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Urology (Expert Forum)
mystery, no one can tell me whats going on
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
mystery, no one can tell me whats going on
by lilwe, Sep 18, 2003 12:00AM
Hello, first of all I would like to ask what these readings mean, they are from a urinalysis I had done. Everything was normal except my
osmolality which said normal range is 300-800 mine was 885
microscopy was abnormal
rbc (norm 1-3) mine 4-10
wbc 4-10
this has been going on for over a year now. In the past two years I have had a cystoscopy, 2 ivp's and a renal ultra sound which shows a 2cc simple cyst. alll normal. they are not sure ifthe cyst is is causing microscopic blood in my urine.
i have also had 5 pelvic surgeries in the last 15months for removal of ovary, adhesions, endometriosis, etc. After the 4th surgery I tested positive for RA, with a slightly elevated RF factor of 26. My rheumatoid doc doesn't think I have this, at least not as of yet, she thinks because my liver enzymes were borderline due to some meds I am taking this could have raised my RF factor. I am still having problems in my lower back that came on after the last surgery, as well as swelling way below my knee and way above my ankle,(not in my joints), also some swelling on the opposite side of my elbows which she said is soft tissue, this she thinks could also be surgery related. myknees do ache alot and never stop my one middle finger in right hand is achy and swolen and I also have a lump in my right upper arm that throbs(mri shows normal), it is right near my bicep(i think thats the muscle). when that gets really hurting so doesmy finger.
I may also have a dislocation of my sacro iliac joint from these surgeries causing the lower back painand knee pain. No one can tell me anything for sure All these pains are becoming so varied that diagnosing me is getting to be a chore. i am being misdiagnosed. anyways, I just wanted to get your take on my readings.
osmolality which said normal range is 300-800 mine was 885
microscopy was abnormal
rbc (norm 1-3) mine 4-10
wbc 4-10
this has been going on for over a year now. In the past two years I have had a cystoscopy, 2 ivp's and a renal ultra sound which shows a 2cc simple cyst. alll normal. they are not sure ifthe cyst is is causing microscopic blood in my urine.
i have also had 5 pelvic surgeries in the last 15months for removal of ovary, adhesions, endometriosis, etc. After the 4th surgery I tested positive for RA, with a slightly elevated RF factor of 26. My rheumatoid doc doesn't think I have this, at least not as of yet, she thinks because my liver enzymes were borderline due to some meds I am taking this could have raised my RF factor. I am still having problems in my lower back that came on after the last surgery, as well as swelling way below my knee and way above my ankle,(not in my joints), also some swelling on the opposite side of my elbows which she said is soft tissue, this she thinks could also be surgery related. myknees do ache alot and never stop my one middle finger in right hand is achy and swolen and I also have a lump in my right upper arm that throbs(mri shows normal), it is right near my bicep(i think thats the muscle). when that gets really hurting so doesmy finger.
I may also have a dislocation of my sacro iliac joint from these surgeries causing the lower back painand knee pain. No one can tell me anything for sure All these pains are becoming so varied that diagnosing me is getting to be a chore. i am being misdiagnosed. anyways, I just wanted to get your take on my readings.
Doctor's Answer
by Kevin Pho, MD, Sep 21, 2003 12:00AM
, Sep 21, 2003 12:00AM
The urine osmolality is a measure of how concentrated the urine is. You have a level suggesting the urine is concentrated. There are several reasons for this. The most obvious is that you are dehydrated, and the body is absorbing more water than usual, resulting in a more concentrated urine.
There are more uncommon causes, such as SIADH (the syndrome of inappropriate ADH release). This is a problem associated with many neurological disturbances, medications, surgery, or pulmonary disease that leads to low serum sodium. To further evaluate for this, I would check the sodium level in your blood.
The elevated RBC's suggests blood in the urine. Causes can include infection, bladder/urethral tumors, or kidney diseases amongst others. You already have had a comprehensive evalation for this - it is unlikely that cancer would be the cause if you had multiple cystoscopies and IVPs. I would continue to monitor this serially - perhaps periodic cystoscopies can be discussed to ensure that cancer is not the reason.
The elevated WBC's suggests some kind of inflammatory response. The most obvious cause is a UTI or other genitourinary infection. If you are having symptoms (i.e. burning on urination, urinary frequency etc.) - I would treat this with antibiotics and recheck the UA in 1 month. If you are asymptommatic, I would continue to observe and follow serial UAs.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
There are more uncommon causes, such as SIADH (the syndrome of inappropriate ADH release). This is a problem associated with many neurological disturbances, medications, surgery, or pulmonary disease that leads to low serum sodium. To further evaluate for this, I would check the sodium level in your blood.
The elevated RBC's suggests blood in the urine. Causes can include infection, bladder/urethral tumors, or kidney diseases amongst others. You already have had a comprehensive evalation for this - it is unlikely that cancer would be the cause if you had multiple cystoscopies and IVPs. I would continue to monitor this serially - perhaps periodic cystoscopies can be discussed to ensure that cancer is not the reason.
The elevated WBC's suggests some kind of inflammatory response. The most obvious cause is a UTI or other genitourinary infection. If you are having symptoms (i.e. burning on urination, urinary frequency etc.) - I would treat this with antibiotics and recheck the UA in 1 month. If you are asymptommatic, I would continue to observe and follow serial UAs.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
