Hello XXXXXXX,
Thanks for writing in.

I have gone through your reports in detail and would like to make the following comments.
a. The Echocardiogram is largely normal. As far as the aortic root diameter is concerned, it increases with ageing and with an increase in the body size. I would suggest that given your height, you should definitely try and lose some weight. This can be done with a mixture of dietary interventions and exercise. I would suggest you avoid refined sugar, junk food, fried food. Eat an early dinner and have small meals at regular intervals.

b. As far as the MRI report is concerned, there is foraminal stenosis. This means that there is a narrowing of the foramina (holes) through which the spinal nerves exit. This presses on the nerves. The degenerative cervical spondylosis that you have can currently explain your symptoms. Simple physiotherapy will help in this regard.

c. The electromyography and the nerve conduction study are normal.
d. The stricture in the bulbous urethra is unlikely to be related to the haematuria or dysmorphic red blood cells. The blood in the urine in your case seems to be originating in the kidneys and we would need a renal biopsy to see the condition of the kidneys.

e. The kidney function tests are largely normal. Everything is fine on that front. I would request that you get a urine microalbumin done as you are diabetic. This is often the first test to become abnormal if the kidneys have been affected due to diabetes.

f. As far as the blood tests are concerned, the urine examination is normal; Your ESR is slightly high. The erythrocyte sedimentation rate is a non specific marker of inflammation. However, this needs to be interpreted with the fact that your ENA titre and C4 levels are high. There can be several reasons for this and only a detailed evaluation by a rheumatologist can help us narrow down the causes. This will probably help us narrow down the cause for the blood in the urine that you are currently having.
This will also put into perspective the changes in the submandibular gland and the parotid gland.

I would suggest you see a rheumatologist, nephrologist and a physiotherapist. We should be able to get to the root of this problem quickly then.

I hope I have addressed your concerns. I will be available for follow ups.
Regards

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Hi XXXXXXX,
Thanks for writing back.

a. The ultrasound of the kidney ureter bladder region (KUB region) is largely normal with a small void residue. This is normal and can be expected at your age due to an age related increase in the size of the prostate gland.

b. As I said before, that the submandibular gland and the parotid gland could be possibly involved by an inflammatory process. This could be due to an infection or an autoimmune disease ( where the cells of your body start attacking your own cells). This would need to be evaluated in the light of other findings.

As I said, certain investigations like a urine microalbumin and other tests like anti-glomerular basement membrane antibodies, anti nuclear antibodies and anti neutrophil cytoplasmic antibodies would be needed.

You would need a detailed evaluation for an autoimmune process. This would be best done by a rheumatologist.

Hope this helps.
I hope I have addressed your concerns. I will be available for follow ups. Please close this discussion if you have no more questions.

Regards

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Hello XXXXXXX,
Thanks for writing back.
While a large body size does correlate with an increase in the size of the aortic root, there is no research to confirm whether it would come back to normal when you lose weight. However, I can assure you that it will not become progressively worse, something that both you and we want.
I would like a kidney biopsy to be done for you and you would need to speak with a nephrologist for that. It is possible that we are looking at some kind of problem in the kidney which is leading to your symptoms like swelling and dysmorphic RBCs in urine.
I would want you to see a rheumatologist for an evaluation for an autoimmune disorder. I do not think you need to see a urologist and a neurologist since you have already had the requisite evaluation.
Hope this helps.

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