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Creatinine Clearance and Film on top of Urine.
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Creatinine Clearance and Film on top of Urine.

32 yr female vegetarian.

Beginning October 09, I started noticing a weird film on top of my urine every single time I urinated, regardless of concentration.  It's always there - sometimes looks like I emptied a whole capsule, swirled it around and it just sits on top of the urine.  It's not from any type of product I use, it's coming from inside.

I had a CT scan with contrast (for an ovarian issue, ruptured cyst) back in the end of May 09.  That was totally normal, except for the cyst. Problems didn't start until after CT scan (4 months later).

I had a renal u/s in November due to this odd film and flank pain and that was also normal - NO abnormalities were seen.  

Most recent:
serum creatinine at 0.68
BUN 8

I recently saw a Uro who did a urinalysis in office.  He said the only thing he saw were some crystals upon micro examination.  

My 24 hr urine collection has left me with more questions. The CrCL wasn't addressed at the appointment and I didn't see it until I walked out of the office.

My serum creatinine was 0.68.

CrCL(adjusted for body surface) was 67 ml/min - the normal range is 75-115.  From what I understand, this signals kidney disease or damage.Is this not true?  

Everything for the 24 hr urine collection were within normal range, however my urine output for 24 hours was 3450 ml, again - I drink a lot.

Metabolic panels are fine, as well as liver,cbc, thyroid studies, lipids are fine.The only major thing off here is the CrCL.No protein in urine, no bacteria, wbc's, no blood, nothing else abnormal. Nothing else shows a red flag for kidney disease or anything else.

When est my GFR (MDRD) based on my serum Cr, it's 107,but this contradicts the CrCL. Emailed the Uro. and he feels this isn't a "problem" but I'm not sure about that.

I have no clue what the residue is. My urine has been looked at under the microscope and there are no casts, just "some crystals". and he said it was normal. Input appreciated.
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796253_tn?1344994932
Hi and thanks for using the forum.

I did some research when I read your question to try and get some info for you.  

You didn't give me the normal ranges for the serum creatinine and BUN at the lab you had your blood work done and each lab can vary, but from what I can gather it looks like your BUN and creatinine are normal.  Your urine creatinine clearance in your 24 hour urine was a little low, but your serum (blood) creatinine is not elevated, so the creatinine is getting excreted from your body.  

I did not find any info about either klonopin or milk thistle and a film on urine.

I am not really sure what is causing this change.  One thought I did have was that it might not be urinary in nature, but rather vaginal.  Have you been seen by your OB/GYN and examined to rule out any gynecological reasons for this?

I am going to continue to do some research on this.  In the meantime, a second opinion by another urologist (if possible one that specifically works with women) might be worth looking into.  

Bridget

7 Comments
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1002601_tn?1264527089
Just a couple other notes that I couldn't fit up top:

- I've been a vegetarian for almost 10 years, but do occasionally consume fish. The only reassuring information I've read is from the NKF where they say that vegetarians tend to have a lower GFR.  This doesn't really make sense to me, considering we also tend to have lower serum Creatinine, but again I'm not a MD or nurse and able to fully understand this.

- This residue in my urine did not appear until I started on Klonopin (0.5x3 per day).  I had been on it at that dosage for a few months and then noticed the film.  I also had started taking Milk Thistle to protect my liver.  I've tried going off the Milk Thistle for a day or two, and the residue/film is still there. I cannot find anything online or in Klonopin side effects that talks about a visible residue left on urine, though I know it can affect the color of urine. If it were actually a med. film I were seeing, I'd be relieved!  It is there every single time I go - I do not even know how to go about finding out what it is considering my urine has been looked at under the microscope TWICE, I have had a 24 hr. urine test done with all things in range except for the CrCl, and have had numerous dipsticks done and the only thing "abnormal" is a low specific gravity, but I am VERY hydrated and my urine is typically very pale yellow except for FMU.  When I've dipped my first morning urine, my specific gravity is quite high, so I'm sure my kidneys can concentrate urine.  My only last thoughts were possibly lipiduria, but then I had my lipid profile done and it was perfect, plus I imagine they'd see fats under a microscope. I've also read that it is VERY rare for lipiduria to be present w/o proteinuria. So I assume that with all this taken into consideration, that can be ruled out. How the heck can anyone tell me what is floating in my urine if they've done all tests they typically do?

- I'm at my wits end on whether I let this go, pursue it further or what.  I was actually given the diagnosis of oxaluria by the Urologist because he said my oxalates were "high" but in seeing my 24 hr urine lab, I realize that he was incorrect.  The range given is 9.7-40.5 mg/spec and my level was 18.5 which is actually on the lower end, not higher.  I honestly don't know why he diagnosed this - he even gave me a low oxalate diet to follow.  At first he thought I may be seeing phosphates when I urinated (which I highly doubt because my urine doesn't clear with vinegar) then he proclaimed it was oxalates after reviewing my 24hr urine - but my numbers are fine.  My urine calcium was very low, so no calcium/oxalate stones/crystals there...

Sorry for being so long winded, just wanted to give all information I can.  Thanks for this forum - it's truly appreciated.
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1002601_tn?1264527089
Really sorry again for adding more, but I wanted to add one more pertinent piece of information on here that I just received.  I called the Urologist's office and was told that the type of crystals seen under the microscope were indeed Oxalates.  Now, I'm not sure why I was diagnosed with Oxaluria considering the Oxalates in my 24 hr urine were quite low, but apparently (and again, I'm not convinced) the type of crystals observed were indeed Oxalates, at least according to the observing Uro.  Still not sure if this could really be the white film I'm observing in my urine.  No casts or other abnormalities were seen.
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1002601_tn?1264527089
Hi Bridget.  Thank you for your help.  

To answer your questions, the lab values are as follows:

Creatinine 0.40-1.10 (mine was 0.68)

BUN 5-26 (mine was 8)

I did see my OBGYN this past summer (before the odd film appeared) for my annual pap.  All was normal.  I also had a transvaginal ultrasound due to the cysts, which were of no concern (according to the OB) and all else appeared normal.  

The Urologist I recently saw did perform a vaginal/rectal exam with no abnormalities noted, however, I don't think this is his specialty.  I do have sensitivity in my bladder area, even more so than my kidneys (during his exam).

I do have a second opinion lined up with another Urologist, but that appt. isn't for a couple weeks.  She's female, and a D.O.  Would someone practicing Urogynecology be preferred, do you suppose?  I honestly just looked for a female Uro, and there was only one within our network that was within an hour of where I live. My previous appt. was unfortunately with a Uro who specializes in male prostate issues, so that probably wasn't a great choice!

I was also wondering the likelihood of it being my bladder if it's not my kidneys.  It's really hard to try to determine these things on my own and then go into a doctor to present my case!  I know that interstitial cystitis can produce odd urine changes (residue, film, white floaties - which I have commonly), as well as frequent urination (which I have), but I don't seem to have the severe pain associated with this condition.  I do have some bladder discomfort at times, but if that's all I were dealing with, I'd be ok.  So obviously, pain is not my biggest complaint here.

I'm wondering what type of gynecological issues could produce something such as this?  For what it's worth, it's definitely not cervical mucus or anything of that nature and the film doesn't appear to change at all while I'm ovulating or even menstruating.

I wish it were something as simple as yeast (due to my heavy abx use), but that has never been observed under the microscope.  It doesn't appear to be an easy find which is rather unfortunate for someone who has severe health anxiety!  

I truly appreciate all of your time on this.  
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796253_tn?1344994932
Hi,

If you have an option of seeing a urogynecologist then it might be a good idea to schedule your second opinion with them.  If not, then just keep the appointment you have.  

I too was wondering if this was a bladder as opposed to a kidney issue.  I don't really think Interstitial Cystitis is the right diagnosis since you don't really have pain and pain is a hallmark sign of IC.

Yeast would have shown up in your previous urine tests, so I don't think it is a yeast infection but I was thinking maybe another type of vaginitis that is causing a discharge.  

I will continue my research, in the meantime keep me posted if anything comes up.

Bridget  
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1002601_tn?1264527089
Hello again.  Unfortunately, I just checked and there is no one within our network even within a 75 mile radius of where I live, so I'll just hold on to the appointment I have.  

I know I don't have a vaginal yeast infection, but I do have general yeast problems/sensitivities due to the antibiotics I've taken for Lyme, so that's why I had though perhaps yeast overgrowth/systemic yeast, but it hasn't shown up (like you said).  I have no vaginal discharge other than the normal cervical mucus based on my cycle time.

If you happen to check back, I do have another question for you.  If this were a fatty substance, or something such as chyle, they would have observed this under the microscope, correct?  I assume that lipids or chyluria would also show with protein?  I had no protein in my urine at all on the 24 hr test, they didn't even report a number because it was under "0.00" (undetectable, I assume).  I only mention Chyluria because it's one of the only things I can find that causes urine to look whitish - but it looks like it turns the entire urine white (which mine isn't).  My urine doesn't look milky, but my husband did mention that the top of it (that film) looks sort of like a milky substance when I urinate in the toilet. Urinating in a cup usually shows very clear (except when I have the white floaties), very pale straw yellow, urine (not milky), though the film is still on top when I look at it in the right light.  

Everyday I become more worried and anxious over this. I just don't know what to think and I've exhausted all non-serious ideas in my head, so I'm heading down a path of 'what if's' and does this urine issue only signal another problem that is connected to my lymph nodes, bladder, kidneys (of course the list is endless).

I actually emptied a capsule of vitamin D (white powdery), put it in the toilet, swirled it around, and that is pretty much what I see sitting on top of my urine every single day, so that gives you an idea of the type of film I'm talking about.

Having something undiagnosed, yet having symptoms everyday, allows the mind to wander to places you don't want to go.  The severe health anxiety I have is making this process of waiting and waiting to find out what is wrong very very hard for me.

I will keep you updated on any progress or anything else that comes to light.  

Thanks again for all of your help.
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1002601_tn?1264527089
Hi Bridget.  I just wanted to give you a quick update (non-update, really) on my appointment with the second Urologist today.  Basically I walked away with no answers again.  

She did not observe anything under the microscope and my dipstick was normal, so she felt that I may never know what I am seeing in my urine.  I brought my husband along so that he could also bear witness to the fact that I am urinating some weird film and he's seen it.  I have urinated in a cup at home and we could tilt the cup and see it, but unfortunately we were unable to view it in the styrofoam cup at the MD's office.  

She did no exam at all - she reviewed my previous tests that I brought along, but did not lay a hand on me which was rather dissapointing.  She also had no insight as to why my CrCl was low.  

We expressed concern that this came out of nowhere and I had stopped all meds (other than Klonopin) to see if it was a filler residue from one of the meds.  I inquired about a bladder issue and she didn't think so.  

If you have found anything else that could point me in some direction, please let me know.  I'm not sure where to go from here.  This is beyond discouraging and very frustrating.  Thanks.
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