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Urology (Expert Forum)
Protein in Urine/Flank Pain
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.
Protein in Urine/Flank Pain
by Suzanne, Sep 18, 1999 12:00AM
Hi! I am 32 years old and have hypertension that was discovered this past December. At that time, I was very short of breath, having dizzy spells, and could do very little without extreme fatigue. (My husband, two little girls and I are extremely active and this is not normal) They did a QV? scan and discovered that I had a blood clot in my lung. I was treated for that and for the hypertension and am on several medications (Metoprolol 50mg 2xd, Triamterene37.5mg 1 x day, and recently was Zestril 10mg 1xd was added). In addition, I have right flank pain that radiates from my lower back in a severe cramping action across my stomach. This pain is not constant and can occur once a week or many times daily......no definite cause that I am aware of. I am spilling 2+ protein into my urine and have had positive blood in my urine on 2 tests. My blood pressure remains uncontrolled. My physician ordered an abdominal ultrasound and nothing abnormal was determined. Everyone seems to feel that something is wrong and are pointing fingers at my kidneys, but can't seem to determine what. I am getting extremely frustrated. Any suggestions or ideas? Thank you so much for your time.
Doctor's Answer
by hfhs M.D.-AK, Sep 20, 1999 12:00AM
Dear Suzanne,
I think you need to have an evaluation by both a urologist and a nephrologist. First for the blood in the urine (hematuria)by the urologist and for the proteinuria and hypertension by the nephrologist.
Hematuria is the medical term for your condition. It is important to have a microscopic cell count done to determine if this amount of hematuria needs to have a full work-up. Above 3 RBC/HPF is suggestive of significant hematuria that needs work-up.
A full work -up consists of a history and physical to direct the studies ,an IVP, a cystoscopy which should be done by a urologist, and a cytology looking for cancerous cells in the urine. About 30% of patients at our institution have some pathology causing there hematuria.
Considering the symptoms that you have, a urinary stone could be a possibility. Keep in mind, some stones are made of Uric acid and are not seen on IVP. But the contrast part of the study will show a filling defect or obstruction.
You could also have an infection. If you are febrile and have flank pain, you should be evaluated for a possible kidney infection. Also, blood in the urine could be caused by a simple infection of the bladder, which could be found on the Urine analysis(UA). If you have a bladder infection, you may just wait until it clears. If the UA is negative, the cystoscopy may not be necessary.
A third possible diagnosis would be bladder cancer. Some times bladder cancer presents with blood in the urine and irritative symptoms. These patients usually do not have flank pain , but it is possible depending on the size and location of the tumor. This is why we perform cystoscopy, to rule out any suspicious lesions in the bladder. The cystoscopy also allows the urologist to examine the anatomy of the bladder and position of the ureteral openings in the bladder.
Our last diagnosis would be idiopathic, simply meaning, we don’t know. Patients that exercise, have kidney disorders or have bleeding conditions or are taking anticoagulants to treat blood clots can often have blood in their urine without a good explanation. These patients get the same work-up listed above to ensure they don’t have a treatable condition. If you are on a “blood thinner”, anticoagulant for your pulmonary embolus, you may have secondary hematuria. However, this still needs to be evaluated.
I would suggest you have a repeat UA and if the microscopic analysis is high, RBC>3/HPF, go and see a urologist a full evaluation.
In regards to the proteinuria, there are different levels of proteinuria. Your nephrologist can tell you to worry or not about the level of protein excretion. A normal range of protein excreted in a 24 hr. period is less than 150mg/d. Of this 150, 5-15 mg is albumin and the rest is composed of over thirty different types of renal proteins. You should probably have the protein fractionated if your 24 hrs urine level is elevated, this will help determined what is causing the proteinuria. Excretion of mainly albumin signifies a glomerular lesion, the glomerulus being the filtering apparatus of the kidney.
By definition, greater than 3.5g in a 24 hr. urine signifies a nephrotic syndrome, a protein losing syndrome. This usually happens when the glomeruli are damaged enough to allow plasma proteins to enter the urine. I don’t know much history here, but if you have a persistence of protein in the urine you should discuss your treatment plan with a nephrologist.
The information provided in this forum is presented for general educational purposes only. Specific questions you have pertaining to your health should always be directed to your personal physician.
Sincerely,
HFHS M.D.-AK
*keyword:Medical renal disease and hematuria
I think you need to have an evaluation by both a urologist and a nephrologist. First for the blood in the urine (hematuria)by the urologist and for the proteinuria and hypertension by the nephrologist.
Hematuria is the medical term for your condition. It is important to have a microscopic cell count done to determine if this amount of hematuria needs to have a full work-up. Above 3 RBC/HPF is suggestive of significant hematuria that needs work-up.
A full work -up consists of a history and physical to direct the studies ,an IVP, a cystoscopy which should be done by a urologist, and a cytology looking for cancerous cells in the urine. About 30% of patients at our institution have some pathology causing there hematuria.
Considering the symptoms that you have, a urinary stone could be a possibility. Keep in mind, some stones are made of Uric acid and are not seen on IVP. But the contrast part of the study will show a filling defect or obstruction.
You could also have an infection. If you are febrile and have flank pain, you should be evaluated for a possible kidney infection. Also, blood in the urine could be caused by a simple infection of the bladder, which could be found on the Urine analysis(UA). If you have a bladder infection, you may just wait until it clears. If the UA is negative, the cystoscopy may not be necessary.
A third possible diagnosis would be bladder cancer. Some times bladder cancer presents with blood in the urine and irritative symptoms. These patients usually do not have flank pain , but it is possible depending on the size and location of the tumor. This is why we perform cystoscopy, to rule out any suspicious lesions in the bladder. The cystoscopy also allows the urologist to examine the anatomy of the bladder and position of the ureteral openings in the bladder.
Our last diagnosis would be idiopathic, simply meaning, we don’t know. Patients that exercise, have kidney disorders or have bleeding conditions or are taking anticoagulants to treat blood clots can often have blood in their urine without a good explanation. These patients get the same work-up listed above to ensure they don’t have a treatable condition. If you are on a “blood thinner”, anticoagulant for your pulmonary embolus, you may have secondary hematuria. However, this still needs to be evaluated.
I would suggest you have a repeat UA and if the microscopic analysis is high, RBC>3/HPF, go and see a urologist a full evaluation.
In regards to the proteinuria, there are different levels of proteinuria. Your nephrologist can tell you to worry or not about the level of protein excretion. A normal range of protein excreted in a 24 hr. period is less than 150mg/d. Of this 150, 5-15 mg is albumin and the rest is composed of over thirty different types of renal proteins. You should probably have the protein fractionated if your 24 hrs urine level is elevated, this will help determined what is causing the proteinuria. Excretion of mainly albumin signifies a glomerular lesion, the glomerulus being the filtering apparatus of the kidney.
By definition, greater than 3.5g in a 24 hr. urine signifies a nephrotic syndrome, a protein losing syndrome. This usually happens when the glomeruli are damaged enough to allow plasma proteins to enter the urine. I don’t know much history here, but if you have a persistence of protein in the urine you should discuss your treatment plan with a nephrologist.
The information provided in this forum is presented for general educational purposes only. Specific questions you have pertaining to your health should always be directed to your personal physician.
Sincerely,
HFHS M.D.-AK
*keyword:Medical renal disease and hematuria
Member Comments (7)
by hfhs M.D.-AK, Sep 20, 1999 12:00AM
To: Kidney/Urinary Stones
0
by hfhs M.D.-AK, Sep 20, 1999 12:00AM
To: Kidney/Urinary Stones
0
by hfhs M.D.-AK, Sep 20, 1999 12:00AM
To: Kidney/Urinary Stones
0
by hfhs M.D.-AK, Sep 20, 1999 12:00AM
To: Kidney/Urinary Stones
0
by hfhs M.D.-AK, Sep 20, 1999 12:00AM
To: Kidney/Urinary Stones
0
by hfhs M.D.-AK, Sep 20, 1999 12:00AM
To: Kidney/Urinary Stones
0
by Dawn, Oct 22, 1999 12:00AM
To: Kidney/Urinary Stones
0
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