Kidney Stones & Protein in the urine, please help.

[Carlos45]

Hello all,

5’.9”, 194 Lbs, 40 Y/O, M, don’t drink or smoke, first kidney stone attack in mid 2007, had two procedures; (a) ESWL end of February 08 which failed and (b) ureteroscopy/laser at the end of May 08 which chattered the targeted stone, post ureteroscopy pain lasted for two month, but in about three month I discovered that more were produced and was able to pass most, as these were slightly softer and easier to pass, recent ultra sound showed only one small fragment at the entry of the bladder.
At the time I saw a GP and he prescribed Cipro, as there were bacteria in urine.

The original stone was solid and looked like real stones; brown/beige, the new ones are redish/yelowish and made up of grains stuck together, they pass either as one stone or fragmented pieces.

Have been doing regular kidney function and urine analysis tests; the thing that is worrying me is the existence of protein in the urine (30mg/dl after fasting/morning) for the past couple of months (was 100mg/dl one month prior to Cipro.), other than this all other aspects are within range.

Last test results (all within range):
RENAL FUNCTION: BUN, Creatinine, Sodium, Potassium, Chloride, Carbon Dioxide, Bun/Crt,
URINALYSIS : Sp. Grav, pH, Glucose, Ketone, Bile, Urine Hgb, Urobilingen, Leukocyte
URINE MICROSCOPY: WBC: 0-1, RBC: 0-2, Epith.cells: 1-2

I also have hereditary high blood pressure (Average 135/85) and high cholesterol, which I’m treating with diet and Crestor 10mg/day (almost within range)

My dad (75) had similar events and now on dialysis as both his kidneys failed recently, which is very disturbing to me.
I’m told that –in the family/paternal- we have some sort of a non-benign cyst on our kidneys, my grand mother had it, but didn’t experience any kidney issues.

Can the recent procedures/constant passing of fragments cause protein in urine?
What other relevant tests should I do?
What do you think is causing this?

I would appreciate any input or thought.

Regards,

Carlos.

[Carlos45]

Hi Doc.

In a way this is good, right?
Many thanks for your advise, I'll keep on researching and arrange to see a specialist ASAP.

Kind regards,

Carlos.

[Dr. Kokil Mathur]

Hi
Thanks for keeping me posted!
Normal creatinine clearance is 90-140mL/min, so your level is within normal range but on higher side. Protein levels are certainly higher than normal. Please read this: http://www.anytestkits.com/utk-protein-in-urine.htm

Protein along with hemoglobin in urine is seen in hemolytic anemias and in kidney diseases. I would advise you to consult an urologist for this and follow his advice, especially since you have a strong family history. It will be worthwhile to once go to a place where complete medical facility is there and get yourself examined and treated by an urologist.
Please let me know if there is any thing else and do keep me posted. Take care!

[Carlos45]

Hello again Doctor.

Well my 24 Hr. Creatinine Clearance results are back (Below), I hope to hear your opinion on them;

Creatinine: 0.9 mg/dL
24 Hour Urine: 2870 mL.
Urine Creatinine: 59.6 mg/dL
Creatinine Clearance: 131 ml/min (Notes indicate it is H.)

I also redid urine analysis and kidney function, all was well except for:
Protein: 30 mg/dL (Notes indicate it is H H.)
Urine Hgb: Trace.

I would truly appreciate any input you may provide.

Kind regards,

Carlos.

[Carlos45]

Hello again, Doc.

For the GFR, the urine needs to be sent abroad so this is going to take some time, I think.

As for the other tests, as I mentioned earlier; all are within normal range, thankfully.
I guess my high blood pressure is what is causing this, and I‘m working on it (DASH diet), it works.

I will keep the forum posted.
Best wishes,
Carlos.

[Dr. Kokil Mathur]

Hi Carlos

Thanks for the post! You are welcome!

Yes, CCr is creatinine clearance test and a measure of the GFR. This should be fine. 0-10mg/dL is within normal range for urinary protein, anything above 10mg/dL needs to be investigated. Also check for specific gravity, WBC, hemoglobin in urine, nitrites in urine and pH of urine.
Do keep writing and let us know the result of the tests. All the best!

[Carlos45]

Dear Doctor,

Many thanks for the reply.

I'm doing the test soon and wanted to know please:
Are the GFR and CCr two deferent types of tests or the same, as when I asked for a GFR test, the urologist recommended a CCr test?

If deferent, should I insist on doing a GFR test?

Also, the urologist was confident that this amount of protein in the urine (30mg/dl) was within the normal range, what do you think please?


I look forward to your reply.
Regards,
Carlos.

[Dr. Kokil Mathur]

Hi

Thanks for keeping me posted!

You can use either terms, they are not same but used interchangeably. Is there an Urologist or Nephrologist in your area, whom you can consult? Maybe the specialist can tell you how and where the test can be done in your area. Here it is, what the test is:
“Renal function, in nephrology, is an indication of the state of the kidney and its role in renal physiology. Glomerular filtration rate (GFR) describes the flow rate of filtered fluid through the kidney. Creatinine clearance rate (CCr) is the volume of blood plasma that is cleared of creatinine per unit time and is a useful measure for approximating the GFR. Both GFR and CCr may be accurately calculated by comparative measurements of substances in the blood and urine, or estimated by formulas using just a blood test result (eGFR and eCCr).”

“In clinical practice, however, creatinine clearance is used to measure GFR. Creatinine is produced naturally by the body (creatinine is a metabolite of creatine, which is found in muscle). It is freely filtered by the glomerulus, but also actively secreted by the renal tubules in very small amounts such that creatinine clearance overestimates actual GFR by 10-20%. This margin of error is acceptable considering the ease with which creatinine clearance is measured. Unlike precise GFR measurements involving constant infusions of inulin, creatinine is already at a steady-state concentration in the blood and so measuring creatinine clearance is much less cumbersome.”

Refer: http://en.wikipedia.org/wiki/Glomerular_filtration_rate


Hope this helps. Do let me know if there is any thing else. Take care!

[Carlos45]

Hello again Doctor,

I called the Lab. about your thoughts, they said that my previous tests (UA & KF) would have revealed issues if there were any blood in the urine.

They didn’t understand my explanation for GFR (Glomerular filtration rate) test, could you please explain it a little.
I forgot to mention that the last -red- stone I passed was sent -abroad- for analysis, so we will know if it was made out of blood clots on not, hopefully.

Any additional thoughts would be greatly appreciated.

Many thanks,

Carlos.

[Carlos45]

doctornee medical,

I truly, highly appreciate your reply.

The thing is, where I live, there is a shortage of specialists in this field (is it Urologist or Nephrologist ?).

I would appreciate it if you can suggest the necessary types of tests to do where I'll take the results with me abroad.

Kind regards,

Carlos.

[Dr. Kokil Mathur]

Hi
Thanks for the post!

Protein in urine can be due to uncontrolled diabetes mellitus, blood pressure (which you have), glomerulonephritis (infection of kidney—you have a history of bacteria or pus in urine), early stages of kidney failure.
You can refer to this link: http://kidney.niddk.nih.gov/kudiseases/pubs/proteinuria/

The fragments that you pass in urine could be blood clots. Has the urine been tested for blood? It is important to test your GFR (Glomerular filtration rate).

Since you have a strong family history, your case should be followed up rigorously, investigated in detail and treated. I think you should discuss this with your doctor. It is difficult to comment beyond this at this stage. Please let me know if there is any thing else and do keep me posted. Take care!