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Can viral infections trigger hematuria in healthy people?

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Posted on Fri, 28 Feb 2014
Question: Hi, I have not been diagnosed yet but was just looking for some info/opinion as I think my symptoms seem very much like IgA nephropathy. Im female in my twenties and I noticed blood in my urine over a month ago around the same time as feeling very tired. I was sleeping loads which lasted 3 days and was just feeling unwell. My urine looked dark and tested for blood on dipstick (my mum tested it shes a nurse) so I went to the gp who said the feeling tired was probably viral but he didnt know what the blood was. I had no other symptoms/no temperature nor pain but was prescribed the antibiotic nitrofurantoin in case it was kidney infection. My urine then started getting even more visible blood in it and at one point went very dark brown like cola coloured (although this might have been the antibiotic discolouring the urine). The antibiotic didnt clear the blood and 2 uranalysis showed no infection. Althugh I was on antibiotic when they were done which could have affected the results. My blood pressure is ok. Also blood tests for infection, urea and electrolytes were normal. I then developed a bad cold/respiratory infection about 4 days after the blood initially started then days after that I developed a throat infection which was treated with erythromoycin antibiotics. My blood was very red at this point and my gp said it was heavy blood and it needed investigating. I was referred to urology and they ruled out bladder cancer with a cytoscopy and after ultrasound and x ray said there were no kidney stones. They said it was probably an infection but I have no symptoms other than bloody urine and tests have shown no infection. The visible blood lasted 16 days then calmed down. The blood is not visible anymore (a bit red/dark in the morning) but looks yellow/clear throughout the day yet it is still testing for blood when i test with dipstick (goes on dark green). However there is no sign of protein on dipstick the colour on the stick stays yellow. Ive also noticed white floaty bits in my urine which look like bits of stringy pus. The only condition my symptoms sound like to me is Iga but just wanted advice /opinion. Does this sound like it could be Iga? Obviously only a biopsy can really diagnose but I doubt my gp would let me have one unless I got other symptoms I do athletic training both aerobic and anaerobic so need make sure I get a lot of protein so do I need to know if this is iga to continue with my life?. (I have not done any exercise for over a month since it started so the blood is not because of exercise) Im just worried I have an IgA nephropathy, are there any reliable blood tests that can detect autoimmune disease? Also, is there a possibility viral infections can trigger hematuria in healthy people?
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Answered by Dr. Rakesh Madhyastha (48 minutes later)
Brief Answer: Macroscopic hematuria Detailed Answer: Hello Thanks for the query There is a good possibility of IgA nephropathy the only other differential being Post streptococcal glomerulonephritis which can trigger hematuria in healthy people however the point against it is that it does not occur repeatedly. Here is what you should do 1. Get a urine microscopy done for dysmorphic RBC, if the RBCs are dysmorphic then the blood is coming from the glomerulus 2. Get a quantitative urine protein done. I personally prefer 24 hour urine protein but a urine protein creat ratio will suffice 3. Get a renal function test done 4. Check your blood pressure to rule out hypertension I strongly recommend that you get a biopsy done as soon as possible. This is not something which can be ignored Autoimmune test are tested with sufficient accuracy by getting an ANA profile, c-ANCA and p-ANCA I hope I was of help, if you have any further queries please get back to me. I wish you good health Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Rakesh Madhyastha (41 minutes later)
ok thanks. Ok thanks. My blood pressure is fine (about 110/72) and there is no protein showing on dipstick just blood. I don't understand why the visible blood started about 4 or 5 days before the respiratory infection as I thought with IgA the visible blood came after the onset of respiratory infection. If the blood is comming from the glomerulus does it almost certainly indicate kidney disease? Also is there any chance viral UTI/kidney infections can cause Hematuria? How common are viral UTI's ?
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Answered by Dr. Rakesh Madhyastha (1 hour later)
Brief Answer: Hello Detailed Answer: Thanks for getting back 1. Haematuria ( blood in urine) in your case is unlikely to be related to the respiratory infection. It was a separate event. urine dipstick method is not confirmatory please get a 24 hour urine protein done 2. If the blood is coming from the glomerulus then it does indicate kidney inury 3. Viral Urinary tract infections are very uncommon in a normal immunocompetent human being. There are a lot of research happening right now for haemorrhagic cystitis caused by BK virus, adenovirus, CMV, etc but these viruses cause infection only in a immunocompromised idividual I hope I was of help Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Rakesh Madhyastha (13 hours later)
ok, Ive heard that in healthcare sometimes they don't like to do biopsy (given the low risks) until other symptoms appear (ie protein) or until the macro hematuria is recurrent (Ive only had 1 episode). If this is the case and my doctor tells me to wait and see how it goes will I be ok to carry on with my anaerobic and weightlifting workouts and eating protein. Thanks
doctor
Answered by Dr. Rakesh Madhyastha (6 hours later)
Brief Answer: Hello Detailed Answer: Thanks for getting back Renal biopsy does carry its own risks and benefits. You could wait as it is not an emergency, but I recommend you get Serum creatinine and urine routine every 4 weeks for the next 12 weeks. Continue exercising and follow your normal routine like before Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Rakesh Madhyastha

Nephrologist

Practicing since :2009

Answered : 4364 Questions

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Can viral infections trigger hematuria in healthy people?

Brief Answer: Macroscopic hematuria Detailed Answer: Hello Thanks for the query There is a good possibility of IgA nephropathy the only other differential being Post streptococcal glomerulonephritis which can trigger hematuria in healthy people however the point against it is that it does not occur repeatedly. Here is what you should do 1. Get a urine microscopy done for dysmorphic RBC, if the RBCs are dysmorphic then the blood is coming from the glomerulus 2. Get a quantitative urine protein done. I personally prefer 24 hour urine protein but a urine protein creat ratio will suffice 3. Get a renal function test done 4. Check your blood pressure to rule out hypertension I strongly recommend that you get a biopsy done as soon as possible. This is not something which can be ignored Autoimmune test are tested with sufficient accuracy by getting an ANA profile, c-ANCA and p-ANCA I hope I was of help, if you have any further queries please get back to me. I wish you good health Regards