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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Urology
Satisfied Customers: 17547
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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The last 2 months i have not had normal healthy urination, I

Customer Question

Hithe last 2 months i have not had normal healthy urination, I hardly go anymore, Occasionally out of the blue i will need to go every 2 hours or so this usually happens around bed time When i do go in the day my urine is dark. Apart from that i hardly go. Im very worried, i drink 3-4 litres per day and have had blood and urine tests all clear. My doctor doesn't know to do.Ihave no visable edema. I am super obese but apart from that healthy.
Submitted: 10 months ago.
Category: Urology
Expert:  Dr. D. Love replied 10 months ago.

Hello from JustAnswer.

Which blood and urine tests have been done?

If you have the lab report, can you attach it (after blacking out your name)?

Customer: replied 10 months ago.
Hi i dont have lab test results available to me only the doctor has,they were kidney fuction and check protein in urine
thanks
Expert:  Dr. D. Love replied 10 months ago.

It certainly is appropriate to check kidney function, but if the only tests that were done were of kidney function, then the next step would be additional blood tests, specifically looking for metabolic conditions that can secondarily affect urine flow.

The first considerations would be the two types of diabetes. The most common type of diabetes, called diabetes mellitus, is due to altered blood sugar metabolism, either because of low levels of insulin or resistance to the effect of insulin. There also can be altered urine flow because of abnormal levels of a different hormone, ADH, which can be high or low, and affect urine flow accordingly. A low ADH causes diabetes insipidus.

I would also usually perform a broader metabolic evaluation, such as for thyroid dysfunction

So, the next step would be additional blood tests including a general chemistry profile, complete blood count, and thyroid profile. It may be necessary to consult with an Endocrinologist, depending upon the initial results, as the evaluation for ADH disorder can be complicated.

Customer: replied 10 months ago.
Hi diabetes was tested for along with thyroid and complete blood count. I do have low testorone etc due to weight and have seen a endocrinologist to investigate my height weight etc.
Expert:  Dr. D. Love replied 10 months ago.

Then I would ask the Endocrinologist to assess for ADH abnormalities that could be affecting urine flow.

Customer: replied 10 months ago.
ok can you have adh abnormalities without diabetes >? thanks
Expert:  Dr. D. Love replied 10 months ago.

It would depend upon which type of diabetes that you mean. If you mean the common type of diabetes, diabetes mellitus then yes. Most people with ADH abnormalities do not have diabetes mellitus. However, everyone with a low ADH will have diabetes insipidus.

Customer: replied 10 months ago.
ok but i have been tested for diabetes in blood test? so adh might not be the cause?
thanks
Expert:  Dr. D. Love replied 10 months ago.

It is not the same test.

Customer: replied 10 months ago.
oh right i see thankyou for your help, i feel like im getting somewhere thanks
Expert:  Dr. D. Love replied 10 months ago.

You are very welcome.

Please remember to provide a positive rating so that I am credited for assisting you.

Customer: replied 10 months ago.
Hi i got a copy of my blood tests
Expert:  Dr. D. Love replied 10 months ago.

OK

Customer: replied 10 months ago.
i send them now
Expert:  Dr. D. Love replied 10 months ago.

OK.

Customer: replied 10 months ago.
my white cells where high which they usually are, they also protein dipped my urine and it cameback +1 which they weren't concerned about
Expert:  Dr. D. Love replied 10 months ago.

Other than the white blood count, there is nothing in these labs that is significantly abnormal. The blood sugar is mildly elevated, but not at a level that would be considered to be diabetes mellitus or that would affect urine flow.

However, these tests did not include blood tests of kidney function, such as BUN and creatinine. A general chemistry profile would also usually include liver tests, although liver dysfunction will typically only affect urine flow if there is a secondary effect on kidney function. From the perspective of ADH metabolism, it is good that the blood electrolytes are normal, but a more complete evaluation would be a comparison of blood and urine electrolytes obtained at about the same time.

Customer: replied 10 months ago.
Creatinine was listed as 73umol/L
Expert:  Dr. D. Love replied 10 months ago.

This creatinine is normal.

Customer: replied 10 months ago.
also are adh abnormailites treatable? or is it a case of managing it cheers
Customer: replied 10 months ago.
Also is there anything else that could effect urine apart from kidney and adh abnormalities?
Expert:  Dr. D. Love replied 10 months ago.

The medicines that are used for diabetes insipidus do not cure the disease, but can help to control the disease process.

Of course, increased urine volume and flow would also be affected by increased oral intake of fluid, but with consistent oral intake, urine flow and volume is only affected by the kidney or systemic conditions that secondarily affect kidney function, such as diabetes mellitus, diabetes insipidus, or thyroid dysfunction, as I discussed above.

Customer: replied 10 months ago.
just to confirm i have low urine output not high
Expert:  Dr. D. Love replied 10 months ago.

You said that you hardly go and then need to go every 2 hour out of the blue, which is the usual description of episodic increased urine output.

Customer: replied 10 months ago.
but that happens very rarley say once a week
Expert:  Dr. D. Love replied 10 months ago.

If you are drinking 3-4 liters of water per day but only having the increased urine output once a week, then there needs to be more detailed information about fluid dynamics, including measuring the amount of urine output each day and monitoring daily weights. The tests of blood and urine electrolytes can also be done on a regular day and on a day during which there is increased urine output.