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Protein in urine, chest heaviness, taken Ciplar, Telma, Amtas, done ECG, renal US, kidney function test, history of vertigo, BP

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Hi, I am a patient of high blood pressure and 25 years old. It all started like this. I was sufferring from positional vertigo. Vertigo in certain positions of head. I got checked for BP few months back. It was 124/82 one time in emergency. Again after 3 weeks, it was 120/80 in some diff hospital. Next day, a diff doc checked it and it was 145/98. He put me on medication, Ciplar La BD. Then after starting medicaiton, after 4 days since the morning it was feeling heaviness in chest and was having fearful thoughts for almost the whole day. Went to emergency at night, bp was 160/100. After 10 mins wait, it was 150/100. I was given an injection and it came to 120/80 in 20 mins. I was asked to go many tests. 2 ECGs earlier in emergency were normal. Next day, ECG showed probable LVH, right atrial abnormality and some anterior injury. I went echo the same day, it showed everythng normal. Some systolic ejection fraction was 54% which should be 56%. Went to cardiologist and he said everythng is ok with heart. Had renal ultrasounds, showed i have single kidney. Had blood tests for sugar, cholestrol, serume , lipid profile etc and all were normal. In urine routine, protein came high 100mg/dl. Doc said its kidney infection and gave antibiotic for 1 week BD. After that, I had 24 hour protein test it was normal. Since then I had 5 routine urine tests,4 Kidney Function Test all were normal. Doc said i may be having BP from single kidney, and put me on Ciplar LA+Telma OD. My bp started showing low 100/60, sometimes < 100/60. I went to a different doc, he put me on Amtas 5mg, OD. And then one day I had BP of 150/90 and he increased my dosage to 10mg BD. Laster sometime, we and doctor realized that my BP increase happens when I am anxious. Then we reduced dosage and BP continued normal and finally reduced my dosage to 2.5mg, OD. Since then my BP stays around 120-80,130-90. Sometimes, it shows readings < 120/80 and sometimes readings around 140/90. High end readings happen when I am feeling very anxious. I also had my renin level test 1 year which was also normal. Also my bp in doctor's office was 127/70 1.5 months back. In doctor's office, the 1st reading was higher but next reading was 130/80 and 3rd one was 127/70. I have anxiety when I visit doctor because of past experience. Also I monitor my bp daily and it remains within 120-130/75-87 usually. When I am really anxious because of measuring BP, it reaches like 135-140+/80-90 and many times when I am relaxed I have seen readings like 110/69,112/76,115/84. Also 1.5 months back, I had my kidney function test and it was normal. Creatinine, Sodium, Potassium, GFR all were normal. Following are the values by Name, Actual Value, Standard Reference Range in my 1.5 months old blood test:
Sodium 141 136-147 mmol/L
Potassium 4.1 3.5-5.1 mmol/L
Chloride 102 98-107 mmol/L
CO2 29 21-32 mmol/L
Glucose 81 70-100 mg/dL
BUN 10 6-25 mg/dL
Creatinine 0.9 0.6-1.3 mg/dL
GFR Est-Other >60 >60 See Cmnt
GFR Est-African American >60 >60 See Cmnt
Calcium 9.3 8.2-10.2 mg/dL

And very recently I had Protein, Total, Random Urine test and Creatinine, Random, Urine test. The values are
Random Urine Total Protein 9.3 mg/dL
Random Urine Creatinine 42.9 mg/dL

But no standard reference range is given. I asked my primary care physician twice and she said its fine. But when I see on internet it says that Protein to Creatinine ratio should be <0.2. But that can be dependent on weight or something. Should I be concerned and go for further evaluation? I am 5'2", 57kg(127 pounds) male 25 years of age. My last conversation with a doctor on XXXXXXX was before the urine test and that can help if you need more context.
For reference, following are the protein values I had in my all the urine tests till date.
100mg/dl 19 months back in random urine test
120mg total in 24 hrs 18.5 months back in 24 hr total urine test
Nil 17 months back in random urine test
Traces 16 months back in random urine test
Nil 16 months back on the next day of the previous test
Nil 13 months back in random urine test
Nil 10 months back in random urine test.
9.3mg/dl 1 day back in random urine test with 42.9 creatinine mg/dl.
I have asked my PCP twice and she said its normal but I am not getting the peace of mind and it won't be good to tell her that I am not able to trust her.

The problem is that I don't understand why protein keep coming sometimes and sometimes in the morning urine, I see more bubbles but as the day progresses and I start drinking water, urine becomes fine which was primarily the reason I went for the urine test. Can it be related to me having single kidney or some problem with the kidney?

Also for anxiety, I went to a psychiatrist 15 months back and took medications but that didn't improve things as its my fear which keeps me occupied. Then I stopped taking meds and tried to be more disciplined and more control and anxiety improved from there though there is still a long way to go. Like here for a normal person, once doctor said its fine, people will relax and go ahead with their daily routine. But I searched all the stuff on internet and had these thoughts that things are not ideal.My main problem is that 1.5 years back, I never had any medical issue like this and life used to be sort of ideal atleast in terms of health and I always knew that things will become normal. But with these health issues, now I can't say for sure and my mind tries to see ideal things and then relax. Like here if it would have been nil protein, it would have relaxed in peace but since it is not zero but though sort of fine, it is still making me worry.
Also, I had my kidney MRI, Ultrasound 1.5 years back which were normal and showed hypertrophy in kidney which doctor said is expected as it is a single kidney. Also I had 5 Kidney function test in last 1.5 years which were normal with the values of the last test mentioned in the above question.
Posted Sat, 21 Apr 2012 in Kidney Conditions
Answered by Dr. Dilip M Babu 2 days later
Thanks for the query.

I have gone through your case history.
Your current problems are
1] Single kidney
2] Proteinuria
3] Hypertension

Majority of patients with unilateral renal agenesis are asymptomatic-detected incidentally in routine ultrasonography.

Contralateral normal kidney is expected to undergo compensatory hypertrophy.An increased risk of renal impairment and hypertension is reported in some but not in all patients with unilateral renal agenesis [common in obese patients].

Instead of cumbersome 24 hour urine collection,urine spot protein creatinine ratio may be used on a first morning spot urine specimen for screening.At least 2 to 3 measurements are necessary before diagnosing proteinuria.

As urine protein levels will change with fever,exercise,posture [orthostatic proteinuria],amount of water intake and high protein diet. If you have proteinuria better to treat with ACE (angiotensin-converting enzyme inhibitors) or ARB(Angiotensin receptor blocker) after consulting your physician.

For hypertension, I think you should undergo 24 hours ambulatory blood pressure monitoring which is gold standard for diagnosing hypertension.

Hope i have answered your query.I will be available for follow up.

Above answer was peer-reviewed by
Follow-up: Protein in urine, chest heaviness, taken Ciplar, Telma, Amtas, done ECG, renal US, kidney function test, history of vertigo, BP 49 minutes later

1.5 year back, I was on Ciplar LA BD + Telma OD and later 5mg Amlodipine BD. But then we realized that high BP in my case happens when I am anxious and then reduced the dosage. Right now I am on 2.5mg OD Amlodipine. My BP mostly remains fine(it increases when I am anxious) and I have measured it almost at every instant of time(I used to measure my blood pressure 20-30 times a day). But now with some discipline and mental control, I measure it only once a day and reading remains around 120-130/75-89. My physician has said that though my BP may be because of anxiety, I can completely get off the medicine when my BP remains stable around 120/80.

My query was about Proteinuria. As I told in my previous query, I had 7 urine tests in the past and 5 were clear and 1 one(the first one) had high protein(2+) but doctor said its because of infection and with antibiotic it cleared, with 120mg total in 24 hrs after 1 week of taking antibiotic. The other one was my 4th urine test which showed traces of protein but subsequent 2 urine test showed no protein. Now the current urine test showed 9.3mg/dl Protein and 42.9mg/dl creatinine making ratio like 0.216 and normal is <0.2. As I mentioned, my kidney fuction test are normal in my 1.5 month old blood test Also, I had relatively higher protein diet than normal 1 day back before the test(like Paneer etc) and jogged for 30 mins, 16 hours before the test. I wanted to know if mentioned amount in protein is something to be concerned or not in the scenario mentioned? My primary care physician says its normal and not proteinuria and I can't ask her for more tests when she says its normal.
Answered by Dr. Dilip M Babu 1 hour later
Thanks for the follow up.

Urine protein creatinine ratio of 0.216 and normal kidney function,I think there is no need to be concerned as urine protein levels will be affected by various factors [infections].

My advice to you is just monitor kidney function and urine protein -creatinine ratio once every 3 monthly.

If proteinuria increases then better to treat it with medications.

Patients with persistent higher degree of proteinuria will have higher chances of chronic kidney disease in long term.But in your case no need of any intervention at present just monitoring and close follow up with your physician is required.

Wishing you good health.

Above answer was peer-reviewed by
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