Doing a urine sample wrong can cause false results
Why do lupus patients need to give a urine sample every 3 months?
Around 40% of systemic lupus erythematosus patients develop kidney inflammation (nephritis).
Some groups get it more often, as high as 80% in Afro-Caribbean women and 50-55% in African American women
Finding excess protein in the urine (proteinuria) is how we identify lupus nephritis at its earliest stages.
How can the urine sample be inaccurate?
If there are white blood cells, red blood cells, and other substances contaminating it from the vagina or foreskin, this can cause an artificially high amount of proteinuria
If you collect it after exercising a lot, or in the afternoon it can be artificially high (orthostatic proteinuria)
How to collect a urine sample optimally (PRINT THIS OUT AND KEEP IT HANDY):
Why this is important: If you get into the habit of doing this correctly, you will save yourself from having to repeat it or from having to collect an unnecessary 24 hour urine collection (which is cumbersome to do)
- Always try to collect your sample first thing in the morning (either the 1st or 2nd void)
- Hydrate. Drink at least 8 glasses of water daily for a few days before the collection (unless your doctor has you on a water restriction)
- Collect a "mid-stream, clean-catch" urine sample:
- 1st wash your hands.
- Carefully remove the lid from the urine sample cup (making sure not to touch the inside of the container or cover) and lay the cover with the inside section facing up.
- If you are giving a urine culture as well to make sure you do not have a urinary tract infection, use a sterile cup.
- Place the cup on an easy-to-reach surface.
- Pull apart the labia (if you are female) or retract the foreskin (if you are a male) with one hand.
- Using your other hand, you wipe the urethra three times with three sterile wipes (front to back if you are a female). Continue to keep the labia or foreskin retracted with one hand and grab the cup with the other hand.
- You then urinate the first couple of seconds into the toilet (this gets rid of any bacteria that may have been in the urethra), and then urinate into the cup to the fill line.
- You should empty the last part of your urine into the toilet again (which is why the term “midstream”). You should immediately put the lid securely on the cup, making sure not to touch the inside of the cover or the container.
- Make sure and place the lid securely on the cup prior to flushing the toilet to prevent contamination from aerosolized droplets from the toilet (thanks to ANON for this great recommendation).
PRINT this out and keep it handy
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The Lupus Encyclopedia
Fanouriakis A, Kostopoulou M, Cheema K, et al. 2019 Update of the Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA–EDTA) recommendations for the management of lupus nephritis. .Annals of the Rheumatic Diseases 2020;79:713-723.
QUESTION OF THE DAY:
Dr. T. I have lupus. I got both of my Moderna COVID vaccines. Can I take off my mask like the CDC recommends?
I am so glad you asked this question!
NO! (generally, see exceptions below)
The CDC's recommendation that vaccinated people can be outside without a mask and indoors when around other vaccinated people apply to the general public.
However, we do not know how well the vaccines work in people with autoimmune diseases?
I am so happy you got vaccinated. Until many more of us get vaccinated, life can't get back to "normal." Although, it is not guaranteed that you responded to the vaccine, if the COVID vaccine goes in line with other lupus vaccine studies, there should at least be some protection. Exceptions would include those who are heavily immunosuppressed may not have a very good response (for example, someone on rituximab who gets vaccinated a month or so after their treatment are unlikely to have a robust response).
Please continue to protect yourself with social distancing. Protect yourself at all times similar to how the CDC recommended prior to the vaccines.
Ask you friends and family to strongly consider getting vaccinated to help protect you as well (the cocoon effect)
If you have very mild lupus that has been in remission, you are young with no other health problems, and you take only hydroxychloroquine as your medication, they you could possibly do OK by not wearing a mask via the May 2021 guidelines for people who have been vaccinated.
Please ask your rheumatologist for their advice.
CDC Study answers this question
QUESTION: How effective is just one COVID-19 vaccine if you did not get the second?
Type of study? A Centers for Disease Study
Where? 33 sites in 25 states (U.S. study)
Who? Health Care Provider recipients of Pfizer and Moderna vaccines
Results? One vaccine offered an 82% protection rate (Pfizer, Moderna)
94% for 2 doses. This similar to what we saw in the clinical trials
How about people with lupus, Sjogren's and other autoimmune diseases?
- They were not studied
- However, there are active studies being done at the NIH, Johns Hopkins, etc
- If you live near Bethesda, MD, call the NIH nurses at 301-435-4489 and 301-451-4990; tell them Dr. Thomas sent you
- If you have an autoimmune disorder, especially if you are on immunosuppressant therapy, you are at higher risk of bad outcomes from COVID-19 infection.
- It is imperative you get vaccinated
- Make sure to stop your immunosuppressants appropriately for vaccination (but ask your doctor 1st to check)
Here is a link on how to stop meds for the vaccines:
- If you get vaccinated, pretend you are as vulnerable as if you did not get vaccinated
- Still practice social distancing
- Ignore the CDC guidance for others who are vaccinated... i.e. still wear your masks and socially distance from everyone and plead the unvaccinated to just stay away from you (I always worry about my patients)
REFERENCE: ACR, COVID-19 Vaccine Clinical Guidance Summary for Patients with Rheumatic and Musculoskeletal Diseases. Developed by the ACR COVID-19 Vaccine Clinical Guidance Task Force.
Pilishvili T, Fleming-Dutra KE, Farrar JL, et al. Interim Estimates of Vaccine Effectiveness of Pfizer-BioNTech and Moderna COVID-19 Vaccines Among Health Care Personnel — 33 U.S. Sites, January–March 2021. MMWR Morb Mortal Wkly Rep. ePub: 14 May 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7020e2external icon.
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Note that Dr. Thomas' posts are for informational purposes only, and are not meant to be specific medical advice for individuals. Always seek the advice of your healthcare provider with any questions regarding your own medical situation.
DONALD THOMAS, MD