Why do lupus patients need to give a clean catch urine sample every 3 months?
Doing a clean catch urine sample wrong can cause false results
Around 40% of systemic lupus erythematosus patients develop kidney inflammation (nephritis) and need to give a clean catch urine sample on a regular basis. It is essential to always give a proper clean catch urine sample so that the results are accurate.
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 get a clean catch urine sample (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)
“What is the best time to take a urine sample?”
– Always try to collect your clean catch urine 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.
How to give a urine sample female:
-Pull apart the labia (if you have them) with one hand.
– Using your other hand, you wipe the urethra three times with three sterile wipes front to back. This is important. If you wipe back to front, then you can introduce bacteria around the anus that can potentially give you a urinary tract infection.
-Continue to keep the labia with one hand and grab the cup with the other hand.
How to give a urine sample male:
– retract the foreskin (if you have one) with one hand.
– Using your other hand, you wipe the urethra three times with three sterile wipes. Continue to keep the foreskin retracted with one hand and grab the cup with the other hand.
Next steps giving a urine sample for both sexes:
– 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 sample 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’s recommendations in the comments section for this great recommendation).
“Can I give a urine sample with my period?
This is an important question. If you are asked to give a clean catch urine sample at a time when you are having any blood at all during your period, tell you doctor or the lab technician that you need to return on a day when you have no more bleeding at all. If red blood cells get into the urine sample, it will cause inaccurate readings of the amount of protein (it will be falsely elevated) and an increased number of red blood cells.
– Congratulations! You have collected an optimal clean catch urine sample
PRINT this out and keep it handy
SHARE with others who have lupus
Don Thomas, MD, author of “The Lupus Encyclopedia” and “The Lupus Secrets”
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.
Just in case flushing could aerosolize other people’s germs that are hanging out in the toilet, I make a point to NOT flush the toilet until AFTER I’ve put the cap on the urine cup, put the cup into the little metal box in the wall, and closed the door to the little metal box. I don’t know how likely this is, but I don’t want to be told I have a UTI and be put on antibiotics unnecessarily due to someone else’s E. coli (or some other bacteria lurking in the toilet from people who used it before me) contaminating my urine sample. I never thought of this until I had to give a urine sample at my GYN’s office and they had very detailed instructions in a fancy frame sitting on a bathroom shelf right with all the necessary supplies … and their instructions said to put the cap on the urine cup before flushing the toilet… and then I thought about why they might have said to do things in that particular order.
I love that ANON. I am going to add that to the instructions when I publish the 2nd edition of my book. E coli does get aerosolized with flushes, so it makes sense to add this recommendation.
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