A total of 12 test panels were collected on March 16, 2026. The majority of results fall within normal reference ranges. Your provider noted that labs are stable and the rheumatoid panel is normal.
Flagged Abnormal Results
| Test | Value | Reference Range | Flag |
|---|---|---|---|
| CO2 (Bicarbonate) | 19 mmol/L | 20 - 29 mmol/L | Low |
| LDL Cholesterol (Calc) | 102 mg/dL | 0 - 99 mg/dL | High |
| Vitamin D, 25-Hydroxy | 112 ng/mL | 30 - 100 ng/mL | High |
| Uric Acid | 2.6 mg/dL | 3.8 - 8.4 mg/dL | Low |
| Urine Glucose | 2+ | Negative | Abnormal |
| Urine Ketones | Trace | Negative | Abnormal |
| Urine Bilirubin | Positive | Negative | Abnormal |
Normal Highlights
Blood Counts
All CBC values normal. WBC, RBC, hemoglobin, hematocrit, and platelets well within range. Differential is balanced.
Kidney Function
Creatinine (1.0), BUN (22), eGFR (85), and microalbumin/creatinine ratio (4) all normal.
Liver Function
AST (25), ALT (12), ALP (96), Bilirubin (0.7), Albumin (4.5) all normal.
Diabetes Screening
HbA1c 4.9% is well within normal. Fasting glucose 95 is normal. But urine glucose 2+ is unexpected and noteworthy.
Thyroid
TSH 2.58 is mid-range normal. Thyroid function appears adequate.
Inflammatory Markers
ESR (11), RF (<10), ASO (56.6) all normal. No signs of systemic inflammation or autoimmune disease.
| Test | Your Value | Reference Range | Status |
|---|---|---|---|
| White Blood Cells (WBC) | 5.1 x10E3/uL | 3.4 - 10.8 | Normal |
| Red Blood Cells (RBC) | 4.48 x10E6/uL | 4.14 - 5.80 | Normal |
| Hemoglobin (Hgb) | 14.6 g/dL | 13.0 - 17.7 | Normal |
| Hematocrit (Hct) | 41.3% | 37.5 - 51.0 | Normal |
| MCV | 92 fL | 79 - 97 | Normal |
| MCH | 32.6 pg | 26.6 - 33.0 | Normal |
| MCHC | 35.4 g/dL | 31.5 - 35.7 | Normal |
| RDW | 12.3% | 11.6 - 15.4 | Normal |
| Platelet Count | 177 x10E3/uL | 150 - 450 | Normal |
| Neutrophils % | 66% | — | Normal |
| Lymphocytes % | 20% | — | Normal |
| Monocytes % | 9% | — | Normal |
| Eosinophils % | 4% | — | Normal |
| Basophils % | 1% | — | Normal |
| Neutrophils (Abs) | 3.3 x10E3/uL | 1.4 - 7.0 | Normal |
| Lymphocytes (Abs) | 1.0 x10E3/uL | 0.7 - 3.1 | Normal |
| Monocytes (Abs) | 0.4 x10E3/uL | 0.1 - 0.9 | Normal |
| Eosinophils (Abs) | 0.2 x10E3/uL | 0.0 - 0.4 | Normal |
| Basophils (Abs) | 0.1 x10E3/uL | 0.0 - 0.2 | Normal |
| Immature Granulocytes % | 0% | — | Normal |
| Immature Granulocytes (Abs) | 0.0 x10E3/uL | 0.0 - 0.1 | Normal |
Red Cell Indices (MCV + MCH + MCHC + RDW): Normal MCV (92 fL) with normal RDW (12.3%) means red cells are uniform in size. This rules out iron-deficiency anemia (low MCV, high RDW), B12/folate deficiency (high MCV), thalassemia trait (low MCV, normal RDW), and mixed nutritional deficiencies. Normal hemoglobin and hematocrit confirm no anemia of any type is present.
White Cell Differential: The neutrophil-to-lymphocyte ratio (66:20, approximately 3.3:1) is in the healthy range. Elevated ratios (>6) can suggest bacterial infection, physiological stress, or systemic inflammation. Your balanced differential makes active bacterial infection, viral infection (would elevate lymphocytes), parasitic infection or allergic reaction (would elevate eosinophils), and leukemia (would distort counts dramatically) all unlikely.
Platelets: At 177, these are in the lower-middle portion of normal. Normal platelet counts rule out immune thrombocytopenia, bone marrow suppression, and consumptive coagulopathies (DIC). The absence of immature granulocytes confirms the bone marrow is not under abnormal stress from infection or malignancy.
| Test | Your Value | Reference Range | Status |
|---|---|---|---|
| Glucose | 95 mg/dL | 70 - 99 | Normal |
| BUN | 22 mg/dL | 8 - 27 | Normal |
| Creatinine | 1.0 mg/dL | 0.76 - 1.27 | Normal |
| eGFR | 85 mL/min/1.73 | >59 | Normal |
| BUN/Creatinine Ratio | 22 | 10 - 24 | Normal |
| Sodium | 139 mmol/L | 134 - 144 | Normal |
| Potassium | 4.2 mmol/L | 3.5 - 5.2 | Normal |
| Chloride | 102 mmol/L | 96 - 106 | Normal |
| CO2 (Bicarbonate) | 19 mmol/L | 20 - 29 | LOW |
| Calcium | 9.1 mg/dL | 8.6 - 10.2 | Normal |
| Protein, Total | 6.9 g/dL | 6.0 - 8.5 | Normal |
| Albumin | 4.5 g/dL | 3.9 - 4.9 | Normal |
| Globulin, Total | 2.4 g/dL | 1.5 - 4.5 | Normal |
| Bilirubin, Total | 0.7 mg/dL | 0.0 - 1.2 | Normal |
| Alkaline Phosphatase | 96 IU/L | 47 - 123 | Normal |
| AST | 25 IU/L | 0 - 40 | Normal |
| ALT | 12 IU/L | 0 - 44 | Normal |
Glucose (95 mg/dL): Measures blood sugar level. At 95, this is normal but in the upper portion of the range (70-99). Combined with HbA1c of 4.9%, long-term blood sugar control is excellent. However, the presence of 2+ glucose in the urine despite a normal blood glucose is a notable discrepancy (discussed in the Urinalysis and Cross-Correlation sections).
BUN (22) & Creatinine (1.0): Waste products filtered by the kidneys. Normal values indicate effective kidney filtration. The BUN/Creatinine ratio of 22 is normal, suggesting adequate hydration. A ratio >20 can sometimes suggest mild dehydration or a high-protein diet, but at 22 this is within the normal range of 10-24.
eGFR (85): Estimates kidney filtration rate. Values >90 are ideal; 60-89 is classified as mildly decreased (CKD Stage 2) but is often age-appropriate. At 85, this is worth monitoring over time, especially in combination with other kidney markers. Your normal microalbumin/creatinine ratio (4) is very reassuring and rules out significant kidney protein leakage.
CO2/Bicarbonate (19 - LOW): Reflects acid-base balance. At 19 mmol/L, it is 1 point below the lower limit. This mildly low value can indicate a mild non-anion-gap metabolic acidosis. Common benign causes include diet (high protein/low carb), intense exercise, mild dehydration, or chronic diarrhea. Your anion gap calculates as: Na - (Cl + CO2) = 139 - (102 + 19) = 18, which is mildly elevated (normal typically <12-16). This mildly elevated anion gap combined with trace urine ketones could suggest a mild ketotic state, possibly from diet or fasting. This is generally not concerning as an isolated finding but worth mentioning to your provider.
Liver Panel (AST 25, ALT 12, ALP 96, Bilirubin 0.7, Albumin 4.5): All liver markers are squarely normal. Normal AST and ALT rule out hepatitis, fatty liver disease, drug-induced liver injury, and other active liver cell damage. Normal ALP with normal bilirubin rules out bile duct obstruction. Normal albumin confirms the liver is producing proteins adequately and also reflects good nutritional status. The albumin/globulin ratio is healthy at about 1.9. However, the positive urine bilirubin is a conflicting finding that merits attention (see Urinalysis section).
| Test | Your Value | Reference Range | Status |
|---|---|---|---|
| Total Cholesterol | 197 mg/dL | 100 - 199 | Normal |
| Triglycerides | 99 mg/dL | 0 - 149 | Normal |
| HDL Cholesterol | 79 mg/dL | >39 | Normal (Excellent) |
| VLDL Cholesterol (Calc) | 16 mg/dL | 5 - 40 | Normal |
| LDL Cholesterol (Calc) | 102 mg/dL | 0 - 99 | HIGH |
HDL (79 mg/dL) — Excellent: HDL is "good" cholesterol that helps remove LDL from arteries. Values >60 mg/dL are considered cardioprotective. At 79, this is exceptionally good and substantially reduces cardiovascular risk. HDL this high is associated with lower rates of heart attack and stroke and partially offsets a mildly elevated LDL.
LDL (102 mg/dL) — Mildly Elevated: LDL deposits cholesterol in artery walls and is the primary driver of atherosclerosis. The lab reference defines optimal as <100. At 102, this is "near optimal" (100-129 range) by ATP III guidelines. Risk interpretation depends on other cardiovascular risk factors such as age, blood pressure, smoking, diabetes, and family history. For a person with no other major risk factors, LDL of 102 is generally not alarming. For those with diabetes or existing heart disease, a target of <70 is often recommended.
Triglycerides (99 mg/dL) — Optimal: Triglycerides are fat molecules from food. Levels <150 are normal, and <100 is considered optimal. At 99, this is excellent. Elevated triglycerides are associated with insulin resistance, metabolic syndrome, and pancreatitis risk at very high levels (>500).
Total Cholesterol (197 mg/dL): Just 2 points below the upper limit of desirable (<200). The total cholesterol/HDL ratio is 197/79 = 2.5, which is excellent (ideal is <3.5 for men, <4.5 for women). This ratio is one of the best predictors of cardiovascular risk, and yours suggests low risk.
VLDL (16 mg/dL): VLDL carries triglycerides. Normal value confirms healthy triglyceride transport.
Combined Cardiovascular Risk Assessment: The excellent HDL, optimal triglycerides, and favorable total cholesterol/HDL ratio collectively indicate a low cardiovascular risk profile despite the mildly elevated LDL. The low triglyceride-to-HDL ratio (99/79 = 1.25) is an indicator of predominantly large, buoyant LDL particles (Pattern A), which are considered less atherogenic than small, dense LDL particles (Pattern B, associated with ratios >3.5).
| Test | Your Value | Reference Range | Status |
|---|---|---|---|
| Hemoglobin A1c | 4.9% | 4.8 - 5.6 | Normal |
Your HbA1c of 4.9% is firmly in the normal range, well below the prediabetes threshold of 5.7%. This corresponds to an estimated average glucose of approximately 94 mg/dL over the past 2-3 months, which correlates well with your fasting glucose of 95 mg/dL.
Significance with other tests: The combination of normal HbA1c (4.9%), normal fasting glucose (95), and normal microalbumin/creatinine ratio (4) effectively rules out diabetes and prediabetes. However, the presence of 2+ glucose in the urine despite normal blood sugar is a paradox that needs to be examined carefully. When glucose appears in urine despite normal blood glucose levels, it can indicate a condition called renal glycosuria, where the kidney tubules have a lower threshold for glucose reabsorption. This is a distinct condition from diabetes (see Cross-Correlations section for full analysis).
Reference scale: Normal: <5.7% | Prediabetes: 5.7-6.4% | Diabetes: >6.4% | Glycemic control goal for diabetics: <7.0%
| Test | Your Value | Reference Range | Status |
|---|---|---|---|
| TSH | 2.58 uIU/mL | 0.450 - 4.50 | Normal |
Cross-test relevance: Normal thyroid function is important context for interpreting other results. Hypothyroidism can cause elevated cholesterol, weight gain, fatigue, and abnormal lipid panels. Hyperthyroidism can cause weight loss, elevated glucose, and abnormal calcium. Since your TSH is normal, these conditions are not influencing your other lab values. Your normal cholesterol panel and normal calcium are consistent with euthyroid (normal thyroid) status.
| Test | Your Value | Normal | Status |
|---|---|---|---|
| Specific Gravity | 1.025 | 1.005 - 1.030 | Normal |
| pH | 5.0 | 5.0 - 7.5 | Normal (acidic end) |
| Color | Yellow | Yellow | Normal |
| Appearance | Clear | Clear | Normal |
| Leukocyte Esterase | Negative | Negative | Normal |
| Protein | Negative | Negative/Trace | Normal |
| Glucose, Urine | 2+ | Negative | Abnormal |
| Ketones | Trace | Negative | Abnormal |
| Blood | Negative | Negative | Normal |
| Bilirubin | Positive | Negative | Abnormal |
| Urobilinogen | 0.2 mg/dL | 0.2 - 1.0 | Normal |
| Nitrites | Negative | Negative | Normal |
Glucose 2+ (Abnormal): Glucose normally does not appear in urine until blood glucose exceeds approximately 160-180 mg/dL (the renal threshold). Your blood glucose was 95 and HbA1c was 4.9% — both solidly normal. Glucose in the urine with normal blood glucose is called renal glycosuria. This can be caused by:
• Benign familial renal glycosuria: A genetic variant affecting the SGLT2 transporter in the kidney, causing glucose spillage at normal blood sugar levels. This is generally harmless.
• SGLT2 inhibitor medication: Drugs like empagliflozin, dapagliflozin, or canagliflozin (used for diabetes or heart failure) deliberately block glucose reabsorption, causing glycosuria. If you take one of these medications, this finding is expected and therapeutic.
• Fanconi syndrome: A proximal renal tubular dysfunction (less likely given your other normal kidney markers).
• Pregnancy: Can lower the renal glucose threshold (not applicable here).
Ketones Trace (Abnormal): Ketones appear when the body burns fat for energy instead of glucose. Trace ketones can result from fasting, low-carbohydrate diet, intense exercise, or prolonged fasting before the blood draw. Combined with the low CO2 (19), this suggests a mild ketotic state possibly from fasting or a low-carb diet. In the absence of diabetes, trace ketones are usually benign.
Bilirubin Positive (Abnormal): Bilirubin in urine indicates the presence of conjugated (direct) bilirubin, which is water-soluble. The lab note suggests evaluating liver function if liver dysfunction is suspected. However, your serum liver enzymes (AST, ALT, ALP) and serum bilirubin (0.7) are all normal. Urine bilirubin can sometimes be a false positive from medications (such as certain vitamins, supplements, or drugs that color the urine), highly concentrated urine (your specific gravity is 1.025, which is on the concentrated side), or be an early marker of subclinical hepatobiliary changes. Given entirely normal liver blood work, a false positive or medication effect is the most likely explanation. This should be discussed with your provider.
Other UA Findings: Negative leukocyte esterase and nitrites rule out urinary tract infection. Negative protein and blood rule out glomerular disease, kidney injury, and urinary tract bleeding. The acidic pH (5.0) is consistent with the mildly low serum CO2 and trace ketones, supporting a mild metabolic acidosis picture. The urine specific gravity of 1.025 indicates concentrated urine, suggesting you may not have been well-hydrated at the time of collection.
| Test | Your Value | Reference | Status |
|---|---|---|---|
| Creatinine, Urine | 256.6 mg/dL | Not Estab. | — |
| Microalbumin, Urine | 10.3 ug/mL | Not Estab. | — |
| Microalbumin/Creatinine Ratio | 4 mg/g creat | 0 - 29 | Normal |
Cross-test significance: Combined with your normal creatinine (1.0), normal eGFR (85), and negative urine protein on dipstick, this provides strong evidence that your kidneys are functioning well with no signs of early damage. This is particularly important to monitor alongside the urine glucose finding — if the glycosuria is from a renal tubular issue, the fact that albumin handling is normal is reassuring and argues against generalized tubular dysfunction like Fanconi syndrome (which would typically show protein, glucose, phosphate, and amino acids all spilling into urine).
| Test | Your Value | Reference Range | Status |
|---|---|---|---|
| Vitamin D, 25-Hydroxy | 112 ng/mL | 30 - 100 | High |
Reference scale:
• Deficiency: <20 ng/mL
• Insufficiency: 21-29 ng/mL
• Sufficient: 30-100 ng/mL
• Your level: 112 ng/mL (above sufficient)
• Potential toxicity: >150 ng/mL
Clinical significance: Your level suggests you may be taking a vitamin D supplement. If so, a dose reduction may be reasonable to bring the level back into the 40-80 ng/mL range, which many experts consider optimal. The most important check for vitamin D excess is serum calcium — your calcium is 9.1 mg/dL, which is perfectly normal. If vitamin D were causing problematic excess, calcium would be elevated (hypercalcemia). Your normal calcium is very reassuring. Also note that your low uric acid (2.6) combined with elevated vitamin D has been discussed in the literature; high vitamin D levels can influence renal uric acid excretion, potentially contributing to low uric acid levels.
Interaction with other results: Normal calcium, normal ALP, and normal kidney function all suggest that the elevated vitamin D is not causing any downstream metabolic problems at this time.
| Test | Your Value | Reference Range | Status |
|---|---|---|---|
| Uric Acid | 2.6 mg/dL | 3.8 - 8.4 | Low |
• SGLT2 inhibitor medications: These drugs increase uric acid excretion through the kidneys, commonly lowering serum uric acid. This is a well-known and often beneficial effect of this drug class.
• High vitamin D levels: Some research suggests vitamin D may enhance renal excretion of uric acid.
• Low purine diet: Very low protein or low purine diets can reduce uric acid production.
• Renal tubular dysfunction: Conditions affecting the proximal tubule can increase uric acid loss (relevant to the glycosuria finding).
• Hereditary renal hypouricemia: Genetic variants in URAT1 or GLUT9 transporters.
• Liver disease: Reduced production (but your liver enzymes are all normal).
Key cross-correlation: Low uric acid combined with urine glucose (2+) is a notable pairing. Both uric acid reabsorption and glucose reabsorption occur in the proximal tubules of the kidney. If an SGLT2 inhibitor medication is being taken, it would elegantly explain BOTH findings simultaneously: the drug blocks glucose reabsorption (causing glycosuria) and also increases uric acid excretion (causing low serum uric acid). If no such medication is being taken, the combination could point to a proximal tubular transport variation.
| Test | Your Value | Reference | Status |
|---|---|---|---|
| RA Latex Turbid. | <10.0 IU/mL | <14.0 | Normal (Negative) |
Combined with ESR and ASO: The combination of negative RF, normal ESR (11 mm/hr), and normal ASO (56.6 IU/mL) collectively provides strong evidence against active rheumatoid arthritis, other systemic autoimmune diseases, and post-streptococcal inflammatory conditions. Your provider confirmed the rheumatoid panel is normal.
| Test | Your Value | Reference Range | Status |
|---|---|---|---|
| Sed Rate | 11 mm/hr | 0 - 30 | Normal |
How ESR works with other inflammatory markers: ESR is often paired with C-reactive protein (CRP) for a more complete picture, though CRP was not ordered in this panel. The combination of normal ESR with negative RF and normal ASO creates a comprehensive anti-inflammatory picture. If there were an active autoimmune process (RA, lupus, vasculitis), infection (endocarditis, abscess), or malignancy (lymphoma, multiple myeloma), the ESR would typically be elevated. Normal ESR also supports the interpretation that the mildly low CO2 is metabolic rather than due to an inflammatory process.
Disease correlation: ESR >100 mm/hr is seen in conditions like temporal arteritis, multiple myeloma, severe infection, or widespread malignancy. Values of 30-100 suggest moderate inflammation. Your value of 11 is solidly in the "no significant inflammation" category.
| Test | Your Value | Reference Range | Status |
|---|---|---|---|
| ASO Antibody | 56.6 IU/mL | 0 - 200 | Normal |
Why this test was ordered: ASO is often ordered alongside RF and ESR when evaluating joint pain, swelling, or symptoms suggestive of rheumatic disease. The combination screens for both autoimmune arthritis (RF) and post-infectious inflammatory arthritis (ASO), with ESR assessing overall inflammation. All three being normal is a very reassuring triad.
Cross-test relevance: Normal ASO combined with normal ESR and no urinary abnormalities (negative blood, negative protein) rules out post-streptococcal glomerulonephritis — a condition where strep infection triggers kidney inflammation, causing blood and protein in the urine and elevated inflammatory markers.
| Test | Your Value | Reference | Status |
|---|---|---|---|
| Lyme IgG WB Interpretation | Negative | Negative | Normal |
| IgG Antibody Bands (p93, p66, p58, p45, p41, p39, p30, p28, p23, p18) | All Absent | — | Normal |
| Lyme IgM WB Interpretation | Negative | Negative | Normal |
| IgM Antibody Bands (p41, p39, p23) | All Absent | — | Normal |
Understanding the bands: The IgG immunoblot requires antibodies to 5 or more of the 10 tested proteins for a positive result. The IgM requires 2 or more of 3 proteins. With zero bands detected in either class, this is an unequivocally negative result.
Why this was likely ordered: Lyme disease can cause joint pain and fatigue, symptoms that overlap with rheumatoid arthritis and other inflammatory conditions. It is commonly tested alongside rheumatologic panels (RF, ESR, ASO) in the evaluation of unexplained joint symptoms, especially in Lyme-endemic regions of the United States.
Combined interpretation: Negative Lyme + Negative RF + Normal ESR + Normal ASO = The entire infectious and inflammatory workup is negative, which is very reassuring.
A. The Glycosuria Paradox: Urine Glucose 2+ with Normal Blood Sugar
This is the most clinically significant correlation in your results. The finding of 2+ glucose in urine while blood glucose (95 mg/dL) and HbA1c (4.9%) are normal is unexpected and tells a specific story.
Involved tests: Fasting glucose (95), HbA1c (4.9%), Urine glucose (2+), Uric acid (2.6 — low), Microalbumin/creatinine ratio (4 — normal), Urine protein (negative), CO2 (19 — low), Urine ketones (trace)
Most likely explanations:
1. SGLT2 Inhibitor Medication (Most Likely if Taking One): Drugs such as empagliflozin (Jardiance), dapagliflozin (Farxiga), or canagliflozin (Invokana) work by blocking the SGLT2 protein in the kidney, which is responsible for reabsorbing glucose from the urine back into the blood. Taking one of these medications would perfectly explain: the 2+ urine glucose (drug's mechanism of action), the low uric acid of 2.6 (SGLT2 inhibitors increase uric acid excretion), the trace urine ketones (SGLT2 inhibitors can cause mild ketogenesis), and the slightly low CO2/bicarbonate of 19 (SGLT2 inhibitors can cause mild metabolic acidosis, a known concern called "euglycemic ketoacidosis" in extreme cases). If you are taking an SGLT2 inhibitor, ALL of these findings are expected pharmacological effects and not concerning.
2. Benign Familial Renal Glycosuria (If Not Taking SGLT2 Inhibitor): This is a genetic condition caused by variants in the SLC5A2 gene (which encodes the SGLT2 transporter). People with this condition spill glucose into the urine at normal blood sugar levels. It is generally benign and does not progress to diabetes. The low uric acid could be a separate finding or could indicate a broader proximal tubular transport variation.
3. Fanconi Syndrome (Less Likely): This involves generalized proximal tubular dysfunction. AGAINST this diagnosis: your urine protein is negative, microalbumin is normal, electrolytes are normal, and phosphate/bicarbonate are only minimally affected. Fanconi syndrome would typically show multiple spillages (glucose, amino acids, phosphate, uric acid, bicarbonate) — you only clearly show glucose and borderline low uric acid.
B. The Acid-Base Correlation: Low CO2 + Trace Ketones + Acidic Urine
Involved tests: CO2/Bicarbonate (19 — low), Urine ketones (trace), Urine pH (5.0 — acidic end), Urine glucose (2+)
These four findings paint a consistent picture of a mild metabolic acidosis with a possible ketotic component. The calculated anion gap is 18 (Na - Cl - CO2 = 139 - 102 - 19), which is mildly elevated above the typical 8-12 range.
Possible explanations: If taking an SGLT2 inhibitor, this represents a well-described mild euglycemic metabolic acidosis due to ketogenesis stimulated by urinary glucose losses. If not on medication, this could reflect fasting state before blood draw, a low-carbohydrate or ketogenic diet, recent vigorous exercise, or mild dehydration (supported by the concentrated urine with specific gravity of 1.025).
Clinical significance: A bicarbonate of 19 (just 1 below normal) with trace ketones is a very mild finding. It does not indicate diabetic ketoacidosis (DKA), which would show much more severely depressed bicarbonate (<15), high anion gap (>20), large ketones, and very elevated glucose. Your picture is orders of magnitude milder.
C. The Urine Bilirubin Paradox: Positive Urine Bilirubin with Normal Liver Enzymes
Involved tests: Urine bilirubin (positive), Serum bilirubin (0.7 — normal), AST (25 — normal), ALT (12 — normal), ALP (96 — normal), Albumin (4.5 — normal)
Urine bilirubin should only be positive when conjugated (direct) bilirubin is elevated in the blood, which occurs in liver disease or bile duct obstruction. Yet all your liver enzymes and serum bilirubin are perfectly normal.
Most likely explanation: This is most likely a false positive result. Urine dipstick bilirubin tests are susceptible to interference from certain medications, vitamins (especially vitamin C in high doses), food coloring, and highly concentrated urine. Given your specific gravity of 1.025 (concentrated) and completely normal liver function panel, a false positive is the most probable explanation. Alternatively, if you take any medications or supplements that produce colored metabolites in urine, these can cross-react with the bilirubin pad on the dipstick.
What to rule out: If this were a true positive, it could indicate very early intrahepatic cholestasis (bile flow impairment before enzyme elevation) or intermittent biliary obstruction. However, with entirely normal liver enzymes, normal serum bilirubin, and normal albumin, this scenario is very unlikely.
D. The Inflammatory/Autoimmune Panel: Clean Sweep
Involved tests: ESR (11 — normal), RF (<10 — negative), ASO (56.6 — normal), Lyme IgG/IgM (negative), WBC (5.1 — normal), CRP (not tested)
All inflammatory and autoimmune markers are negative. This combination rules out active rheumatoid arthritis (negative RF + normal ESR), post-streptococcal disease including rheumatic fever and post-strep glomerulonephritis (normal ASO + normal ESR + no urine blood/protein), active Lyme disease (completely negative immunoblot), systemic lupus erythematosus or vasculitis (normal ESR + normal WBC), and active infection of any kind (normal WBC + normal ESR + normal differential).
Clinical context: These tests were likely ordered as a workup for joint pain or musculoskeletal symptoms. The entirely negative panel suggests that any such symptoms are not caused by an inflammatory, autoimmune, or infectious process. Possible non-inflammatory causes of joint symptoms include osteoarthritis (degenerative), mechanical injury, vitamin D-related issues (though your level is actually high), or fibromyalgia.
E. Cardiovascular Risk Profile Integration
Involved tests: LDL (102 — borderline high), HDL (79 — excellent), Triglycerides (99 — optimal), Total Chol (197 — normal), Glucose (95 — normal), HbA1c (4.9% — normal), BUN/Creatinine (normal)
Your cardiovascular risk profile is favorable overall. The excellent HDL of 79 provides significant cardioprotection that offsets the mildly elevated LDL of 102. The total cholesterol/HDL ratio of 2.5 and triglyceride/HDL ratio of 1.25 both indicate low cardiovascular risk and favorable LDL particle size (large, buoyant Pattern A rather than small, dense Pattern B). Normal glucose and HbA1c mean diabetes is not contributing to cardiovascular risk. Normal kidney function (eGFR 85) with normal microalbumin ratio indicates no renal contribution to cardiovascular risk.
F. Kidney Function Comprehensive Assessment
Involved tests: Creatinine (1.0), BUN (22), eGFR (85), Microalbumin/creat ratio (4), Urine protein (negative), Urine blood (negative), Urine glucose (2+), Uric acid (2.6)
The glomerular function of your kidneys (filtering waste from blood) is normal, as shown by normal creatinine, eGFR, and microalbumin ratio. The tubular function shows a specific abnormality in glucose reabsorption (glycosuria) and possibly uric acid handling (low uric acid), but other tubular functions appear intact (normal electrolytes, normal phosphate implied by normal calcium). This pattern — normal glomerular function with selective tubular glucose loss — is characteristic of either SGLT2 inhibitor effect or benign renal glycosuria, rather than generalized kidney disease.
Based on the combination of all results, here is an assessment of various disease states — whether they are supported, ruled out, or require monitoring. Remember: these are analytical assessments based on lab values only. Clinical correlation by your physician is essential.
Diabetes Mellitus
Ruled OutEvidence: HbA1c 4.9% (well below 5.7% prediabetes cutoff), fasting glucose 95 mg/dL (normal). Normal microalbumin ratio rules out diabetic nephropathy. The 2+ urine glucose is NOT indicative of diabetes in this context — it represents renal glycosuria (glucose spillage at normal blood sugar levels), most likely from medication effect (SGLT2 inhibitor) or a benign renal tubular variant.
Progression notes: There are no signs of progression toward diabetes. HbA1c of 4.9% is firmly in the normal category. Continue routine annual screening.
Chronic Kidney Disease (CKD)
MonitorEvidence: eGFR of 85 is technically in the CKD Stage 2 range (60-89, mildly decreased), but this is very common and often age-appropriate. Creatinine is normal (1.0), BUN is normal (22), microalbumin/creatinine ratio is normal (4), and urine protein is negative. There is NO albuminuria, which is required for a CKD Stage 2 diagnosis when eGFR is 60-89.
Progression notes: Without albuminuria, an eGFR of 85 does not meet criteria for CKD Stage 2 diagnosis per KDIGO guidelines. The selective glycosuria with normal albumin handling suggests a tubular transport variation rather than kidney disease. Trend the eGFR over time to ensure stability. A declining eGFR trend would warrant closer evaluation.
Cardiovascular Disease / Atherosclerosis
Low RiskEvidence: LDL of 102 is borderline high, but the excellent HDL (79), optimal triglycerides (99), favorable total cholesterol/HDL ratio (2.5), and triglyceride/HDL ratio (1.25) indicate a low-risk lipid profile. No diabetes. Normal kidney function. Normal thyroid (ruling out secondary causes of dyslipidemia).
Progression notes: The LDL of 102 is classified as "near optimal" by ATP III guidelines. For primary prevention (no existing heart disease), lifestyle measures (diet, exercise) are typically recommended at this level before medication. If additional risk factors are present (hypertension, smoking, family history, age), your provider may consider more aggressive LDL targets. The outstanding HDL level provides substantial protection.
Rheumatoid Arthritis
Not SupportedEvidence: Negative RF (<10 IU/mL), normal ESR (11 mm/hr), normal WBC with balanced differential. The complete absence of inflammatory markers makes active RA very unlikely.
Progression notes: Note that approximately 20% of RA patients can be seronegative (negative RF). If joint symptoms persist, anti-CCP antibodies (more specific for RA than RF) and imaging may be warranted. However, normal ESR strongly argues against active inflammatory arthritis of any type.
Lyme Disease
Ruled OutEvidence: Completely negative IgG and IgM immunoblot. No antibodies to any B. burgdorferi proteins detected. Combined with normal WBC, normal ESR, and normal joint markers, there is no evidence of Lyme disease.
Progression notes: If you are in the early acute phase of Lyme disease (<2 weeks after tick bite), antibodies may not yet have developed. If strong clinical suspicion exists despite negative serology, retesting in 4-6 weeks or PCR testing may be considered. However, the completely negative panel makes Lyme disease very unlikely.
Post-Streptococcal Disease (Rheumatic Fever, Glomerulonephritis)
Ruled OutEvidence: Normal ASO (56.6 IU/mL), normal ESR, no urine blood, no urine protein, normal kidney function. The combination rules out both rheumatic fever and post-streptococcal glomerulonephritis.
Liver Disease
Not SupportedEvidence: Normal AST (25), ALT (12), ALP (96), total bilirubin (0.7), albumin (4.5), total protein (6.9). All liver markers are solidly normal. The positive urine bilirubin is likely a false positive given normal serum liver function.
Progression notes: The positive urine bilirubin is a minor discrepancy that may warrant repeat testing if your provider has any concern. For now, the liver function panel is entirely reassuring. Nonalcoholic fatty liver disease (NAFLD) is not suggested by these results (ALT is particularly low at 12).
Vitamin D Toxicity / Hypervitaminosis D
Monitor — Reduce SupplementationEvidence: Vitamin D level of 112 ng/mL exceeds the upper reference range of 100. However, serum calcium is normal (9.1 mg/dL), which is the most important check — vitamin D toxicity manifests through hypercalcemia. No symptoms of toxicity are evident from the labs (normal calcium, normal kidney function, normal ALP).
Progression notes: True vitamin D toxicity typically occurs above 150 ng/mL and manifests as hypercalcemia, nephrolithiasis (kidney stones), and nephrocalcinosis. At 112, you are above optimal but below toxicity. It would be prudent to reduce vitamin D supplementation (if taking) to bring levels into the 40-80 ng/mL range. Recheck in 3-6 months after dose adjustment.
Gout
Ruled OutEvidence: Uric acid of 2.6 mg/dL is well below the saturation point for monosodium urate crystal formation (~6.8 mg/dL). This level is far too low to cause gout. In fact, the therapeutic target for gout patients is <6.0, and your level is well below even that. Normal ESR also argues against an acute gout flare.
Anemia (All Types)
Ruled OutEvidence: Normal hemoglobin (14.6), hematocrit (41.3%), RBC count (4.48), MCV (92), MCH (32.6), MCHC (35.4), and RDW (12.3%). This rules out iron-deficiency anemia (would show low MCV, low MCH, high RDW), B12/folate deficiency (would show high MCV), anemia of chronic disease (would show low hemoglobin with normal or low MCV), thalassemia trait (would show low MCV with normal or slightly low hemoglobin), and hemolytic anemia (would show low hemoglobin with high reticulocytes and elevated bilirubin).
Thyroid Disorders
Ruled OutEvidence: TSH 2.58 uIU/mL is solidly mid-range normal (0.45-4.50). This rules out both hypothyroidism and hyperthyroidism. Normal cholesterol and normal calcium are consistent with normal thyroid function.
SGLT2 Inhibitor Effect Profile (If Applicable)
Medication Effect — ExpectedIf you are taking an SGLT2 inhibitor (Jardiance, Farxiga, Invokana, etc.): The following constellation of findings represents the expected pharmacological effect of this drug class:
• Urine glucose 2+ — The drug's primary mechanism of action (blocking glucose reabsorption)
• Low uric acid 2.6 mg/dL — SGLT2 inhibitors increase urinary uric acid excretion (a beneficial cardiovascular side effect)
• Trace urine ketones — SGLT2 inhibitors can stimulate mild ketogenesis
• Low CO2/bicarbonate 19 mmol/L — Mild metabolic acidosis is a recognized class effect
• Normal blood glucose and A1c — The drug works by causing glucose loss through urine rather than lowering blood production
If you are NOT taking any SGLT2 inhibitor: The combination of glycosuria with normal blood sugar and low uric acid suggests either benign familial renal glycosuria or a mild proximal tubular transport variation. The normal microalbumin ratio and negative urine protein argue against more serious tubular diseases. Genetic testing for SLC5A2 variants could confirm benign familial renal glycosuria if desired.
Metabolic Syndrome
Not MetCriteria assessment (3 of 5 required for diagnosis):
• Waist circumference: Not measured in labs
• Triglycerides ≥150: NO (yours: 99)
• HDL <40 (men) or <50 (women): NO (yours: 79)
• Blood pressure ≥130/85: Not measured in labs
• Fasting glucose ≥100: NO (yours: 95)
Of the three lab-based criteria, you meet zero. Your lipid profile and glucose are in excellent territory for metabolic syndrome assessment.
Positive Findings
Excellent Blood Sugar Control
HbA1c 4.9% and fasting glucose 95 demonstrate excellent glycemic status with no evidence of diabetes or prediabetes.
Strong Cardiovascular Profile
Exceptional HDL of 79, optimal triglycerides, and favorable cholesterol ratios indicate low cardiovascular risk despite borderline LDL.
Healthy Kidney Function
Normal creatinine, eGFR, and microalbumin ratio show kidneys are functioning well with no protein leakage.
Clean Inflammatory Workup
Normal ESR, negative RF, normal ASO, and negative Lyme panel rule out inflammatory, autoimmune, and infectious causes of joint symptoms.
Normal Liver Function
All liver enzymes, bilirubin, albumin, and protein are solidly normal.
Normal Thyroid
TSH mid-range normal. No thyroid contribution to any symptoms.
Items to Discuss with Your Provider
1. Urine Glucose 2+ with Normal Blood Sugar
Clarify whether you are taking an SGLT2 inhibitor. If yes, this is an expected drug effect. If no, this may represent benign familial renal glycosuria. Ask whether further evaluation is warranted.
2. Vitamin D Level of 112
Discuss your current vitamin D supplementation dose. A reduction is likely appropriate to bring levels into the 40-80 ng/mL optimal range. Your normal calcium is reassuring, but sustained levels above 100 are unnecessary and potentially risky.
3. Low Uric Acid (2.6)
Ask whether this is related to medication or requires further evaluation. If taking an SGLT2 inhibitor, this is expected. If not, it may suggest increased renal excretion.
4. LDL Cholesterol (102)
Discuss your overall cardiovascular risk and whether the borderline LDL warrants lifestyle modification or monitoring. Your excellent HDL and favorable ratios are strong protective factors.
5. Positive Urine Bilirubin
Given normal liver function, this is likely a false positive. Ask whether repeat testing or a fractionated bilirubin test is warranted to confirm.
Sample report — anonymized example of BloodWorker output.
Based on lab results collected March 16, 2026. All identifying information has been removed.
This is not a medical document. Consult your physician for medical advice.