Aa
Microscopic Haematuria
Hi
A routine health check revealed microscopic haematuria on a dipstick test. A urine MCS showed ery / leu at normal levels <10 ery/ul
The dipstick tests still continue to show trace / small amounts of blood (typically haemolysed ..i.e uniform colour on dipstick).
The strange thing is that the dipstick tests are always negative on passing urine first thing in the morning but subsequent tests as the day goes on reveals increasing amounts of blood on the dipstick.
What is going on here ..I'm a bit confused.
I'm taking simvastin , trandolapril and indapamide as medication for high cholesterol and hypertension. I've been taking these for 4-5 years. I'm a 38 year old male.
Cheers
Mark
A routine health check revealed microscopic haematuria on a dipstick test. A urine MCS showed ery / leu at normal levels <10 ery/ul
The dipstick tests still continue to show trace / small amounts of blood (typically haemolysed ..i.e uniform colour on dipstick).
The strange thing is that the dipstick tests are always negative on passing urine first thing in the morning but subsequent tests as the day goes on reveals increasing amounts of blood on the dipstick.
What is going on here ..I'm a bit confused.
I'm taking simvastin , trandolapril and indapamide as medication for high cholesterol and hypertension. I've been taking these for 4-5 years. I'm a 38 year old male.
Cheers
Mark
MEDICAL PROFESSIONAL
Hi Mark,
The low specific gravity could not have affected the testing for erythrocytes as these are checked for microscopically as well as through biochemical tests. The number of cells reported is of those that are present per high power field. So if none were reported, then there was no blood.
A daily water intake in excess of 2000 ml (2 liter) would be optimal given that you are on diuretics as well.
regards
The low specific gravity could not have affected the testing for erythrocytes as these are checked for microscopically as well as through biochemical tests. The number of cells reported is of those that are present per high power field. So if none were reported, then there was no blood.
A daily water intake in excess of 2000 ml (2 liter) would be optimal given that you are on diuretics as well.
regards
Hi Smitha
Many thanks. You have put my mind at ease.
Could the low specific gravity(1.002) have affected the results of my last test? i.e a dilute sample masking blood
I'll start taking the vitamin/fish liver supplements asap.
What daily water inake would you recommend in light of the mix of medication i'm on namely diuretics and ACE's ?
Thanks again
Mark
Many thanks. You have put my mind at ease.
Could the low specific gravity(1.002) have affected the results of my last test? i.e a dilute sample masking blood
I'll start taking the vitamin/fish liver supplements asap.
What daily water inake would you recommend in light of the mix of medication i'm on namely diuretics and ACE's ?
Thanks again
Mark
MEDICAL PROFESSIONAL
Hi Mark,
Your last urinalysis does not report any erythrocytes or leucocytes in urine. This indicates that there is no blood in urine, hence, it means no hematuria.
As urine dipsticks can report erroneous results, it would be better to consider the report of the lab superior to the dipstick result. This is not to say that there was no hematuria in the past. It is possible that there is some amount of microscopic hematuria related to the simvastatin. Another possibility is that your mucosal membranes are thinner and they might be prone to mild, exercise-induced bleeding.
As your kidney function tests are normal, there is no cause for worry. However, it would be good if you could start vitamin C, A, and E supplements as these help in restoring mucosal integrity. You may want to consider taking fish liver oil capsules as they are a rich source of vitamins A and E and contain omega-3 fatty acids that will also lower your blood pressure and cholesterol levels.
regards
Your last urinalysis does not report any erythrocytes or leucocytes in urine. This indicates that there is no blood in urine, hence, it means no hematuria.
As urine dipsticks can report erroneous results, it would be better to consider the report of the lab superior to the dipstick result. This is not to say that there was no hematuria in the past. It is possible that there is some amount of microscopic hematuria related to the simvastatin. Another possibility is that your mucosal membranes are thinner and they might be prone to mild, exercise-induced bleeding.
As your kidney function tests are normal, there is no cause for worry. However, it would be good if you could start vitamin C, A, and E supplements as these help in restoring mucosal integrity. You may want to consider taking fish liver oil capsules as they are a rich source of vitamins A and E and contain omega-3 fatty acids that will also lower your blood pressure and cholesterol levels.
regards
Hi Smitha
Do you have any views with respect to my latest urine MCS.
Many thanks Mark
Do you have any views with respect to my latest urine MCS.
Many thanks Mark
Hi Stephen
Do you have any views regarding the above posts and my latest results / observations
Do you have any views regarding the above posts and my latest results / observations
Hi
Results of the latest urine MCS are back.
ph=5
Protein = Nil
Glucose = Nil
SG = 1.002
Leucocytes = 0 x 10^6/L
Erythrococytes = 0 x 10^6/L
Squam Epi Cells = 0
Culture = No growth
No casts
The SG is low as my doctor advised me to drink plenty of water to "flush myself through".
It all looks very clear but my dipstix still show the following despite this result.
First urine (mid stream sample) of the day immediately after sleep = negative for blood
As the day goes on i notice that the level of blood on the dipstick increases to either "trace" or "small" . It seems pretty much proportionate to changes in SG. Higher SG more blood etc.
I have no symptoms.
My GP doesn't appear concerned.
He reviewed urine mcs / blood tests taken over the past 6 months and all is "well"
Creatinie levels vary between 85-90
eFGR between 89 and 82
sodium, pottassium, urea etc are all within range.
Previous urine mcs (may 08)
ph = 5
Protein = Nil
Glucose = Nil
SG = 1.008
Leucocytes = 6 x 10^6/L
Erythrococytes = 2 x 10^6/L
Squam Epi Cells = 0
Culture = No growth
Daily meds are
trandolapril (gopten) 1mg
indapamide (natrilix ) 1.5mg
Simvastatin 60mg
Can you work out while i'm still showing small amounts of blood in urine.
My doc says it could be thin membrane related ?
Cheers
Mark
Results of the latest urine MCS are back.
ph=5
Protein = Nil
Glucose = Nil
SG = 1.002
Leucocytes = 0 x 10^6/L
Erythrococytes = 0 x 10^6/L
Squam Epi Cells = 0
Culture = No growth
No casts
The SG is low as my doctor advised me to drink plenty of water to "flush myself through".
It all looks very clear but my dipstix still show the following despite this result.
First urine (mid stream sample) of the day immediately after sleep = negative for blood
As the day goes on i notice that the level of blood on the dipstick increases to either "trace" or "small" . It seems pretty much proportionate to changes in SG. Higher SG more blood etc.
I have no symptoms.
My GP doesn't appear concerned.
He reviewed urine mcs / blood tests taken over the past 6 months and all is "well"
Creatinie levels vary between 85-90
eFGR between 89 and 82
sodium, pottassium, urea etc are all within range.
Previous urine mcs (may 08)
ph = 5
Protein = Nil
Glucose = Nil
SG = 1.008
Leucocytes = 6 x 10^6/L
Erythrococytes = 2 x 10^6/L
Squam Epi Cells = 0
Culture = No growth
Daily meds are
trandolapril (gopten) 1mg
indapamide (natrilix ) 1.5mg
Simvastatin 60mg
Can you work out while i'm still showing small amounts of blood in urine.
My doc says it could be thin membrane related ?
Cheers
Mark
MEDICAL PROFESSIONAL
Hi Mark,
Urine dipsticks have variable ranges of sensitivity. It may be as high as 91-95% where it detects for traces of blood and the accuracy may fall to 60-65% where there is more blood in urine.
As dipsticks can detect hematuria even if there are 3-4 RBCs (considered normal on urinalysis), the readings from a dipstick need to be corroborated with a microscopic examination of urine.
As the hematuria is detected in the morning sample or in concentrated urine, two matters need specific attention - Blood pressure control, as blood pressure is normally at its highest in the early hours (around 4 a.m.), and hydration.
Ensure that your fluid intake is regular and optimal as it can help prevent damage to the kidney, especially when you are on medications that can prove toxic to kidney function.
Do post the results of your forthcoming urinalysis so that we can evaluate the findings to correlate it with your symptoms.
regards,
Urine dipsticks have variable ranges of sensitivity. It may be as high as 91-95% where it detects for traces of blood and the accuracy may fall to 60-65% where there is more blood in urine.
As dipsticks can detect hematuria even if there are 3-4 RBCs (considered normal on urinalysis), the readings from a dipstick need to be corroborated with a microscopic examination of urine.
As the hematuria is detected in the morning sample or in concentrated urine, two matters need specific attention - Blood pressure control, as blood pressure is normally at its highest in the early hours (around 4 a.m.), and hydration.
Ensure that your fluid intake is regular and optimal as it can help prevent damage to the kidney, especially when you are on medications that can prove toxic to kidney function.
Do post the results of your forthcoming urinalysis so that we can evaluate the findings to correlate it with your symptoms.
regards,
Smitha
I'm not sure whether this is relevant but i'd appreciate it if you had some opinion on the info below.
The dipstick blood readings are always indicating as Trace (10 ca) or small (25ca). I do notice that if i empty my bladder and then drink 600ml of water the subsequent test is always completely negative if i retest within an hour or two.
Cheers
Mark
I'm not sure whether this is relevant but i'd appreciate it if you had some opinion on the info below.
The dipstick blood readings are always indicating as Trace (10 ca) or small (25ca). I do notice that if i empty my bladder and then drink 600ml of water the subsequent test is always completely negative if i retest within an hour or two.
Cheers
Mark
Hi
Thanks again
The blood tests were carried out at the same time as the urine MCS.
The urine MCS was all clear and blood tests for kidney functions were all clear.
The dipstix were and still are the only things that keep showing trace / small amounts of haematuria.
I'm having another Urine MCS in a week or so.
Cheers
Mark
Thanks again
The blood tests were carried out at the same time as the urine MCS.
The urine MCS was all clear and blood tests for kidney functions were all clear.
The dipstix were and still are the only things that keep showing trace / small amounts of haematuria.
I'm having another Urine MCS in a week or so.
Cheers
Mark
MEDICAL PROFESSIONAL
Hi,
If your renal functions were normal, there is no cause to suspect renal impairment due to the drugs you are on.
Simvastatin has been known to cause hematuria and proteinuria in a small group of patients, but does not require any intervention or withdrawal or dose adjustment.
Check whether your blood pressure control is adequate and ensure that your daily fluid intake is optimal in view of all the medications you are on.
As the hematuria is not detected on lab investigations, you can wait for a week or two and have your kidney function tests repeated (assuming your previous tests were done prior to the appearance of hematuria as detected by the dipstick test.
Do keep us posted.
regards,
If your renal functions were normal, there is no cause to suspect renal impairment due to the drugs you are on.
Simvastatin has been known to cause hematuria and proteinuria in a small group of patients, but does not require any intervention or withdrawal or dose adjustment.
Check whether your blood pressure control is adequate and ensure that your daily fluid intake is optimal in view of all the medications you are on.
As the hematuria is not detected on lab investigations, you can wait for a week or two and have your kidney function tests repeated (assuming your previous tests were done prior to the appearance of hematuria as detected by the dipstick test.
Do keep us posted.
regards,
Many thanks for your quick response.
Some additional info.
Blood tests were carried out recently and all kidney function related tests were normal (Creatinine , sodium, pottassium etc. etc.)
Does this pin point anything?
Cheers
Mark
Some additional info.
Blood tests were carried out recently and all kidney function related tests were normal (Creatinine , sodium, pottassium etc. etc.)
Does this pin point anything?
Cheers
Mark
MEDICAL PROFESSIONAL
Hi,
Both simvastatin and trandolapril can cause hematuria. You will need to discuss the finding of persistent microscopic hemturia and evaluate whether you need to switch to other drugs which may not impair renal function. Though indapamide has not been reported to cause hematuria, it has been known to compromise renal function.
Another factor that can induce hematuria is nonoptimal control of blood pressure. You will need to check whether your hypertension is adequately controlled by the trandolapril.
If the cause of microscopic hematuria is identified and is not considered to be of significant import, no intervention may be warranted. But, if there is any damage to the kidney, even at the microscopic level, medical intervention is required.
Do contact your prescribing doctor at your earliest convenience to have the problem evaluated.
regards,
Both simvastatin and trandolapril can cause hematuria. You will need to discuss the finding of persistent microscopic hemturia and evaluate whether you need to switch to other drugs which may not impair renal function. Though indapamide has not been reported to cause hematuria, it has been known to compromise renal function.
Another factor that can induce hematuria is nonoptimal control of blood pressure. You will need to check whether your hypertension is adequately controlled by the trandolapril.
If the cause of microscopic hematuria is identified and is not considered to be of significant import, no intervention may be warranted. But, if there is any damage to the kidney, even at the microscopic level, medical intervention is required.
Do contact your prescribing doctor at your earliest convenience to have the problem evaluated.
regards,
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