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filaments in urine
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filaments in urine


Is it normal to have filaments in the urine?  I only noticed these after I started getting a bloody discharge which after many consultations was determined to be coming from my kidneys. I also have had protein and hemosiderin in my urine.  This all occurred after being treated for a nasty sinus infection that has cultured out many gram negative bacteria (Klebsiella 5X in the last year and one/half) and fungi (mainly Fusarium).  I can't get rid of the sinus infection and these strange looking filaments in my urine seem to correlate with the sinus symptoms especially when it is draining. I have looked at the urine under the microscope and the filaments are curved and many times they are in a tangled mass.  I can see them as specks without the microscope and the same kind of filaments have been in the sinus secrections.   Is it possible for whatever is in my sinuses to be coming out in my urine?  If so, would it not have to go through the blood to get to my kidneys?
Any ideas on what the filaments are would be appreciated.
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Avatar_dr_f_tn
Hi,

How many times have you had a urinalysis and for each time they noted the presence of these filaments?

Do you have an underlying disease ?

One needs to exclude the possibility of  sample contamination and another is to consider a systemic infection with the chronic sinus infection as the primary focus.Firstly however it has to be ascertained that these filaments are actually the same organisms they found in your sinus specimens.This is something that neds to be further evaluated.

Do keep us posted.
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Avatar_n_tn
   Thanks for replying.  I haven't read enough of the forum to know if you are in the health field or not.  I posted the same questions to the doctor, but haven't gotten a reply yet.
I've been to 3 nephrologists and about 5 ENTS.  They don't know and aren't willling to try to find out what the filaments are.  From my research they could be sporangia or conidia from the Fusarium, another fungus, an actinomyces (has never cultured out) or they may not be organisms at all.  All the nephrologists do is a dip stick and measure creatinine which has been slightly elevated a few times, but not to the point that I need dialysis, so they have been useless.  Occasionally, they have done a microscopic, but won't do it on urine I bring in and since this is intermittent, is not always there.  I can't even get them to do a culture.  I"ve even taken pictures of the filaments  and they say it is just contaminant, but I know it isn't.  The same thing has occurred over and over again for at least the past year (have been sick for a long time, but having been a biology teacher for 30 years, I bought a microscope about a year ago)..   Both the urine and sinus mucus have been full of them at times. I'm pretty sure the urine has had numerous casts at times and sometimes looks waxy on the top.
     The ENTs haven't been much better.  They just say it's fungus in the sinus drainage and diagnose me with allergic fungal sinusitis and give me antibitoics and antifungals which aren't really doing a lot of good.  I'm pretty sure it is the same thing in the sinus drainage and the urine.  I was recently diagnosed with an IgG1 subclass deficiency and have been getting weekley subcutaneous IgG replacement for about 10 weeks.  So, I feel like it is an organism or something produced by one, but I really don't know and I don't know where else to turn.  It doesn't seem to be happening whenever I can get an appointment with a doctor.   I've also been diagnosed with mild transient hemolytic anemia and iron deficiency anemia.   My potassium has been elevated several times also, and then low another time.  There are some other weird lab results that point to chronic inflammation, but they don't correlate with each other.  Some are even contradictory like I'll have the hemosiderin in my urine at one time, but hatoglobin is elevated, and from what I have read is supposed to be low in hemolytic anemia.  My last blood work showed a mild left shift with wbcs.  They have also showed pyknotic nuclei and myelocytes and metamyelocytes and once basophilic stippling.  I've had polychromatic rbcs and elliptocytes a couple of times.  
      I've even gone through the labs and written down all the abnormal ones and tried about 4 PCPs, but they just say I'm too complicated and they don't have time to figure it out and refer me back to the specialists.    I've been to several "well respected"  clinics and university medical centers.  Since everything is "mild" noone has any idea of what is wrong or suggestions on what to do to keep from going into kidney failure.  (My GFR has been in the low 50s even when the creatinine is normal, and the report says mild-moderate chronic kidney failure.)   I'm almost completely disabled from the sinusitis, and I really think it is the source.  I was finally able to find an environmental firm that would take my specimens and try to identify whatever this is (both sinus drainage and urine).  Hopefully, I will get some answers, but even then won't know what to do with them, since it is not a clinical lab and the doctors don't want to accept anything that they haven't found themselves.  I've been to so many places, that I just don't have the energy right now to find out where to turn next.  Sorry for the rambling;  just needed to get this off of my chest.
    BTW,  this all started after I cleaned up after a major mold remediation at the school where I taught.  I had to quit work 4 years ago and have never recovered.  My bloodwork shows exposure to Fusarium (to the point of sensitization (IgG) and the past year skin ***** tests were positive for allergy to Fusarium.  I also showed chronic exposure to T-2 toxin and vomitoxin, both of which are produced by Fusarium.  I've read about T-2 toxin. and it affects the bone marrow, the immune system, and mucus membranes.  It is the only thing that could explain all of the symptoms that I've had, but the doctors have never heard of it and aren't willing to find out.  So, basically, I feel like I've been thrown into a medical "waste basket" with no one willing nor interested in taking the time to find out what is wrong.  I've been in excruciating pain with my sinuses;  don't have that many urinary symptoms, but the bloodwork and urinalysis scares me.  My urine has ranged from dark brown-reddish to almost white to normal.  This can all occur within a 24 hour period.  I've about given up hope, but am still trying to get help.
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Avatar_dr_f_tn
Hi,

One reason that i actually asked regarding presence of other underlying  disease is I am quite concerned with the presence of a chronic fungal infection in your case.
Immunodeficient individuals are highly susceptible to develop chronic infections by  otherwise fairly harmless and benign organisms.These infections  may be easily resolved and contained by the immune system in healthy immunocompetent individuals.The decreased IgG may be able to explain this.At this point you have gone through a lot already. I do suggest that you have all these documented very well so that other physicians will be able to easily follow your medical history.

With regards to the filaments in the urine it has to be ascertained that this is Fusarium and if contamination could have been likely. A systemic fusarium infection is rare and requires intensive management .

This is the most that i can help. But do keep us posted regarding your progress. Have you had consult with an infectious medicine specialist?
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Avatar_n_tn
Thanks again for responding.  How do you ascertain that the filaments are  Fusarium?  I have come to that conclusion myself through extensive research.  They look like the macroconidia.  I know it isn't a contaminant because they have been there literally hundreds of times and the urine has been so full of them at times that they are too numerous to count.  Before I started the IgG I had lesions on my elbows that were full of pus, blister like lesions on my face and a place on my leg that oozed out some kind of fluid.  I know that I have read that if this were in my blood I should be dead, but I've been on antifungals off and on most of this time.  Most recently I've been on voriconazole for 2 months and most of the lesions have healed, but I still get the filaments from the sinus drainage and the urine.  I feel like the Vfend is helping but my ID doctor (who has been the only one willing to help, but doesn't believe this is systemic) won't give me any more oral  Vfend because my liver enzymes have been slightly elevated.  He is going to give me nebulized Cipro for the Klebsiella and nebulized Vfend.  Hopefully these will help, but I'm afraid that if the fungus is in the tissue, it won't penetrate that way.  I guess my only hope is that the IgG has "kicked in" and will contain it if it is in the blood.  
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Avatar_dr_f_tn
Hi,

I do agree that this does not seem systemic. But it seems that one point you have been infected by the fusarium considering that you are a biologist .The fusarium may have caused some localized infections that could have been readily controlled by medications and the IgG replacements but not to the point of totally eradicating it. The infection may not be totally eradicated because of some degree of immunodeficiency. These are just insights from me.Your case requires a close follow up and an open communication with your doctors.

I hope I can really help more. Do keep us posted ok?
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