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What Does Material In Urine Stream Indicate?

Posted on Wed, 5 Mar 2014

Question: I have had cloudy urine on and off since November. Dipstick tests have been positive for blood, but both micro blood labs I have done are negative for blood. I have included my most recent blood & urine lab results below. (All results were within normal range.) Almost three weeks ago, I had solid material come out with my urine stream. It looked like small, soft yellow finger-shaped pieces, a strange black thread and a very tiny hard black speck. I have included a photo. These were sent to a lab. The lab said the yellow pieces were "ground substance" and that the rest was "bladder debris." But my urgent care doctor had no idea what that means diagnostically. So I need an expert's opinion. Could you please advise? Thank you & namaste XXXXXXX RECENT TEST RESULTS Comprehensive Metabolic Glucose 91 BUN 16.0 Creatinine .8 BUN/Creat ratio (calc) 20 GFR (calc) 106 AST(SGOT) 15 ALT (SGPT) 22 Alkaline phosphatase 59 Bilirubin, total .2 Calcium 9.7 Sodium 141 Potassium 4.0 Anion gap (calc) 14.0 Chloride 104 CO2 27 Total Protein 6.8 Albumin 4.6 Globulin 2.2 A/G Ratio (calc) 2.1 Urinalysis w/ Rfx micro Color Yel Appearance Clear pH 7.0 Sp Grav 1.021 Leuk Neg Nitrite Neg Urobil .2 Protein Neg Blood Neg Ketone Neg Bilirub Neg Glucose Neg

Answered by Dr. Ravi Bansal (2 hours later)

Brief Answer: cloudy urine Detailed Answer: Hi XXXXXXX A very warm Namaste to you also. I see you could get the sample analysed. As described by You 'ground substance' refers to digested proteinacious meterial. which can arise from episode of hematuria ( blood in urine) or stone debris. So it is of no significance as such. I think you should not worry. But you should be watchful in future if you again have cloudy urine. You should again sample it for urine routine microscopy ( especially for urine WBC's). notice if these episodes are related to fever or abdominal pain or intake of fat/oil/butter rich food. If any of these is there bring it into notice of your treating doctor. Best wishes.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ravi Bansal (7 hours later)

Hi Dr Bansal, I'm very happy to have you back on the case. The urologist mentioned an "organized clot" but I can't find out what that is from the Internet. What is that, and do you concur that the material in the photo could be such an "organized clot"? I still have cloudy urine. I do consume a coffee latte with almond milk daily. Almond milk is a bit oily. I was under the possibly mistaken impression that "ground substance" refers to the intracellular jelly between cells. But you said it could be proteins from food/drink? Could you help me to understand the process by which these proteins could come to be in this form in my urinary tract? Does this information from the lab result help rule out anything diagnostically? Thanks for your time. Namaste XXXXXXX

Answered by Dr. Ravi Bansal (6 hours later)

Brief Answer: flesy material in urine. Detailed Answer: Hi XXXXXXX 'Organised clot' means that there was some blood there ( could have come from bladder or the kidney) . after some time the color and texture of the blood changes and appears like a dirty material. Some portion of the material in photo could be organized clot also. consuming coffee should not give cloudy urine. You see if the morning urine you passed was normal but after having food , in next 1 to 2 hour, you are passing cloudy urine which again clears, then it could have relation with diet. The material cannot be proteins from food and drink. the food passage and the urine passage are totally separate. Protein coming in urine is from filtration at the kidney. But as you have provided your urine reports there is no protein in the urine. There no evidence of acute infection at present in the urine in the reports provided So what is left is - chyluria if the urine is totally cloudy and white. or any chronic infection of the urinary tract. I think best is to just observe it for some time ( 2 Weeks). And notice the extent of problem, any day to day variation, any other associated physical problems. best wishes.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ravi Bansal (4 hours later)

Hi Dr Bansal Thank you for the excellent and thorough answer. My urine is not milky white like chyle, but more like a particulate solute has been mixed in it. I looked at photos of chyluria and that's not what my urine looks like. So maybe we can rule that out... If I had a chronic infection, wouldn't it have shown up in my blood/urine labs -- or not necessarily? Have you ever had clinical experience with a case like mine, when the histopathology reports say such material is "ground substance" and "bladder debris"? Thank you! XXXXXXX PS: This is the definition of "ground substance" I found online: WWW.WWWW.WW

Answered by Dr. Ravi Bansal (6 hours later)

Brief Answer: white colour urine. Detailed Answer: Hi XXXXXXX You can go through one of my publications WWW.WWWW.WW It is about papillary necrosis in a kidney transplant patient. the article also contains a photograph of the tissue passed in urine. I have seen many cases like yours. We have to consider lot of clinical facts like history, examination , test reports and imaging reports to make a diagnosis. It is not just the appearance of what you have passed in urine. Diagnosis i have seen varied from bladder cancer to renal TB, to fungal infections. ground substance label to the specimen passed has no clinical relevance. I saw your link. It is well known already that the tissue framework of collagenous material is called ground substance, but this does not contribute to any diagnosis. Though the color is only like a suspension still it may be chyle. because color may vary from time to time. similar are cases with chronic infection. So we cannot rule them out. Only way is to observe the condition for some days. it may resolve spontaneously or may progress. In that case we can revisit the situation after few weeks. Meanwhile you should stop worrying and continue with life normally. Bye

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ravi Bansal (2 hours later)

Dear Dr Bansal Namaste & thanks for your answer. Do you still recommend a visit to a urologist and a CT scan? And if so, what specific type of CT scan should I ask for? We've discussed cancer, necrosis, TB...it's a bit disconcerting, even though I am trying not to worry. I guess what I'm asking is, can we rule anything out? Sounds like bladder cancer, renal necrosis, TB, fungus, kidney stones, chyluria, chronic infection are all still possible diagnoses? Or am I not understanding? Are any of these less likely or more likely than they were before, based on all the lab results? Thank you! XXXXXXX

Answered by Dr. Ravi Bansal (11 hours later)

Brief Answer: white material in urine Detailed Answer: Hi XXXXXXX You don't have to panic these are all differentials for such presentation. But there is no Clinical correlation by symptoms. As far as testing is concerned you can go ahead with CECT KUB after discussion with your treating doctor. This will help us rule out lot of these causes at the outset and then we can follow the case . So what you need to understand is that rather than re-analyzing what little symptoms and evidence we have, discussing possibilities and then worrying about them ; we should gather more clinical and lab evidence to reach a conclusion. I am hopeful that nothing serious will come out, so keep calm and discuss with your treating doctor regarding follow-up plan. keep well!

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar