I’m here for a DOT physical, why are they making me do a urine test?
When patients come to see me for their DOT physical, they are often surprised they have to provide a urine sample. “I have to do a drug test right now?” is the most common response I get, but this is not a drug test, it is a simple urinalysis. Your Certified Medical Examiner (CME) will be testing your urine for three specific things: glucose, protein and blood. In a normal healthy patient, none of these will be present in their urine. However, it is not uncommon to see glucose, protein or blood and it does not necessarily mean you have a serious underlying illness.
Glucose in the urine (glycosuria) can be a sign of several different problems but the majority of patients with glycosuria are suffering from diabetes mellitus. When the blood levels of glucose remain too high for too long, the kidneys are no longer able to reabsorb this sugar so it begins to spill out into the urine. Other less common kidney diseases and even some medications can cause glycosuria but they are not the usual culprit. If your CME tells you there is glucose in your urine, they may do a fingerstick glucose level. Either way, you will need to see your primary doctor to follow up on this abnormal finding. It is up to the CME whether or not to allow you continue to drive at this point. Based on a number of factors, the CME may put your examination on hold until you see a primary doctor or they may certify you for a short time frame while allowing you to go see a primary doctor.
Protein in the urine (proteinuria) can mean a number of things. A normal kidney does not allow significant amounts of protein to be released into the urine. Damage to the kidneys through hypertension and diabetes are common causes of proteinuria. Other cause of proteinuria are medication related, toxin exposure, infections, etc. All of these will require further testing to rule out any serious underlying disease. As with glycosuria, discretion is left to the CME.
Blood in the urine (hematuria) may be invisible to the naked eye but can be detected by a urine dipstick. As with glucose and protein, blood in the urine is not normal. Kidney stones, bladder or kidney infections, certain types of cancer can all cause blood in your urine. Like both glycosuria and proteinuria, hematuria can be a sign of a serious underlying illness. The CME may certify you to drive or place you on hold while you complete further testing with your doctor.
The urinalysis is a required and important part of the DOT medical examination. It allows a quick glance at your health. An abnormal test result needs to be followed up with further testing from your primary doctor. I have discovered patients with untreated diabetes, cancer, kidney disease and other issues much sooner than had they waited for symptoms to appear. A DOT urinalysis might just save your life.