Hematuria and Proteinuria May Signal Chronic Kidney Disorder

Q: I am 27 years old, 115 pounds and typically in relatively good health. In 2009, I developed a UTI for which I was treated with antibiotics. Since then, a few times a year I get severe pain in my lower right back and side for several weeks. The pain feels the same as the one that I had with the UTI.  So I suspect it is my kidney and is consistent with the location. Last year my doctor suggested that I may have kidney stones but didn’t do any tests at that time.

For the last several weeks the pain is back. Prior to that, for the last several months I have noticed more frequent urination particularly at night. I always have to get up at least once during the night, even though take limited amount of liquids before bed. I’ve also been fatigued and had a slight metallic taste in my mouth periodically, although I attributed that to a lingering cold. I get out of breath easily and often wake up at night sweating and breathless, even though the room is cool. I went to the doctor about the pain and my blood pressure was extremely high. I don’t have the exact number, but she seemed very concerned and made me lay down for ten minutes. When she took it again, it was better but still on the high side. My blood pressure has gotten progressively higher over the last two years. She did a urinalysis and found no infection but blood and protein in my urine. She said it was fine, since I was menstruating. Since then, I have done some reading and found that urinary protein is considered an abnormal finding.

They did an ultrasound and the doctor said my kidney appeared abnormally dense. She didn’t really tell me what this could mean and I can not find much online. I am going to have more blood tests next week but, frankly, I am concerned my doctor is not looking for the right things. She keeps telling me, based on nothing, that the pain is probably just muscle related. She keeps telling me to do stretches but I definitely feel the pain is internal. If combined with the other symptoms, it is probably related to kidney. I had to implore her to get the renal ultrasound in the first place because she only wanted to do a pelvic ultrasound for some reason. The results of the pelvic ultrasound were normal.

Can you tell me what this could mean? What the next steps should be so I can make sure they are testing for the right thing? I feel like something is definitely wrong and that my doctor is being dismissive. I do not want it to affect my ability to have children in the future.

Reply:

The overall picture does point towards some kidney disorder.

Kidney stones, tumors or other masses usually show up on ultrasound as dense shadow ‘spots’. Since your ultrasound has not shown anything of that sort, such lesions are unlikely.

The picture matches with a condition of the kidney called glomerulonephritis. Although, nothing can be said with surety. We require investigation to confirm the diagnosis.

What Is Glomerulonephritis?

Our kidney is a bean shaped structure. The upper part of the kidney contains a tuft of tiny tubules. This tuft is kept in a cup like structure draining into the ureter.

The tiny tubules are the main filtering unit of the kidney. They are highly porous and filter out body waste (toxins) along with water. This fluid gets collected in the cup-like structure below.

The fluid flows from this cup, through the ureter, to enter the urinary bladder where it is stored and released periodically as per nature’s call.

The tiny tubules are called glomeruli. An inflammation of these tubules is called glomerulonephritis.

Reasons Leading to Inflammation of Glomeruli

• It may be an autoimmune cause. The immune system sometimes produces antibodies against its own tissues. The exact cause of this erroneous work is not clearly known.
• Glomerulonephritis may be a part of some broader disorder like SLE or vasculitis.
• Sometimes, this condition is post infectious. It may follow some infective condition like streptococcal throat infection, endocarditis, viral infections etc.
• Too much consumption of pain relievers may lead to it.
• Exposure to hydrocarbon solvents also contribute.

Diagnostic Symptoms

The condition is characterized by reduced kidney function and complications due to it.

An increase in blood pressure follows most of the kidney disorder. Since the increase in your case is quite rapid, it hints that glomerulonephritis is of progressive kind. Quick intervention is probably required.

How to Confirm the Diagnosis?

Diagnosis is confirmed only by kidney biopsy. A small tissue sample is taken via a syringe from the kidney and examined under the microscope. You may require a local anesthesia for it.

Some blood work needs to be done. This is to investigate into the cause of glomerulonephritis.

It would include testing blood for specific antibodies as Anti-glomerular basement membrane antibody, Anti-neutrophil cytoplasmic antibodies (ANCAs) and Anti-nuclear antibodies.

Urine analysis needs to be repeated to test the presence of blood and protein (since you were menstruating then).

You may talk with your doctor about these investigations. A thorough evaluation is definitely required for earliest medical intervention.

Treating Inflammation of Glomeruli

• Treatment focuses on controlling symptoms like high blood pressure and anemia.
• Corticosteroids are usually given.
• Specific medications to suppress the immune system are given.

Taking less of salt, potassium and protein in your diet would benefit.

Take Care,

Buddy M.D.