In the US legal system, judicial decisions create legal precedents that guide judges in deciding similar future cases. The decisions of the highest court in a jurisdiction create mandatory precedent that must be followed by lower courts in that jurisdiction.
Usually a bubble echo is looking for an opening between the top 2 chambers in the heart. During a regular echo, which is totally noninvasive, they inject some saline with a small amount of air into an IV. That is the only invasive part of the test. They then look at the screen and see where the bubbles go. In a negative study, they all go over to the left side of the heart. In a positive study, some don't go to the left side, indicating a possible connection or small hole in the heart. It is totally painless; I have had 2 done.
However, bubbles in urine can in some cases normal and does not definitely mean kidney problem. To know how much bubbles in urine mean kidney problem, we need first make clear the differences and relationships between several terms---bubbly urine, foamy urine and proteinuria. Bubbly urine and foamy urine are the same and it means there are obvious bubbles or foams in urine. In such case, the bubbles can be caused by kidney disease, Diabetes or it can be due to dehydration, pregnancy or just because of too much protein intake or too fast urination. Proteinuria is a typical sign of kidney disease due to damaged renal filtration system. In routine urine test, proteinuria can be detected. In case of proteinuria, there will be noticeable bubbles in urine. However, some cases of bubbles in urine may not mean proteinuria.