Also known as diuretics, water pills help your body get rid of sodium and water.

What Happens During the Test
You’ll pee into a container, typically in your doctor's office, and it will be taken to a lab. The lab will analyze the sample and let you know whether there was a normal amount of sodium in your urine.

Depending on what your doctor suggests, you could provide just one sample or you may need to collect samples throughout a 24-hour period.

What Do My Results Mean?
You’ll be given your results in the form of milliequivalents per liter (mEq/L). The normal value may differ slightly depending on your lab.

For a one-time urine sample, the normal urine sodium value is around 20 mEq/L. For the 24-hour urine test, the norm ranges from 40 to 220 mEq/L per day. The wide range reflects your dietary salt intake.

Catecholamines - urine

Catecholamines are chemicals made by nerve tissue (including the brain) and the adrenal gland.

The main types of catecholamines are dopamine, norepinephrine, and epinephrine. These chemicals break down into other components, which leave your body through your urine.

A urine test can be done to measure the level of catecholamines in your body. Separate urine tests may be done to measure related substances.

Catecholamines can also be measured with a blood test.

How the Test is Performed?
For this test, you must collect your urine in a special bag or container every time you urinate for 24-hour period.

On day 1, urinate over the toilet when you wake up in the morning and discard that urine.
Urinate into the special container every time you use the bathroom for the next 24 hours. Keep it in the refrigerator or a cool place during the collection period.
On day 2, urinate into the container in the morning again when you wake up.
Label the container with your name, the date, the time of completion, and return it as instructed.
For an infant, thoroughly wash the area where urine exits the body.

Open a urine collection bag (a plastic bag with an adhesive paper on one end).
For males, place the entire penis in the bag and attach the adhesive to the skin.
For females, place the bag over the labia.
Diaper as usual over the secured bag.
This procedure may take a few tries. An active baby can move the bag causing urine to go into the diaper.

Check the infant often and change the bag after the infant has urinated into it. Drain the urine from the bag into the container provided by your health care provider.

Deliver the sample to the laboratory or to your provider as soon as possible.

How to Prepare for the Test
Stress and heavy exercise may affect the test results.

Some foods can increase catecholamines in your urine. You may need to avoid the following foods and beverages for several days before the test:

Coffee
Tea
Bananas
Chocolate
Cocoa
Citrus fruits
Vanilla
Many medicines can interfere with test results.

Your provider will tell you if you need to stop taking any medicines before you have this test.
DO NOT stop or change your medicines without talking to your provider first.
How the Test will Feel
The test involves only normal urination, and there is no discomfort.

Why the Test is Performed
The test is usually done to diagnose an adrenal gland tumor called pheochromocytoma. It may also be used to diagnose neuroblastoma. Urine catecholamine levels are increased in most people with neuroblastoma.

The urine test for catecholamines may also be used to monitor those who are receiving treatment for these conditions.

Normal Results
All of the catecholamines are broken down into inactive substances that appear in the urine:

Dopamine becomes homovanillic acid (HVA)
Norepinephrine becomes normetanephrine and vanillylmandelic acid (VMA)
Epinephrine becomes metanephrine and VMA
The following normal values are the amount of the substance found in the urine over a 24-hour period:

Dopamine: 65 to 400 micrograms (mcg)/24 hours (425 to 2610 nmol/24 hours)
Epinephrine: 0.5 to 20 mcg/24 hours
Metanephrine: 24 to 96 mcg/24 hours (some laboratories give the range as 140 to 785 mcg/24 hours)
Norepinephrine: 15 to 80 mcg/24 hours (89 to 473 nmol/24 hours)
Normetanephrine: 75 to 375 mcg/24 hours
Total urine catecholamines: 14 to 110 mcg/24 hours
VMA: 2 to 7 milligrams (mg)/24 hours (10.09 mcmol/24 hours)
Normal value ranges may vary slightly among different laboratories. Talk to your provider about the meaning of your specific test results.

The examples above show the common measurements for results for these tests. Some laboratories use different measurements or may test different specimens.

What Abnormal Results Mean
Elevated levels of urinary catecholamines may indicate:

Acute anxiety
Ganglioneuroblastoma (very rare)
Ganglioneuroma (very rare)
Neuroblastoma (rare)
Pheochromocytoma (rare)
Severe stress

The test may also be performed for:
Multiple endocrine neoplasia (MEN) II

Risks
There are no risks.

What is a urine calcium test?
A urine calcium test is done to measure how much calcium is passed out of the body through urine. The test is also known as the urinary Ca+2 test.
Calcium is one of the most common minerals in the body. All cells throughout the body use calcium for various functions. The body uses calcium to build and repair bones and teeth. Calcium also helps nerves, the heart, and muscles function properly, and helps blood to clot.
Most of the calcium in the body is stored in bones. The remainder is found in the blood.
When calcium levels in the blood get too low, the bones release enough calcium to bring the level in the blood back to normal. When calcium levels get too high, the surplus of calcium is either stored in bones or expelled from the body through your urine or stool.

The amount of calcium that’s in your body depends on the following factors:
amount of calcium taken in from food
amount of calcium and vitamin D absorbed through the intestines
level of phosphate in the body
certain hormone levels — such as estrogen, calcitonin, and parathyroid hormone

Often, people who have high or low levels of calcium don’t show any symptoms, especially if the calcium levels change slowly. Calcium levels need to be extremely high or extremely low, or changing quickly, to show symptoms.

How do you prepare for the urinary calcium test?
In preparation for the urinary calcium test, your doctor may instruct you to stop taking medications that could affect the test results. In addition, your doctor may ask you to follow a diet with a specific level of calcium for several days leading up to the test.
If the urine sample is being collected from your infant, your child’s doctor will provide special collection bags with instructions on how the urine should be collected.

Urine Calcium Level Tests
Medically reviewed by Daniel Murrell, MD on July 9, 2018 — Written by Karla Blocka

Purpose
Preparation
Procedure
Results

What is a urine calcium test?
A urine calcium test is done to measure how much calcium is passed out of the body through urine. The test is also known as the urinary Ca+2 test.

Calcium is one of the most common minerals in the body. All cells throughout the body use calcium for various functions. The body uses calcium to build and repair bones and teeth. Calcium also helps nerves, the heart, and muscles function properly, and helps blood to clot.

Most of the calcium in the body is stored in bones. The remainder is found in the blood.

When calcium levels in the blood get too low, the bones release enough calcium to bring the level in the blood back to normal. When calcium levels get too high, the surplus of calcium is either stored in bones or expelled from the body through your urine or stool.

The amount of calcium that’s in your body depends on the following factors:

amount of calcium taken in from food
amount of calcium and vitamin D absorbed through the intestines
level of phosphate in the body
certain hormone levels — such as estrogen, calcitonin, and parathyroid hormone

Often, people who have high or low levels of calcium don’t show any symptoms, especially if the calcium levels change slowly. Calcium levels need to be extremely high or extremely low, or changing quickly, to show symptoms.


Why is the urine calcium test performed?
Reasons to perform a urine calcium test include:

evaluating whether high calcium levels in the urine resulted in the development of a kidney stone
evaluating whether your dietary intake of calcium is high enough
evaluating how well your intestines are absorbing calcium
detecting conditions that lead to calcium loss from your bones
evaluating how well your kidneys are functioning
looking for problems with the parathyroid gland

A blood calcium test is usually more accurate in detecting certain conditions like specific bone diseases, pancreatitis, and hyperparathyroidism.
How do you prepare for the urinary calcium test?

In preparation for the urinary calcium test, your doctor may instruct you to stop taking medications that could affect the test results. In addition, your doctor may ask you to follow a diet with a specific level of calcium for several days leading up to the test.

If the urine sample is being collected from your infant, your child’s doctor will provide special collection bags with instructions on how the urine should be collected.
How is the urine calcium test performed?

A urine calcium test measures the amount of calcium in a sample taken from all the urine that’s produced in a 24-hour period. The test lasts from the morning of one day to the morning of the next day.

These steps are usually followed for the urine test:

On the first day, you urinate after awakening and don’t save the urine.
For the next 24 hours, you collect all subsequent urine in a container provided by a health professional.
You then close the container and keep it refrigerated during the 24-hour collection period. Be sure to put your name on the container as well as the date and time the test was completed.
On day two, you urinate into the container after awakening.
Return the sample as instructed by your doctor or other health professional.

There are no risks associated with the urine calcium test.

What do the test results mean?
Normal results

The amount of calcium in the urine of someone eating a normal diet is 100 to 300 milligrams per day (mg/day). A diet that’s low in calcium results in 50 to 150 mg/day of calcium in the urine.
Abnormal results

If calcium levels in the urine are abnormally high, it may be a sign of:

Hyperparathyroidism: A condition where the parathyroid gland produces too much parathyroid hormone, which may also cause fatigue, back pain, and sore bones
Milk-alkali syndrome: A condition that results from taking too much calcium, usually seen in older women who take calcium to prevent osteoporosis
Idiopathic hypercalciuria: Too much calcium in your urine without a reason
Sarcoidosis: A disease in which inflammation occurs in the lymph nodes, lungs, liver, eyes, skin, or other tissues
Renal tubular acidosis: High acid levels in the blood because the kidneys don’t make the urine acidic enough
Vitamin D intoxication: Too much vitamin D in your body
Use of loop diuretics: A type of water pill that works on one part of the kidney to increase water loss by the kidney
Kidney failure

Uric Acid Test (Urine Analysis)

What is a uric acid test?

A uric acid test measures the amount of uric acid in the body. Uric acid is a chemical that’s produced when your body breaks down purines. Purines are compounds that enter the bloodstream during the natural breakdown of cells in the body. They’re also created during the digestion of certain foods, such as:

anchovies
sardines
mushrooms
mackerel
peas
liver

Once purines release uric acid, most of it’s dissolved in the blood and transported to the kidneys, where it’s removed from the body through urination. Some uric acid also leaves the body through defecation. When this process is disrupted, however, your body can produce too much or too little uric acid.

A uric acid test is often performed to help determine the underlying cause of abnormal uric acid levels. By measuring the amount of uric acid in your body, your doctor can evaluate how well your body is producing and removing uric acid. Your doctor can perform a uric acid blood test, or they can test your uric acid using a urine sample.

Why is a uric acid urine test performed?

Your doctor will usually recommend a uric acid urine test when you’re showing symptoms of a medical condition that causes uric acid levels to rise.

An increased amount of uric acid in the urine often indicates gout, which is a common form of arthritis. This condition is characterized by severe pain and tenderness in the joints, especially those in the toes and ankles. Other symptoms of gout include:

swelling in a joint
reddened or discolored skin around a joint
a joint that’s hot to the touch

A high amount of uric acid in the urine can also be a sign of kidney stones. Kidney stones are solid masses made of crystals. The excess uric acid in the body causes the formation of these crystals in the urinary tract. The symptoms of kidney stones include:

severe pain in the lower back
blood in the urine
a frequent need to urinate
nausea
vomiting
a fever
chills

Your doctor may order a uric acid urine test to determine how well you’re recovering from either kidney stones or gout. A uric acid urine test might also be used to monitor your condition if you’re undergoing chemotherapy or radiation treatment. These treatments can lead to an accumulation of uric acid in the body.

How do I prepare for a uric acid urine test?

It’s important to tell your doctor about any prescription drugs, over-the-counter medicines, or supplements you’re taking before you have a uric acid urine test. Certain medications can affect the accuracy of this test, including aspirin (Bufferin), ibuprofen (Advil), and water pills. Your doctor may tell you to stop taking these medicines prior to the test. Your doctor may also ask you to refrain from drinking alcohol immediately before and during the test.

How is a uric acid urine test performed?

A uric acid urine test is a safe, painless procedure that requires only the collection of urine. The urine samples need to be collected over a 24-hour period. Your doctor will explain how to collect the urine properly.

The urine collection procedure is as follows:

On day 1, urinate into the toilet after waking up. Flush this first sample away.
After that, take note of the time and collect all urine for the remaining 24 hours. Store the urine samples in a refrigerator or other cool place.
Return the containers to the appropriate person as soon as possible.

It’s important to wash your hands carefully before and after collecting each urine sample. Make sure to cap the containers tightly and to label the containers.

Once the samples have been collected, the urine is sent to a laboratory for analysis. The results will be delivered to your doctor within a few days. Your doctor will discuss your individual results with you and explain what they mean in further detail.

Breath Test

What is the hydrogen breath test?
The hydrogen breath test is a test that uses the measurement of hydrogen in the breath to diagnose several conditions that cause gastrointestinal symptoms. In humans, only bacteria - specifically, anaerobic bacteria in the colon-are capable of producing hydrogen. The bacteria produce hydrogen when they are exposed to unabsorbed food, particularly sugars and carbohydrates, but not proteins or fats. Although limited hydrogen is produced from the small amounts of unabsorbed food that normally reach the colon, large amounts of hydrogen may be produced when there is a problem with the digestion or absorption of food in the small intestine, that allows more unabsorbed food to reach the colon. Large amounts of hydrogen also may be produced when the colon bacteria move back into the small intestine, a condition called bacterial overgrowth of the small bowel. In this latter instance, the bacteria are exposed to unabsorbed food that has not yet had a chance to completely traverse the small intestine to be fully digested and absorbed. Some of the hydrogen produced by the bacteria, whether in the small intestine or the colon, is absorbed into the blood flowing through the wall of the small intestine and colon. The hydrogen-containing blood travels to the lungs where the hydrogen is released and exhaled in the breath where it can be measured.

When is hydrogen breath testing used?
Hydrogen breath testing is used in the diagnosis of three conditions. The first is a condition in which dietary sugars are not digested normally. The most common sugar that is poorly digested is lactose, the sugar in milk. Individuals who are unable to properly digest lactose are referred to as lactose intolerant. Testing also may be used to diagnose problems with the digestion of other sugars such as sucrose, fructose and sorbitol.
The second condition for which hydrogen breath testing is used is for diagnosing bacterial overgrowth of the small bowel, a condition in which larger-than-normal numbers of colonic bacteria are present in the small intestine.
The third condition for which hydrogen breath testing is used is for diagnosing rapid passage of food through the small intestine.
Above conditions may cause abdominal pain, abdominal bloating and distention.

How does hydrogen breath testing work?
The bacteria in the colon, including the anaerobic bacteria, are able to digest and use sugars and carbohydrates as food. When the anaerobic bacteria digest sugars and carbohydrates, they convert some of the sugars and carbohydrates into gases, most commonly hydrogen. They also may produce and release into the colon other substances, for example, chemicals that cause the colon to secrete water and cause diarrhea. As previously mentioned, some of the hydrogen gas is absorbed by the colon into the blood and is eliminated in the breath where it can be measured. As long as little sugar or carbohydrate reaches the colon, the small amounts of gas and other substances that are produced do not cause a problem. When larger amounts of sugar or carbohydrate reach the colon because they are not digested and absorbed in the small intestine, larger amounts of gas and substances are formed in the colon. For example, if an individual digests and absorbs the sugar in milk (lactose) normally, then none of the lactose that is given for the lactose hydrogen breath test reaches the colon, and no increase in the concentration of hydrogen in the breath is seen during the breath test. On the other hand, if the individual does not digest and absorb the lactose completely, that is, he or she is lactose intolerant, the lactose travels through the small intestine and enters the colon where the bacteria digest it and produce hydrogen. An increase in hydrogen in the breath then is seen. Other sugars for which poor digestion can be diagnosed by breath testing include sucrose and fructose (found in corn syrup), and sorbitol (a sugar that is used as a low-calorie sweetener).
There are ways other than abnormal digestion of dietary sugars by which the bacteria can cause problems. Unlike in the colon, the number of hydrogen-producing, anaerobic bacteria in the small intestine is small. If, however, large numbers of hydrogen-producing bacteria move into the small intestine from the colon, a condition called bacterial overgrowth of the small bowel, the bacteria may digest the sugars and carbohydrates before the small bowel has had a chance to digest and absorb them and produce large amounts of hydrogen. Finally, if individuals have abnormally rapid passage of food through the small intestine, there may not be enough time for the small intestine to digest and absorb sugars and carbohydrates. This results in the entry of larger amounts of sugar and carbohydrate into the colon where the bacteria can digest and convert them to gas.
To diagnose bacterial overgrowth and rapid transit through the small intestine, a sugar that is not digested and absorbed by man, such as lactulose, usually is used for the test. In the case of rapid passage through the small intestine, the sugar passes quickly through the small intestine and into the colon so that hydrogen is found in the breath very soon after ingestion of the sugar. In the case of bacterial overgrowth, production of hydrogen occurs twice during the test. Once as the sugar passes the bacteria in the small intestine and again when the sugar enters the colon.

How is hydrogen breath testing performed?
Prior to hydrogen breath testing, the patient fasts for at least 12 hours. At the start of the test, the patient blows into and fills a balloon with a breath of air. The concentration of hydrogen is measured in a sample of breath removed from the balloon. The patient then ingests a small amount of the test sugar (lactose, sucrose, sorbitol, fructose, lactulose, etc. depending on the purpose of the test). Additional samples of breath are collected and analyzed for hydrogen every 15 minutes for up to five hours.

How are the results of hydrogen breath testing interpreted?
The interpretation of the results of hydrogen breath testing depends on the sugar that is used for testing, and the pattern of hydrogen production after the sugar is ingested. After ingestion of test doses of the dietary sugars lactose, sucrose, fructose or sorbitol, any production of hydrogen means that there has been a problem with digestion or absorption of the test sugar and that some of the sugar has reached the colon. When rapid intestinal transit is present, the test dose of non-digestible lactulose reaches the colon more quickly than normally, and, therefore, hydrogen is produced by the colonic bacteria soon after the sugar is ingested.
When bacterial overgrowth of the small bowel is present,ingestion of lactulose results in two separate periods during the test in which hydrogen is produced, an earlier period caused by the bacteria in the small intestine and a later one caused by the bacteria in the colon.


What are the limitations of hydrogen breath testing?
For unclear reasons, testing for bacterial overgrowth of the small bowel with lactulose can diagnose only 60% of cases. In addition, with bacterial overgrowth there may be an overlap of the early and later periods of hydrogen production that can be misinterpreted as a single period characteristic of rapid intestinal transit. Finally, some normal individuals may have slow transit through the small intestine making prolonged testing - up to 5 hours - necessary, and many individuals are unwilling to undergo such prolonged testing.
Some individuals do not have bacteria that produce hydrogen, and in these individuals hydrogen breath testing is not possible. Most of these individuals have bacteria that produce a different gas, methane. (There are individuals who produce both hydrogen and methane.) Methane can be measured in the breath just like hydrogen, and the production of methane can be used for diagnosis in the same way as hydrogen. There is much less experience with methane, however, and the production of methane is more complex than the production of hydrogen. Therefore, it is not clear if the pattern of methane production after ingestion of sugars can be interpreted in the same way as hydrogen production, particularly for the diagnosis of bacterial overgrowth.
A pattern of hydrogen production that is typical for bacterial overgrowth does not necessarily mean that an individual's symptoms are caused by the overgrowth. For example, there may be anatomic abnormalities of the small intestine such as narrowing or functional abnormalities in the way the muscle of the small intestine works. These abnormalities can cause symptoms of bloating, distention, pain, and diarrhea themselves, but they also can lead to bacterial overgrowth with its similar symptoms. Therefore, it may be an underlying abnormality that is responsible for the symptoms and not the bacterial overgrowth. The only way to differentiate between the two causes of symptoms-an underlying problem or bacterial overgrowth - is to treat and eradicate the bacteria. If the symptoms disappear, then it is more likely that it is the overgrowth rather than the underlying abnormality that is responsible for the symptoms.
Any condition that results in the delivery of undigested or unabsorbed food to the colon may result in abnormal breath tests when dietary sugars are used for testing. Both pancreatic insufficiency and the condition called celiac sprue can cause abnormal breath tests, in the former instance because pancreatic enzymes that are necessary for the digestion of carbohydrates are missing, and in the latter instance because the lining of the small intestine is destroyed, and digested food cannot be absorbed. It may be necessary to exclude these causes of abnormal breath tests by additional tests-pancreatic function tests and small intestinal biopsy.

Are there other ways in which hydrogen breath testing can be used?
Antibiotics are used for treating bacterial overgrowth of the small bowel; however, any one antibiotic may be effective at eliminating the overgrowing bacteria only 50%-60% of the time. Therefore, if symptoms do not disappear in an individual following treatment with antibiotics, it may be useful to repeat the breath test to determine if the antibiotics have eliminated the bacteria. If not, a different antibiotic or non-antibiotic treatment can be tried.

What are the side effects of hydrogen breath testing?
The side effects of hydrogen breath testing are exactly what one would expect to see in individuals who poorly digest and absorb sugars and carbohydrates, for example, bloating, distention, pain, and diarrhea. When lactulose is used these symptoms are unlikely to occur or are mild because the dose of lactulose used for testing is small.

What are the alternatives to hydrogen breath testing?
For diagnosing lactose intolerance, an alternative procedure to breath testing requires blood samples to be taken after the ingestion of lactose. If the digestion and absorption of lactose is normal, the levels of glucose in the blood should rise. The elevation of blood glucose occurs because the lactose is broken down into its two component sugars, galactose and glucose, as it is absorbed into the blood. A second alternative is to give a dose of lactose (or other dietary sugar) and observe an individual for symptoms. If the individual is intolerant, bloating, distention, pain, flatulence, and diarrhea are likely to occur. A third alternative is a trial of a diet in which the potentially-offending sugar is strictly eliminated.