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.
Learn why we want a urine sample every few months
Watch the video below to learn about lupus nephritis and why it is so important to give a urine sample every a3 months when you have systemic lupus.
You will learn:
- Why lupus nephritis is important for all systemic lupus patients
- How to properly collect a urine specimen
- The symptoms of lupus nephritis
Did you know that the most common symptom of early lupus nephritis is no symptoms at all?
- The different kinds of lupus nephritis
- How it is diagnosed
- The importance of diet, exercise, mindfulness
- How it is treated
- What happens when it is not treated
- How to get the most out of virtual online doctor visits
- An online support group for people who have lupus nephritis
Brought to you by Lupus LA, Aurinia, and Don Thomas, MD
What is anti-SSA antibody?
Know your labs!
I recommend that all lupus patients get copies of their labs every time they are done. Look up any abnormal results from a reliable source to know what they mean. If you cannot find a reliable source, then ask your doctor.
Remember... Knowledge is Power!
So, let's talk about anti-SSA (also called anti-Ro).
Anti-SSA antibody: Also called Anti-Sjögren’s Syndrome A, Sjögren’s Anti-SS-A, Ro Antibody
Why is anti-SSA also called anti-Ro?
Anti-SSA and anti-SSB antibodies were first discovered in 1961 in people who had Sjögren’s syndrome. This systemic autoimmune disorder attacks the body's moisture-producing glands, commonly causing dry eyes and dry mouth. The medical terms for them are “Sjögren’s syndrome-A” and “Sjögren’s syndrome-B” antibodies (or SSA and SSB for short). In 1969, another laboratory described antibodies in people who had lupus and named them anti-Ro and anti-La. “Ro” and “La” were the first two letters of the last names of the lupus patients in whom the antibodies were initially found (Robert and Lane respectively, according to Dubois’ Lupus 9th edition). Researchers later showed that anti-SSA was the same as anti-Ro and that anti-SSB was the same as anti-La. These terms are now interchangeable, with anti-SSA meaning the same thing as anti-Ro and anti-SSB meaning the same thing as anti-La.
How often does it occur?
Anti-SSA is more commonly positive in SLE patients than anti-SSB. SSA is positive in 20% to 60% of people who have SLE (depending on the patient population and the laboratory method used to detect the antibodies). Anywhere from 75% to 95% of people who have Sjögren’s syndrome are positive for this antibody. It can be present in any of the systemic autoimmune diseases and nonautoimmune conditions.
Some things may occur more often in people positive for anti-SSA antibodies
People who have SLE (systemic lupus erythematosus) and are anti-SSA positive have an increased risk of developing rashes with sun exposure (especially subacute cutaneous lupus), inflammation of the lungs (pneumonitis), shrinking lung syndrome, inflammation of the liver (hepatitis), inflammation of the pancreas (pancreatitis), inflammation of the heart (myocarditis), low platelet counts (thrombocytopenia), low lymphocyte counts (lymphopenia), and an overlap syndrome with Sjögren’s.
IMPORTANT NOTE: From the list above, the most important ones are sun-sensitive rash and Sjögren’s. Most do not develop the other problems, but are listed for your knowledge. Your doctor will monitor your liver enzymes and blood counts (hopefully every 3 months) and make sure to let your doctor know if you get chest pain, shortness of breath, bruising, rash, dry mouth or dry eyes.
Anti-SSA positive patients should particularly avoid ultraviolet light and become UV protection fanatics. Please download and follow my UV protection handout from this page:
ANA-negative SLE patients and anti-SSA
Although it is rare, some people who have SLE and are negative for ANA are positive for SSA antibody. If someone is thought to have SLE, but their ANA is negative, doctors should check for SSA antibodies. A newer ANA test, called “HEp-2000 ANA” (by a laboratory called Immuno Concepts in Sacramento, California), may be better at showing ANA positivity in these patients who are SSA antibody positive.
Anti-SSA can become positive years before SLE occurs
SSA antibody can be positive in someone many years before they develop lupus or Sjögren’s. It is one of the earliest antibodies to appear in many patients. This was figured out from blood samples of Army soldiers at the old Walter Reed Army Medical Center (Washington, DC) where I did my rheumatology fellowship.
It is essential that people found to have a positive SSA antibody (but not have evidence of having lupus, Sjögren’s, or any associated disease) be checked regularly by a doctor. I recommend that people in this situation learn what the symptoms of lupus and Sjögren’s are, and if any occur, to see a rheumatologist right away. Also, it is a good idea to see a rheumatologist regularly (such as once or twice a year) to have a proper physical examination and labs done. SLE can be potentially diagnosed by blood work (such as finding low blood counts or protein in the urine), yet the person may feel perfectly fine. The faster a proper diagnosis is made, the better the person usually does. Of course, someone who is SSA antibody positive may never develop any disease with it, but it better to be safe. I’d also recommend that someone in this category (antibody positive but no disease) avoid all potential triggers that may cause lupus (see table 3.1).
Important pregnancy information about anti-SSA
One of the most important potential problems is that this antibody can cross through the placenta and enter the fetus of a woman who is positive for this antibody. These antibodies can potentially cause tissue damage in the unborn baby's heart or skin (called neonatal lupus) whose mother is anti-SSA positive. Fortunately, this occurs in only about one out of fifty mothers who are positive for anti-SSA.
However, suppose a mother with SSA antibody has one child with neonatal lupus. In that case, her chances of each subsequent baby having neonatal lupus are approximately 20%.
Source of text: from "The Lupus Encyclopedia" preliminary write up for the upcoming 2nd edition, by Don Thomas, MD and Johns Hopkins University Press
References for the above can be found under chapter 4 here:
Photo credit (1st photo of lab test HeP immunofluorescence of anti-SSA test = from www.wikipedia.com article on Anti-SSA/anti-Ro antibodies, photo by Simon Caulton
Protect yourself from medical mistakes.
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