Frequently Asked Questions
Dilute UAs
Q:
A:
What is a “normal” creatinine?
Most normal urine samples will have a creatinine value between 20-350 mg/dL, (milligrams per deciliter)
with the norm around 100 mg/dL. Creatinine levels will differ between women and men (related to muscle
mass), age (as we age we produce less creatinine typically due to less muscle mass), and certain medical
conditions.
Q:
A:
What constitutes a “dilute UA”?
When the creatinine falls below 20 mg/dL. Drugs are present in the urine in proportion to the urine
concentration. When the urine is less concentrated, there is a lower concentration of drugs. When the urine
is too dilute, a negative result does not assure non-drug use. Norchem measures the urine creatinine level
on every specimen tested and reports when the specimen is too dilute. Dilute urine will be considered a
positive drug test.
Q:
A:
Is it “normal” to have a urine sample less than 20 mg/dL of creatinine?
The medical literature states that less than 1-2% of the population will have a UA with a creatinine below
20 mg/dL. A dilute UA is considered rare. PAS interprets dilute UAs as very serious as we cannot be
assured that drug/alcohol usage is not occurring.
Q:
A:
Why is Creatinine used as the standard for determining urine concentration?
Creatinine is produced as a result of muscle metabolism; it is produced by the body at a relatively constant
rate throughout the day; it is a compound that is unique to biological material (i.e., urine, other body
fluids); it can determine the “strength” or concentration of a urine sample and ensure the sample is urine.
Q:
What are my responsibilities when it comes to producing a urine sample that meets the
cutoff of greater than 20 mg/dL of creatinine?
It is your responsibility to produce a urine sample that is above the 20 mg/dL cutoff for creatinine. This
may mean that you have to reduce your liquid intake and cutback or stop consuming caffeine, herbal teas,
etc. Failure to provide a specimen suitable (urine creatinine greater than 20 mg/dL) for testing will be
considered a positive test for alcohol/drugs and your respective regulatory board may be notified. Most
people will comply unless they are attempting to mask their drug use.
A:
Talk with your physician if you are prescribed medications that could be a diuretic that may cause dilute
UAs. You will also need to talk with your case manager to discuss your situation in further detail.
Q:
A:
What happens if I do not produce a urine specimen or if I do not produce enough urine?
It will be considered a positive test for drugs/alcohol and your respective regulatory board may be
notified.
Q:
A:
What happens if I miss a test?
Contact your case manager as soon as you realize you missed a test. Complete a UA the next day. If it is
the weekend, a holiday, or after 5pm, call the after-hours phone (720-291-3209) for Peer Assistance
Services.
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Q:
A:
What causes a “dilute UA”?
The most common way for a donor to produce a urine specimen with a creatinine level below 20 mg/dL is
to drink large quantities of liquid and/or take diuretics prior to providing a specimen. This is referred to as
“internal flushing.”
Diuretics, some antibiotics, some medications, herbal teas, caffeine, poppy seeds, goldenseal, dandelion
and other herbs will likely cause a dilute UA.
Creatinine can vary due to kidney disease, diets high in meats, certain medications, as well as age, gender,
and metabolism. However, rapid intake of copious amounts of fluids, particularly when the client has
ingested a diuretic, can dramatically increase urine production in a state of polyuria that produces diluted
samples (very low creatinine levels - less than 20 mg/dL). Conversely, a simple case of dehydration can
dramatically increase urine creatinine levels 2-3 fold.
Q:
A:
Am I allowed to have coffee, tea, or other caffeinated drinks?
It is your responsibility to know what you are consuming (eating, drinking, etc.), as well as how much you
are consuming. It is your responsibility to avoid products and foods that could dilute your urine or lead to a
positive drug/alcohol test. You may have to change your drinking patterns in order to have a urine sample
above 20 mg/dL.
Q:
A:
What can I do to prevent dilute UAs?
Complete your UA first thing in the morning with your first urine of the day because it is typically more
concentrated and should have a higher creatinine. Another option is to urinate, do not consume any fluids,
and then complete your UA with your next urination. Each person’s body chemistry can be different and
results from the suggestions can vary.
Restrict your fluids prior to testing. Consume no more than 12 oz of fluid during the hour prior to providing
a urine sample.
Avoid caffeinated drinks (e.g., soda’s, tea, coffee, energy drinks, etc.) as these act as a diuretic and create
“internal flushing” which creates dilute UAs. See list of caffeinated drinks.
Ask the collection site to throw away your first urine specimen if you think you produced a dilute urine
specimen (urine is typically clear or straw colored). Wait in the lobby area and do not leave until you are
ready to complete another UA. This may take up to an hour but you will likely produce an adequate
specimen above a creatinine level of 20 mg/dL.
Q:
A:
What do I do if I receive a call from my case manager that I had a “dilute UA”?
Re-test the same day you are called by your case manager or PAS staff and leave a message for your case
manager that you completed a UA.
Q:
A:
Why is a dilute UA so serious?
Drugs are present in the urine in proportion to the urine concentration. When the urine is less concentrated,
there is a lower concentration of drugs. When the urine is too dilute, a negative result does not assure nondrug use. Therefore, PAS considers it a positive test for drugs/alcohol. Conversely, a positive result on a
dilute specimen would not be disqualified, because this indicates that the drug was in such high
concentrations that it was detected even with a low urine concentration.
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Q:
A:
What do I do if I get more than one dilute UA?
Follow PAS’s dilute UA policy. A dilute UA does not necessarily mean that subversive action is occurring
to mask the results of the UA. It does mean, however, that something is askew. More than one dilute UA
means that you need to get medically evaluated to further understand what is causing your dilute UAs. It is
your responsibility to ensure that your urine specimens meet the cutoff of greater than 20 mg/dL of
creatinine.
Q:
A:
Why should I get medically evaluated?
Creatinine is a break-down product of muscle metabolism in the body. It is produced in the body at a
constant rate and is excreted through urine. Creatinine is not reabsorbed into the body from the kidneys.
Hence, any failure on the part of the kidneys to excrete creatinine results in rise of creatinine levels in the
blood. Variations from normal creatinine levels could indicate kidney dysfunction and muscle problems
(like rhabdomyolysis). Hence, tests are conducted to find out creatinine levels in blood and the amount of
creatinine expelled through urine. These tests are usually performed as screening tests for evaluating kidney
function.
Most likely you will need to be seen by a Nephrologist for an evaluation to see what is causing your dilute
UAs. We will walk you through the steps to get medically evaluated.
Q:
Can working out/exercising cause a dilute UA?
Working out or doing “heavy exercising” is more likely to increase your creatinine. However, if you are
drinking water heavily during this period, which would equate to “internal flushing”, you are likely to end
up with a dilute UA.
Q:
It is possible for a client to achieve a normal urine creatinine greater than 20 mg/dL under extreme
conditions (e.g., heat).
Normal hydration would not cause a dilute UA even under extreme conditions. However, if you are
"internally flushing", meaning drinking copious amounts of water, this will likely produce a dilute UA.
A:
If you are anticipating exercising, working in extreme heat, etc. you may want to consider completing your
UA at the beginning of the day.
Q:
A:
Does specific gravity correlate with urine creatinine?
Specific gravity does not always correlate with creatinine levels and as a separate test is not helpful as it
does not yield any additional information. Norchem typically runs a specific gravity for creatinine’s that are
5 or under.
Q:
A:
Does eating protein 2-4 hours before I drop a UA increase my creatinine levels?
According to medical research, eating protein does not increase urine creatinine. It does increase blood
creatinine but this is not correlated to urine creatinine.
Eat a proper diet if you have kidney problems. It may help the kidneys function better which in turn will
increase the amount of creatinine in the urine. Creatinine level is not directly affected by diet, however,
proper functioning of the kidneys is affected by diet.
Please note: Substituting or altering urine specimens or trying in any way to modify body fluids for the
purposes of changing the drug testing results will be considered as a positive test for drugs/alcohol and will
result in a notification to your respective board.
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