Question

I am preparing for the American Board of Obesity Medicine.  After the exam, one has to provide fifteen case studies.  I looked at the checklist the board uses to make sure that everything is complete.  One of the things on the checklist for VLCD patients is a UA (to check for nephropathies or renal disease). As far as I know, there is no evidence to show that getting a UA is helpful beyond what is determined by serology.

Before I contact the board, I want to check with you about standard practice.  It makes sense if there is an abnormal creatinine, that a workup to determine the cause has been completed prior to the VLCD.  However, this is different than just a UA prior to every VLCD patient. 
What do you all do?


Treatment Recommendation

You are correct in that an initial UA doesn't need to be done and, if done, wouldn't exclude a person from doing a VLCD. I think a young patient with no chronic medical issues doesn't need one routinely. However, older people with diabetes, hypertension or other chronic medical issues should get one to screen for baseline proteinuria, which has long term implications and may actually improve with a VLCD. That's what we do. —Peter H. Jones, MD 


We order a UA for all patients but screening for hematuria and proteinuria beyond a history and chemistries would be low yield.  However, hematuria and proteinuria can be detectable before decreasing GFR such in a patient with Lupus or diabetes.  Regardless, these patients would benefit from weight loss. —Christopher Case, MD