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Pus cells, RBC and WBC in urine test. Fever, pain in the hip area. History of Lupus, Addisons disease and Right vertebral dissection. What to do?

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Gastroenterologist, Surgical
Practicing since : 1989
Answered : 883 Questions
My urine test came back with red blood cells 4-10 wbc 11-30 esterase 2+ calcium oxalate, pus present and I am hurting so bad in my right kidney/hip area with fevers off and on. At first the pain was every so many hrs now for last couple days never stops. My major medical is Lupus, Addisons Diease Right Verterbral Dissection Right Carotid Artery AVM & a right port-a-cath. I dont know if I should just keep taking pain meds that arents even touching it or go to ER and get more stressed. Cipro x 5 days has done nothing. Was told any stress on the body is danagerous due to the Addisons & I am hurting but also dont want to be in ERs due to two autoimmune problems a portacath could again get Sepsis again.
Posted Tue, 29 May 2012 in Lupus
Answered by Dr. Ketan Vagholkar 2 hours later

Due to a multitude of medical disorders your kidneys are bearing the brunt. Lupus is known to cause glomerulonephritis. This is the cause for abnormal findings in the urine. You need to get an Ultrasound done of the kidney region to look for peri-renal sepsis in view of fever and pain in that region. If there is a pus collection then that needs to be drained immediately. Too many analgesics are to avoided. same applies to nephrotoxic antibiotics. Monitoring the renal function meticulously is important. Sepsis imposes the most severe stress on the body. but a calculated risk needs to be taken for surgical intervention for the perinephric collection if it is present.

Let me know if you have further queries.
Above answer was peer-reviewed by
Follow-up: Pus cells, RBC and WBC in urine test. Fever, pain in the hip area. History of Lupus, Addisons disease and Right vertebral dissection. What to do? 1 hour later
Thanks, the culture grow showed nothing thankfully but I was sure after 5 days of Cipro would of made some difference but didnt. Rarelly in my case antiboditics by mouth do help & I end up in hospital for 7 days on IV antibodicts. I dont have a history of bladder infections maybe 2 in 58 yrs & those were minor & never a kidney issue thank god having Lupus SLE as well for over 25 yrs. So this is very different for me. Other than urinating alot there is no pain in the bladder area just over the right hip down the right side, low back, fevers and nausea. I dont want to look crazy to the ER doc.
Bacteria - FEW
WBC 11-30
RBC 4-10
Epitheial Cells - IN RANGE
Specific Gravity - >1.030
Appearance - CLOUDY
WBC Esterase - 2+
Urobilinogen, Semi-QN - 0.2.

Does any of this concern you or indicate infection in kidney or possible stone knowing my history. I am on Hyrdrocodon-Acetaminophn without any relief also HydroCortisone for my Addisions. In your opinion should I go to the ER always try to avoid due to accessing port-a-cath, possible Sepsis or worst. Lost 2 ports in pass due to hospital problems. Thanks for your help.
Answered by Dr. Ketan Vagholkar 13 hours later

Thanks for giving more information. I understand the stress you are experiencing.

Looking at the urine report it appears to be a chronic infection of the kidney which is called as chronic pyelonephritis. This infection perhaps is perpetuated by the steroid therapy which you are taking for your endocrine insufficiency. This could also affect the function of the kidneys in due course. The superadded acetaminophen can also cause additional problems to the kidney.

You need to be very watchful of your kidneys. Instead of consulting ER docs I would suggest you to get evaluated by a Nephrologist. As you are delicately balanced on medications, meticulous and compulsive monitoring of the kidney function is mandatory.

I hope this provides you a road map for further treatment.

With regards
Above answer was peer-reviewed by
Follow-up: Pus cells, RBC and WBC in urine test. Fever, pain in the hip area. History of Lupus, Addisons disease and Right vertebral dissection. What to do? 9 hours later
Wow great thanks for the information, It is very hepful only wish the bank of doctors I have Critical Care, Neuro, Rhem, Endoconogist & Pain Management was a open and informative as you before I lost my life for no reason. Again thanks.
Answered by Dr. Ketan Vagholkar 14 hours later

I hope my explanation helps you to allay your fears about the reports.

In case you do not have any more queries, I request you to complete the review page and close the discussion.

You may ask me a query directly at this link in future.

With regards
Above answer was peer-reviewed by
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