Occasional Back Pain and Urine Ketones in Young Patients

Q: Occasional Back Pain and Urine Ketones in Young Patients

Hello： In response to your question, the urine test indicated the presence of OB (+) and slightly elevated WBC, which may suggest a urinary tract infection, potentially causing fever. <br>At this time, proteinuria may occur, but this type of proteinuria is referred to as "functio

Occasional lower back pain?

Hello, Director Yang.
My daughter has disliked drinking plain water since she was little, which has led to some abnormalities found during her health check-ups.
I would like your help in clarifying a few things.
Her pH levels are slightly higher than the normal range, and she often shows 1+ for occult blood (OB) and slightly elevated white blood cells (WBC).
In her most recent test, there was no OB, but there were ketones and 1+ protein.
I wonder if this could be due to a fever she had the night before, as I read that fever can lead to protein in the urine.
I would like to know what the presence of "ketones" in the urine indicates.
Does it suggest a risk for diabetes, especially since my grandmother has a family history of diabetes? PS: I do not have glucose in my urine! In previous urine tests, ketones appeared only once (during a newborn check-up), and they have not shown up in other tests.

Additionally, I occasionally experience left-sided lower back pain (about every 3 to 4 months).
I visited a nephrologist once, and when the doctor tapped on the area of discomfort, I did not feel any pain, so he said there was nothing to worry about.
However, the pain still occasionally occurs.
Should I request further tests or evaluations?

Yun-Jie, 20~29 year old female. Ask Date: 2004/02/22

Dr. Yang Jun reply Internal Medicine

Hello: In response to your question, the urine test indicated the presence of OB (+) and slightly elevated WBC, which may suggest a urinary tract infection, potentially causing fever.
At this time, proteinuria may occur, but this type of proteinuria is referred to as "functional proteinuria," and it will naturally resolve once the infection and fever subside.
Regarding the presence of "ketones" in the urine, this may be due to diabetic ketoacidosis or could result from prolonged fasting, leading to the natural production of ketones in the body.
Further testing of blood glucose levels is necessary to determine if diabetes is the underlying cause.
If there are occasional symptoms of lower back pain, frequent urination, or dysuria, it is advisable to conduct another urine test to confirm whether a urinary tract infection is present.

Reply Date: 2004/02/22

More Info

Understanding the presence of ketones in urine and occasional back pain in young patients can be quite complex, especially when considering the patient's history and lifestyle choices. In your case, the presence of ketones in the urine, along with a family history of diabetes, raises some important considerations.

Firstly, the presence of ketones in urine typically indicates that the body is using fat for energy instead of carbohydrates. This can occur in several scenarios, including prolonged fasting, low carbohydrate diets, or uncontrolled diabetes. In your situation, since you mentioned a dislike for drinking water, it’s possible that dehydration could be contributing to the concentration of ketones in your urine. Dehydration can lead to a higher concentration of substances in the urine, including ketones and proteins, which might explain the occasional presence of these elements in your urine tests.

It's important to note that the presence of ketones alone does not necessarily indicate diabetes, especially since you mentioned that you have not had any glucose in your urine tests. However, given your family history of diabetes, it would be prudent to monitor your blood sugar levels regularly. If you have not done so already, consider discussing with your healthcare provider the possibility of performing a fasting blood glucose test or an HbA1c test, which can provide a clearer picture of your glucose metabolism over time.

Regarding the occasional left-sided back pain, it’s good to hear that you have already consulted a nephrologist. The fact that you do not experience pain upon palpation suggests that there may not be an acute issue with your kidneys. However, if the pain persists or worsens, further evaluation may be warranted. Common causes of back pain in young individuals can include muscle strain, postural issues, or even stress-related tension. If the pain is recurrent and bothersome, you might consider asking your doctor about imaging studies, such as an ultrasound or MRI, to rule out any underlying structural issues.

Additionally, lifestyle factors such as hydration, physical activity, and posture can significantly impact both urinary health and musculoskeletal pain. Ensuring adequate hydration is crucial, not only for kidney function but also for overall health. Aim to increase your water intake gradually, as this can help dilute your urine and potentially reduce the concentration of ketones and proteins.

In summary, while the presence of ketones in your urine may not immediately indicate a serious condition, it is essential to monitor your blood sugar levels, especially with a family history of diabetes. For your back pain, consider lifestyle modifications and further evaluation if symptoms persist. Regular follow-ups with your healthcare provider will be key in managing both your urinary health and any musculoskeletal concerns.

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