B. 2023 Healthline Media UK Ltd, Brighton, UK. Although the urinalysis results are consistent with a urinary tract infection, the clinical history suggests asymptomatic bacteriuria. All Rights Reserved. Immunoglobulin A nephropathy (Berger disease), Mesangial proliferative glomerulonephritis, Cancer (kidney, ureteral, bladder, prostate, or urethral), Drugs (e.g., nonsteroidal anti-inflammatory drugs, heparin, warfarin [Coumadin], cyclophosphamide), Trauma (e.g., contact sports, running, Foley catheter), Exposure to chemicals or dyes (benzenes or aromatic amines), History of chronic indwelling foreign body, History of chronic urinary tract infection, History of exposure to carcinogenic agents or chemotherapy (e.g., alkylating agents). Diabetes and your eyes, heart, nerves, feet, and kidneys. Be sure to let your doctor know about all the medicines you take, including over-the-counter drugs, vitamins, and supplements. MNT is the registered trade mark of Healthline Media. After some predetermined amount of time (usually indicated in the instruction manual or on the box), you'll check the color of the urine strip to determine your glucose levels. The patient's blood will be purified for 24 hours. Conditions with problems using or making the hormone insulin, Conditions with the kidney where the tubules are damaged, or other kidney defects, Eating more sugars than the body can process at once, Your baby grows too big, and you need a C section, Risk of heart disease and type 2 diabetes after your pregnancy is over, Anti-glucagon-like peptide-1 receptor antagonists. It usually resolves after delivery, but it can affect the fetus, lead to complications during labor, and may put the individual at a higher risk of developing type 2 diabetes later in life. Decreased serum albumin due to renal loss. People may have a higher risk of kidney disease if they have: Addressing high glucose and blood pressure can reduce the risk. The test can show warning signs but cant tell your doctor for sure that anything is wrong with you. In the long-term, it can lead to widespread damage throughout the body and a wide range of conditions, such as cardiovascular disease. High ketone levels can be dangerous, and may lead to ketoacidosis. However, healthcare professionals may use a urine test if they cannot access a vein for a blood test, or if a person has anxiety or a fear of needles. Thank you, {{form.email}}, for signing up. Normal USG can range from 1.003 to 1.030; a value of less than 1.010 indicates relative hydration, and a value greater than 1.020 indicates relative dehydration.14 Increased USG is associated with glycosuria and the syndrome of inappropriate antidiuretic hormone; decreased USG is associated with diuretic use, diabetes insipidus, adrenal insufficiency, aldosteronism, and impaired renal function.14 In patients with intrinsic renal insufficiency, USG is fixed at 1.010the specific gravity of the glomerular filtrate. However, a person with diabetes should discuss their dietary plan with their doctor and seek advice on any nutritional changes they wish to make. In this article, we look at types of urine tests for diabetes and how to understand the results. Which of the following should be considered first? A blood glucose test is more accurate than a urine test and is often used to confirm the diagnosis of diabetes if a urine test is positive for glucose. The urine will be looked at for color and clearness. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Urinalysis is useful in diagnosing systemic and genitourinary conditions. A. According to the American Diabetes Association, symptoms of DKA include: Anyone who thinks they might have DKA should first check their blood sugar levels. Uncomplicated urinary tract infections diagnosed by positive leukocyte esterase and nitrite tests can be treated without culture. Liman, M., Jialal, I., Physiology, Glycosuria, StatPearls Publishing, 2021. If a person finds ketones in their urine, they should ask their doctor for advice. C. The patient may have diabetes mellitus. At your appointment with your healthcare provider, you will be given a container to collect a sample of your urine and instructions on the "clean catch" method to help ensure the sample is sterile. Your body gets rid of the excess through your urine., Gestational diabetes is a type of diabetes that happens during pregnancy. Pregnancy: Around half of women have glucose in their urine during pregnancy, even if they do not have diabetes. What is a urinalysis? Dipstick test. Urinalysis (UA) is used as a screening and/or diagnostic tool to detect substances or cellular material in the urine associated with metabolic disorders, renal dysfunction or urinary tract infections (UTI). A urinalysis is a simple test that looks at a small sample of your urine. Home tests are similar to these. In a person with diabetes, this can lead to diabetic ketoacidosis (DKA), a potentially fatal condition that needs emergency treatment. Forty-five (6.0% . Standards of medical care in diabetes 2019 abridged for primary care providers. Microscopic examination is an indispensable part of urinalysis; the identification of casts, cells, crystals, and bacteria aids in the diagnosis of a variety of conditions. Quiz, Neurological Tests of Major Importance Too much glucose can damage your organs and nerves, but your body does need enough sugar for energy.. He reports that he often has strong-smelling urine, but has no dysuria, urge incontinence, fever, or suprapubic pain. How reliable are home testing kits? Further evaluation of patients with glomerular and nonglomerular hematuria should include determination of renal function and 24-hour urinary protein or spot urinary protein-creatinine ratio. A urine glucose test is an indirect measure of your blood sugar (glucose) levels. In this setting, plain radiography of the kidneys, ureters, and bladder would be useful to determine the presence of a stent. It is characterized by an inability to produce enough insulin or use the hormone insulin properly, which causes blood sugar levels to be abnormally high. Sometimes a urine test can detect bilirubin, a substance which can indicate liver damage and certain other health conditions. Decreased glomerular filtration rate (GRT) is concentrating the urine too much C. The patient may have diabetes mellitus D. The patient has kidney failure C. A urinalysis (also known as a urine test) is a test that examines the visual, chemical and microscopic aspects of your urine (pee). In these assessments you'll be tested on: To learn more about sugar's effects on the body, have a look at the accompanying lesson titled Glucose Levels in Blood and Urine. One is a visual exam, which checks the color and clarity. A. Often, substances such as protein or glucose will begin to appear in the urine before patients are aware that they may have a problem. All rights reserved. English, science, history, and more. Gram staining can help guide antibiotic therapy, but it is not indicated in routine outpatient practice. A urine glucose test can be part of a urinalysis, a test to evaluate the content and chemical makeup of urine. 38 Cerebral edema predominantly. People sometimes call a urine test a dipstick test because it involves dipping a strip into the urine and reading the results using a color chart. In glomerular proteinuria, the most common type, albumin is the primary urinary protein. Inform the patient that he has a urinary tract infection, obtain a urine culture, and treat with antibiotics. This content is owned by the AAFP. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. It may also show presence of protein, ketones, bacteria, and/or casts. Knowing as soon as possible whether their blood sugar levels are high means a person can take measures to prevent the condition from worsening. High urine glucose levels may be an early sign of kidney complications. Treatment of asymptomatic bacteriuria is not recommended in nonpregnant adults, including those with prolonged urinary catheter use. The excess of glucose produced by the. 30 Survivors are at risk of residual neurologic problems. They should do the test in the morning before eating breakfast. Clean-catch specimens from female patients frequently are contaminated by vaginal flora. The decision to go to a lab or buy a urine glucose test online is one that you will make under the guidance of your healthcare provider, who will need to refer you to a lab. Renal glycosuria usually doesnt have any symptoms and doesnt need treatment. Exercise-induced hematuria is a relatively common, self-limited, and benign condition. Uric acid crystals are yellow to orange-brown and may be diamond- or barrel-shaped. Photo by Peter Dazeley/Getty Images What a Urine Glucose Test Measures Diabetes is a group of conditions that affect the body's ability to regulate blood sugar levels. ", Kids Health from Nemours Foundation: "Urine Tests.". It also may be recommended if diabetes is suspected. Everything You Need to Know About Blood Sugar Tests, 6 Blood-Sugar Friendly Foods to Eat During Diabetes Awareness Month. Simple steps to prevent diabetes. If the acid is abnormal, you could have, Glucose. Quiz & Worksheet - Blood & Urine Glucose Levels, Glucose Levels in the Blood and Urine The ADA recommend screening for type 2 diabetes from the age of 45 years or earlier if a person has risk factors, such as obesity. If ketone levels are high, they may need treatment in the hospital, with: Some low-carb diets can cause the body to break down fat and produce ketones for fuel. If you have signs of blood sugar problems, talk to your doctor., Diabetes Canada: Gestational Diabetes, What is diabetes?. , Diabetes causes glycosuria because there either isnt enough insulin, or your body cant use what's available. Use this quiz/worksheet combo to help you test your understanding of blood and urine glucose levels. Getting a diagnosis of diabetes can be shocking and life-altering, but the good news is that there are steps that you can help you take to maintain adequate control of your blood sugar levels. To ensure reliability, check that the test strips have not expired and follow the directions carefully. Causes of hematuria can be classified as glomerular, renal, or urologic35 (Table 16 ). Which of the following should be considered first? A doctor may offer regular screening for protein in the urine, as this can help detect kidney problems in the early stages, while there is still time to take preventive action. Some types like renal glycosuria and gestational glycosuria dont cause any symptoms.. A blood test is necessary to make a diagnosis. After one week of exposure, one third of strips give false-positive results, and after two weeks, three fourths give false-positive results.36 Non-nitratereducing organisms also may cause false-negative results, and patients who consume a low-nitrate diet may have false-negative results. A self-monitoring urine glucose test usually involves holding the test strip under a stream of urine or placing a test strip into a sample cup of urine that you have collected. copyright 2003-2023 Study.com. Which of the following bacterial infections is most worrisome to the clinician in regards to glomerular damage? Treat with 14 days of ciprofloxacin, and tailor further antibiotic therapy according to culture results. Once you have collected an ounce or two of urine, you will return the container to the healthcare provider, and it will be sent to the lab for analysis. Macroscopic Urinalysis: Characteristic Result Color Yellow Appearance Turbid Leukocyte Esterase 3+ Nitrite Results of his urinalysis with microscopy are shown in Table 5. Knowing about self-testing for both glucose and ketones can enable a person with diabetes to have more control over their condition. A. Cushing Syndrome: mutated vasa recta carries glucose to the kidney B. phenylketoneuria: inability to breakdown phenylalanine C. diabetes mellitus: A person with diabetes should speak to their doctor if they notice the following symptoms: People with kidney disease often do not notice any symptoms until the later stages, when the kidneys no longer work effectively. See permissionsforcopyrightquestions and/or permission requests. Urinalysis: A test that is done in order to analyze urine. There are three ways to analyze urine, and your test might use all of them. Treat with three days of ciprofloxacin (Cipro), and tailor further antibiotic therapy according to culture results. How does glucose change the color of pee? Because a urinary tract infection cannot be ruled out by the absence of an active urine sediment, a urine culture should always be performed in glucosuric animals, because infection is commonly present. 14 Increased USG is associated with. Which metabolic disorder would explain the results, and how does the glucose physically "spill over" into the urine? Quiz, Electrolytes in Urine: Normal Lab Values and Causes of Change It is important to note that urine tests will not indicate whether blood glucose levels are too low. Blood glucose levels become abnormally high after eating, the glucose is passed into your urine, and levels take longer to normalize., This is a temporary condition in healthy people, but it can be a sign of renal glycosuria. This is sometimes also called glucosuria., Normally, your body eliminates glucose in your urine when your blood sugar levels are too high. Etiologies include diabetes mellitus, Cushings syndrome, liver and pancreatic disease, and Fanconis syndrome. Quiz, Arterial Blood Gas and Acid Base Balance: Tests and Interpretation Still, urine glucose testing is a relatively inexpensive and quick way to assess your need for a follow-up blood glucose test for diabetes. Quiz, Urine Test Types: pH, Ketones, Proteins, and Cells, Urine Test Types: pH, Ketones, Proteins, and Cells Urinalysis results yield routine clinical information necessary for everyday diagnoses localized to the renal and urologic systems; findings such as pyuria indicative of cystitis or hematuria related to renal calculi are some commonplace examples. As a result, the body starts to break down fat to use for energy instead. He reports increased frequency of urination and nocturia, but does not have gross hematuria. Lifestyle strategies that have been shown to help keep blood sugar levels under control and prevent or delay complications of diabetes include: Diabetes is a complicated disease that requires daily self-management to keep blood sugars at healthy levels. Under normal circumstances, glucose is actively reabsorbed in the proximal convoluted tubule. There are three main causes of glycosuria:, Diabetes, called diabetes mellitus, is a condition where your body cant make enough insulin or use insulin properly. A urine test can detect various substances, including glucose, ketones, protein, bacteria, and bilirubin. In healthy persons, the glomerular capillary wall is permeable only to substances with a molecular weight of less than 20,000 Daltons. Typically, microscopic hematuria requires follow-up to ensure that there is not an underlying treatable etiology. What is the correct interpretation by the nurse. High blood sugar levels during pregnancy can cause problems for you and your baby: Your doctor might do in-office urine tests at your regular prenatal visits to check for glycosuria. Type 2 diabetes usually appears later in life and takes years to develop. On physical examination, he has a temperature of 39.6C and has mild right costovertebral angle tenderness. Urine normally does not contain detectable amounts of bilirubin. Blood may make urine look red or the color of tea or cola. Quiz, Crystals in Urine: Meaning and Causes Search dates: October 2012 and June 2013. [ corrected] To detect significant pyuria accurately, 30 seconds to two minutes should be allowed for the dipstick reagent strip to change color, depending in the brand used. A metabolic stone workup may be useful for prevention of future kidney stones, but it is not indicated in the acute setting. Ana Maria Kausel, MD, is a double board-certified endocrinologist affiliated with Mount Sinai St. Luke's/Mount Sinai West in New York City. What may be the primary cause of this edema? Although flank pain and urinalysis suggest possible pyelonephritis, this patient should not be treated for simple pyelonephritis in the absence of radiography to identify a stent. It can help find problems that need treatment, including infections or kidney problems. Urinalysis will reveal the presence of glucose. The normal odor of urine is described as urinoid; this odor can be strong in concentrated specimens but does not imply infection. Is the ketogenic diet right for autoimmune conditions? Asymptomatic bacteriuria is the isolation of bacteria in an appropriately collected urine specimen obtained from a person without symptoms of a urinary tract infection. This situation initially results in alkaline urine, but as the filtered load of bicarbonate decreases, the urine becomes more acidic. Be prepared with good lighting and a timer to help you accurately read the results. C. Treat with an antibiotic and repeat the urinalysis with microscopy. However, the doctor may also need to send the sample to a laboratory for culturing if they are testing for a UTI. The prevalence of asymptomatic microscopic hematuria varies among populations from 0.18% to 16.1%.4 The American Urological Association (AUA) defines asymptomatic microscopic hematuria as three or more red blood cells per high-power field in a properly collected specimen in the absence of obvious causes such as infection, menstruation, vigorous exercise, medical renal disease, viral illness, trauma, or a recent urologic procedure.5 Microscopic confirmation of a positive dipstick test for microscopic hematuria is required.5,7. It often develops later in life, but children who have obesity can also get type 2 diabetes. In this condition, lowmolecular-weight proteins predominate over albumin and rarely exceed 2 g per day. Pregnancy and kidney disorders are the most common nondiabetic causes of high glucose levels in urine. Type 1 diabetes usually develops in childhood or teenage years., Type 2 diabetes. A person with diabetes who finds ketones in their urine needs to seek medical advice to prevent the problem from getting worse. Cloudy urine often is a result of precipitated phosphate crystals in alkaline urine, but pyuria also can be the cause. Foam can be a sign of kidney disease, while cloudy urine may mean you have an infection. Urinalysis with microscopy has proven to be an invaluable tool for the clinician. Specific gravity provides a reliable assessment of the patients hydration status. A high sugar content is a marker for. Urine dipstick testing and microscopy are useful for the diagnosis of several genitourinary and systemic conditions.1,2 In 2005, a comprehensive review of urinalysis was published in this journal.3 This article presents a series of case scenarios that illustrate how primary care physicians can utilize the urinalysis in common clinical situations. Midstream clean collection is acceptable in most situations, but the specimen should be examined within two hours of collection. Epithelial cells often are present in the urinary sediment. The risk of DKA is also higher when a person with diabetes has a cold or flu. Routine urinalyses were abnormal less frequently than clinically indicated urinalyses (18.1% vs 39.6%) and when abnormal, were responded to less often (33.3% vs 75.4%). You may also want to drink fluids before you arrive at your appointment so that you can easily produce urine when asked to do so. Based on this patient's history, symptoms, and urinalysis findings, which one of the following is the most appropriate next step? Because toxins and excess fluid are removed from the body in urine, analysis of urine can provide important health clues. The test involves the examination of different aspects of the urine, including: appearance (cloudy or clear . This test is specific but not highly sensitive. WIthout insulin, blood glucose levels become too high, and your kidneys cant filter and reabsorb it. 2005 - 2023 WebMD LLC, an Internet Brands company. , contains very high levels of glucose, or the patient may . If you have a health savings account (HSA), you can also use those funds to cover the cost of glucose urine strips. Microscopic exam. Urinalysis and Kidney Disease: What You Need to Know. These cells are smaller and rounder than squamous cells, and they have larger nuclei. Hemolysis and hepatocellular disease can elevate urobilinogen levels, and antibiotic use and bile duct obstruction can decrease urobilinogen levels. If your pee has blood in it, it might be red or dark brown. A patient is taking a nephrotoxic drug. The presence of a ureteral stent causes mucosal irritation and inflammation; thus, findings of leukocyte esterase with white and red blood cells are not diagnostic for urinary tract infection, and a urine culture is required. Follow your doctors directions for handing over the sample. A doctor may test for protein in the urine to monitor for kidney problems. We avoid using tertiary references. the patient may have diabetes mellitus A critical care patient is to receive continual renal replacement therapy (CRRT). Although urine cytology is typically part of the urologic workup, it should be performed at the time of cystoscopy; the AUA does not recommend urine cytology as the initial test.5, After ureteroscopy with lithotripsy, a ureteral stent is often placed to maintain adequate urinary drainage.10 The stent has one coil that lies in the bladder and another that lies in the renal pelvis. Quiz, Amylase and Pancreatic Lipase: Causes & Associated Conditions Patients with ureteral stents may experience urinary frequency, urgency, dysuria, flank pain, and hematuria.10 They may have dull flank pain that becomes sharp with voiding. Visual exam. A urinalysis tests a person's urine for signs of disease, infection, or other issues. ", National Kidney Foundation: "What is a Urinalysis? However, a doctor may also prescribe medication or recommend hospitalization in some cases. Further evaluation of persistent proteinuria usually includes determination of 24-hour urinary protein excretion or spot urinary protein-creatinine ratio, microscopic examination of the urinary sediment, urinary protein electrophoresis, and assessment of renal function.32. In this article, learn, Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. The next steps depend on why you had the test in the first place. However, myoglobin and hemoglobin also will catalyze this reaction, so a positive test result may indicate hematuria, myoglobinuria, or hemoglobinuria. a "fruity" or acetone smell on the breath frequent urination thirst dry or flushed skin difficulty breathing confusion abdominal pain nausea and vomiting high blood sugar levels In severe cases, a. Usually. Ans: 3) Fatty tissue holds the kidneys in place. Normally, urine contains very little or no glucose. Do health insurance policies cover urine glucose tests? The doctor will compare the strip with a color chart to determine the level of glucose, ketones, and protein in the urine. Guidelines from the American Urological Association were also reviewed. It also can alert the physician to the presence of systemic disease affecting the kidneys. Copyright 2005 by the American Academy of Family Physicians. Choose an answer and hit 'next'. In most cases, it is necessary to compare the color of the strip against a color chart. Renal glycosuria is a rare inherited condition where your body eliminates sugar in your urine even though your blood levels are normal. As a result, excess sugar is excreted in the urine. Before an operation to screen for problems. A urinalysis involves checking the appearance, concentration and content of urine. This means that there is an infection with certain kinds of bacteria. If a person receives an early diagnosis of kidney disease, they may be better able to control it through diet and possibly medications. Although urinalysis is not recommended as a routine screening tool except in women who may be pregnant, physicians should know how to interpret urinalysis results correctly. Physical examination reveals an enlarged prostate. In these patients, five bacteria per HPF represents roughly 100,000 colony-forming units (CFU) per mL, the classic diagnostic criterion for asymptomatic bacteriuria and certainly compatible with a UTI. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. No matter the type, the following symptoms may be an early sign of diabetes: If you plan to take a urine glucose test at a healthcare providers office, you may want to bring with you a list of medications that you are taking, as some medications may affect your test results. If a doctor finds high levels of glucose, ketones, or protein in a persons urine, they may order further tests. Things the dipstick test can check for include: Acidity, or pH. In patients with suspected microscopic hematuria, urine dipstick testing may suggest the presence of blood, but results should be confirmed with a microscopic examination. ) A urinalysis reveals that the patient's urine contains glucose, hemoglobin, and white blood cells (pus). Often, lifestyle measures such as a healthful diet and exercise are key to reducing the risks of further complications. Dipstick tests for trace amounts of protein yield positive results at concentrations of 5 to 10 mg per dLlower than the threshold for clinically significant proteinuria.15 A result of 1+ corresponds to approximately 30 mg of protein per dL and is considered positive; 2+ corresponds to 100 mg per dL, 3+ to 300 mg per dL, and 4+ to 1,000 mg per dL.31,32 Dipstick urinalysis reliably can predict albuminuria with sensitivities and specificities of greater than 99 percent.4 Asymptomatic proteinuria is associated with significant renal disease in less than 1.5 percent of patients.4,33. All other trademarks and copyrights are the property of their respective owners. Visualization of intact erythrocytes on microscopic examination of the urinary sediment can distinguish hematuria from other conditions. Oral Glucose Tolerance Test: Uses and Results. If urine or other tests reveal high levels of protein, glucose, or ketones, the person should take measures to prevent any problems from getting worse. Ketonuria most commonly is associated with uncontrolled diabetes, but it also can occur during pregnancy, carbohydrate-free diets, and starvation. The presence of transitional epithelial cells is normal. A low-carb diet alone does not cause ketoacidosis and is different from DKA. A doctor may use a urine test to check for a urinary tract infection (UTI). Without treatment, this can lead to complications, such as a kidney infection. If you already have a kidney issue or urinary tract infection, your doctor may want to change your treatment plan. If an infection is present, they may prescribe antibiotics. If these are over 240 milligrams per deciliter (mg/dl), the ADA recommend testing for ketones. Phosphaturia, pyuria, chyluria, lipiduria, hyperoxaluria, Diet high in purine-rich foods (hyperuricosuria), Levodopa (Larodopa), metronidazole (Flagyl), nitrofurantoin (Furadantin), some antimalarial agents, Cascara, levodopa, methyldopa (Aldomet), senna, Amitriptyline (Elavil), indigo carmine, IV cimetidine (Tagamet), IV promethazine (Phenergan), methylene blue, triamterene (Dyrenium), Phenothiazines, phenazopyridine (Pyridium), Hematuria, hemoglobinuria, myoglobinuria, porphyria, Dehydration, exercise, hemoglobinuria, menstrual blood, myoglobinuria, Captopril (Capoten), elevated specific gravity, pH < 5.1, proteinuria, vitamin C, Elevated specific gravity, uric acid, vitamin C, Acidic urine, elevated specific gravity, mesna (Mesnex), phenolphthalein, some drug metabolites (e.g., levodopa), Elevated specific gravity, glycosuria, ketonuria, proteinuria, some oxidizing drugs (cephalexin [Keflex], nitrofurantoin [Furadantin], tetracycline, gentamicin), vitamin C, Contamination, exposure of dipstick to air, phenazopyridine, Elevated specific gravity, elevated urobilinogen levels, nitrate reductase-negative bacteria, pH < 6.0, vitamin C, Alkaline or concentrated urine, phenazopyridine, quaternary ammonia compounds, Acidic or dilute urine, primary protein is not albumin, Dextran solutions, IV radiopaque dyes, proteinuria, Cancer (kidney, ureteral, bladder, prostate, and urethral), Drugs (e.g., NSAIDs, heparin, warfarin [Coumadin], cyclophosphamide [Cytoxan]), Trauma (e.g., contact sports, running, Foley catheter), Collagen vascular diseases (e.g., systemic lupus erythematosus), Drugs (e.g., NSAIDs, penicillamine [Cuprimine], gold, ACE inhibitors), Infections (e.g., HIV, syphilis, hepatitis, post-streptococcal infection), Malignancies (e.g., lymphoma, solid tumors), May be a normal finding in patients who play contact sports, Pyelonephritis, glomerulonephritis, interstitial nephritis, renal inflammatory processes, Acute tubular necrosis, interstitial nephritis, eclampsia, nephritic syndrome, allograft rejection, heavy metal ingestion, renal disease, Nephrotic syndrome, renal disease, hypothyroidism.
Dr Scott Orthopedic Surgeon,
Articles A