Ask Dr. Atef about Urine Testing

What is the use of 24 hour urine protein in patients with swelling in their legs or with generalized body swelling? 24 hour urine test in patients with swelling in their legs or with generalized body swelling. What is the use of 24 hour urine protein in patients with swelling in their legs or with generalized body swelling? In certain diseases of kidneys, large amount of protein can pass the kidney filter and find their way to urine. In this setting, the amount of protein in the vessels decreases and this can lead to retention of fluid and swelling in body. A clue that should make a person suspicious of passing large amount of protein in the urine – having “persistent” foamy urine may be a clue toward passing large amount of protein in urine. Foamy urine is shown in the following pictures:

Foamy urine in toilet

Foamy urine in toilet (source: buzzle)

Foamy urine specimen

Foamy urine specimen (source: kidneyfailureweb)

Why the doctor asked for 24 hour Creatinine as well? Each person passes a fixed amount of Creatinine in urine in 24 hours. In all 24 hour urine tests we also ask for 24 hour urine Creatinine. By doing so we can verify if the urine was collected properly or not.

Please read more about Creatinine on my site by clicking here.

Ask Dr. Atef about Swelling

I have noticed swelling in my ankles. The swelling has been there for a few weeks. I am concerned about it. Do you have any advise? Swelling in feet, ankles and lower part of legs is due to leakage of fluid from the vasculature in the soft tissues around the vessels. Fluid makes about %60 of our body weight. It is important to know that this fluid is all placed in different compartments. Two third of this fluid in placed in the cells. The rest of this fluid is outside the cells. These two fluids have different constituents. From the one third which is outside the cell, one fourth of it is in blood vessels and the rest (three fourth of the fluid which is outside the cells) is distributed between the different tissues of the body (the fluid between the cells).

Just for the sake of better understanding imagine if somebody is 160 pounds (lbs). This person will have about 96 lbs of fluid in the body. From this 96 lbs, about 64.3 is inside the cells, 21.2 lbs are between the cells and 10.5 lbs are in the vessels.

Under different conditions the amount of fluid which resides in the area between the cells (interstitial fluid) increases. This excessive amount of fluid in the areas between the cells is called edema.

Edema moves with gravity. This is why if somebody develops edema, this fluid tends to accumulate in the lower part of the body (ankles and legs). And if the person lies flat, this fluid tends to move away from the legs.

This is a simplified way of understanding edematous state.

Now in our example person, when he or she develops edema his or her weight increases. In this case the person’s weight can increase to about 175 lbs or more.

This excessive fluid will show itself mostly in interstitial area and is called edema.

Edematous status requires further work up.

This information is important for patients who have edema (such as in patients with heart failure, kidney failure or liver disease) and take water pills (diuretic).

I will post more info on that on my near future blog posts.

Dr. Atef (Dallas)

Ask Dr. Atef about Creatinine

I was told my serum creatinine level was high. What does that mean and why should I see a kidney doctor about it? First of all “serum creatinine” is a blood test. In order to this test a sample of blood is drawn from a vein. This test is mostly done in the labs (not in the office). The test for serum creatinine measures a compound which is called creatinine. Creatinine is a byproduct of energy metabolism expenditure by muscles. The more muscle a person has the more creatinine will gets released to the blood and this is why his or her serum creatinine will be on the higher end of normal. But more than muscle mass serum creatinine is determined by the filtering function of kidneys. We use this test (serum creatinine) not as indicator of muscle mass but as an indicator of kidney function.

How these two (serum creatinine and kidney function) relate? As you know as blood passes through kidneys some of chemicals in blood gets filtered out into urine. One of these chemicals is creatinine. If kidney function deteriorates (such as in kidney disease) the filtration function of kidneys deteriorates as well. In this case creatinine does not get filtered in urine in normal amount and its concentration in blood increases.

If you look at the blood test you will see this test written and reported as: “Cr”, “Creat” or “Creatinine”.

If you have any further question please contact Dr. Atef, kidney specialist in Dallas.

Ask Dr. Atef about Chocolate

I crave chocolate every day. Is this normal or am I addicted to it? Women’s health expert Dr. Pamela Talley says that chocolate cravings can be driven by the change in balance of male and female hormones in a woman’s monthly cycle. That same flux can contribute to the periodic acne that some women experience. Chocolate and other food cravings are part of a larger serotonin issue, which is why antidepressants such as Prozac are often the treatment of choice for premenstrual symptoms. Roseanne Rust, a registered dietitian, suggests one reason that people might crave chocolate is that it has some amphetamine-like properties. “Also, the cannabinoid-like fatty acids mimic the effects of marijuana, producing euphoria,” she says.

Five hundred years ago, Spanish conquistadors called chocolate the “food of the gods” when they first discovered it in South America. That kind of reverential attitude hasn’t altered much over the centuries, as we still love it. The U.S. Chocolate Manufacturers Association says that each of us consumes 5.32 kg or about 12 lbs. per year.

So when you need a little afternoon pick-me-up, you can now confidently turn to chocolate. Before chocolate-phoria over takes you, though, remember that even though cocoa powder in itself is intrinsically low in calories, all the added ingredients that help make it so tasty are high in caloric content, fat and cholesterol.


147 calories
2 g protein
9 g fat
16 g carbohydrate
65 mg calcium
65 mg phosphorus

References: * Roseanne Rust, certified dietician, regular columnist for the Meadville Tribune, May 2000.