Any ideas of what could be going on?

[beth0277]

My husband is currently going through testing for proteinuria and I don't know what the issue is at this point. He has, for a few years, had either negative, trace, or +1 protein on a dipstick UA. He did a 24 hour test 3 years ago and it was normal, though I am not sure of the exact amount. He did one last month again, and this time it was slightly elevated at 218. They are testing him for all kinds of autoimmune disorders and so far the only test that has been positive is the serum protein electrophoresis which read: POLYCLONAL GAMMOPATHY: Serum protein electrophoresis demonstrates a diffuse polyclonal increase in the gamma region. No monodispersed zones are evident. Pattern is consistent with hypergammaglobulinemia (polyclonal gammopathy). Consider chronic infection, chronic liver disease, autoimmune diseases, sarcoidosis and other chronicinflammatory conditions.

So that test shows that *something* is going on, but so far testing for autoimmune disorders has been okay. ANA, Sedimentation rate, CRP, Anti-Double Stranded DNA, Rheumatoid Factor, and Cyclic Citrullinated Peptide have all been normal. They are also testing for Hepatitis although he gave blood a few years ago and I am pretty sure they screen for that when giving blood.

He had a kidney ultrasound that was also normal. Next step is meeting with nephrologist next week. I assume (?) they will order a biopsy.

Anyone have a similar presentation to this? My husband is 29, a little overweight but overall very healthy. Great blood pressure, cholesterol, all other blood work other than slightly high bilirubin and mild jaundice which he has experienced since he was an adolescent and was diagnosed with Gilbert's disease.

Anyone have any ideas?

Thanks in advance for any help! We are scared but trying to stay calm.

[beth0277]

Thank you for the response. All tests, except the serum protein electrophoresis, have been normal. He has no other conditions. Serum A1C was great. Vasculitis test was negative, no hypertension, no known heart conditions. I believe they tested for myeloma and it was negative, though I don't know the specific test. So far he has tested negative for Hepatitis A, B, and C, vasculitis, liver/kidney microsome antibodies, smith antibodies, rheumatoid factor, etc. Everything, except the serum protein electrophoresis has been normal. For urine eosinophils, no eosinophils were seen, and mononuclears, epithelial cells, and pmn's were all "rare".

As far as kidney function tests, his creatinine was 0.96, Estimated Glomerular Filtration Rate was >59, Bun was 12, Bun/Creat Ratio was 13. It shows me that all of these were in the "standard range".

It is just frustrating because we know "something" is going on, but nothing is coming back. Does this additional information point to anything? Is Chronic Kidney Disease in and of itself an "inflammatory" disease? If so, I guess that could explain the proteinuria and polyclonal gammopathy. From what I understand, the doctor has no other plans for blood work. Next is meeting with the nephrologist. I am just frustrated because as much as I don't want something to be wrong, it is clear that there is something going on and I just want an answer.

[Dr Santos]

Hi,
How is your husband? Are there other symptoms present?  What was the kidney function test results and does he have co-morbid conditions?  It can indeed be duet o kidney issues or outside the kidney conditions like diabetes mellitus, connective tissue diseases, vasculitis, amyloidosis, myeloma, heart conditions, hypertension as well as other autoimmune conditions. With the differentials mentioned, additional diagnostic tests may indeed be requested to rule them out. Not knowing the underlying cause can indeed be frustrating and stressful but try to hang on and continue being  positive.  It is good that he will be seeing his nephrologist. Management will depend on the findings of the diagnostic tests. Take care and do keep us posted.