Question

Bob has been active all of his life. He played soccer from elementary school all the way through college. He even played on a community team but now at age 45, he’s been diagnosed with high blood pressure (hypertension). At times he ate too much junk food and occasionally drank too much alcohol but he couldn’t get around the fact that the men in his family all had high blood pressure. Dr. Miller, Bob’s primary care physician, had to prescribe two different antihypertensive medications in order to get his blood pressure under control. She also recommended Bob continue his regular soccer workouts but suggested a low-salt diet and more modest alcohol intake. Bob heeded Dr. Miller’s recommendations. His father and his 2 uncles had hypertension at a young ages, and all 3 men ended up on dialysis before dying from complications of kidney failure.Bob began the recommended lifestyle changes at age 45 and even started running regularly to keep his blood pressure under control. Now, 10 years later, he was a marathoner and participated in local marathons, competing with, and outrunning many his own age. However, Bob noticed that during the past several months, he’d experienced more fatigue than normal and some dehydration symptoms after his long runs. After consulting with Dr. Miller, Bob sought the help of Ty, an exercise physiologist, to help him maintain his exercise regime and his health without feeling “old”.Ty worked with Dr. Miller to make sure that Bob was monitored closely since he was still taking his anti-hypertensive medications. Ty suggested a urinalysis to assess Bob’s physical condition before, during and after his workouts. Bob dutifully supplied urine samples to Dr. Miller for evaluation as Ty recommended. Ty explained that Bob’s dehydration symptoms were more difficulty to evaluate since the medication Bob took to control his high blood pressure could affect his renal status or physiologic functioning.Dr. Miller logged the following results of Bob’s urinalysis immediately after, and six hours after, a rigorous 2-hour run.

Time	color	Specific gravity	protein	glucose	PH
Before exercise	pale yellow	1.002	none	none	6.0
Immediately after exercise	dark yellow	1.035	small amount	none	4.5
6 hours after exercise	yellow	1.025	none	small amount	5.0

Ty was concerned about the small amount of glucose found in Bob’s urine 6-hours after his long run. He asked Bob if there was any diabetes in his health history. Bob confessed he had eaten an entire large pizza an hour before that specific urine collection. Explain why glucose might show up in Bob’s urine after a particularly carbohydrate-laden meal.

Ty had no doubts that Bob’s kidneys were functioning physiologically. One of the tests of the urinalysis showed normal ranges at all 3 collection times. What is the test? Describe how this test can confirm normal physiologic kidney function during heavy exercise.

Answer 1

Urine dipstick test helps to find out the level of glucose in the urine using color change of the urine. Urinalysis helps to detect urine with ketones that are released into urine during fat break down while exercise. High blood sugar may reduce the capacity of the insulin to reduce the level of ketones. Blood sugar must be between a range of 100-250mg/dl to maintain safety while exercising. This range confirms a normal kidney function that would predict exercise safety.