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Suggest Treatment For IGA Nephropathy And Presence Of Protein And RBC In Urine
Question: Hi I was diagnosed with early IGA nephropathy about 5 years ago and am on medication. Protein and blood is present in the urine and its levels have varied over time ranging from Trace to ++. My recent urine analysis showed Protein in the urine at + and Erythrocytes at ++. RBCs were present at 8-10 /hpf. Creatinine was 1.2 mg/dl and eGFR around 67. Total cholestrol at 128. My question is whether the fluctuating levels of protein and blood present in the urine sample is considered "normal" given that I have been diagnosed with early IGA and am undergoing medication. My concern is that the levels tend to fluctuate with every test (which is usually conducted at 6 monthly intervals) e.g. in an earlier urine analysis test the protein level was Trace but then became '+' in the next test. Similarly, RBCs in one test was Nil and then increased to 4-5 /hpf in the next test and then went back to Nil again. Your advise and views are appreciated.
Brief Answer:
Fluctuations are common
Detailed Answer:
Hi,
IGA nephropathy is a disease involving the kidney which is caused by the deposition of IGA proteins. this leads to excretion of RBC and proteins in urine. your concern regarding the constant fluctuation of readings is valid any change in body physiology including blood pressure , fever can lead to change in values . even there is a diurnal variation that if you do the test in morning and again in evening there will be difference. so but what is more important is that whether there is a constantly rising trend of the protein and RBC . Then it will require some special treatment. If protein in urine quantification shows more than one gram of proteins then you may required some other medications to control the proteins.
so the variation in reports around a single value should not be a point of concern
best wishes
Fluctuations are common
Detailed Answer:
Hi,
IGA nephropathy is a disease involving the kidney which is caused by the deposition of IGA proteins. this leads to excretion of RBC and proteins in urine. your concern regarding the constant fluctuation of readings is valid any change in body physiology including blood pressure , fever can lead to change in values . even there is a diurnal variation that if you do the test in morning and again in evening there will be difference. so but what is more important is that whether there is a constantly rising trend of the protein and RBC . Then it will require some special treatment. If protein in urine quantification shows more than one gram of proteins then you may required some other medications to control the proteins.
so the variation in reports around a single value should not be a point of concern
best wishes
Above answer was peer-reviewed by :
Dr. Prasad
Thank you for your comprehensive reply.
My microalbumin in spot urine was 143 mg/l with an ACR of 178 ug/g in my recent test. This is more or less in line with past trends over the years although it suddenly spiked to 459 mg/l in Sept15 but then became gradually lower with each subsequent test. At that time my BP medication (10 mg Cardace) was increased with 2.5 mg of Maxipress. Creatinine has been at 1.2 mg/dl for the last 3 years. My protein in spot urine per Oct 15 test was 44mg/dl. I usually do a spot microalbumin test.
My concern was over the RBCs at 8-10 hpf given that these were either nil (in the previous test 6 months ago) or was at 4-5 hpf in earlier tests.
I also have a benign enlarged prostrate problem which was diagnosed in July16 -no medication at present. My PSA total was 1.04 ng/ml and Free PSA 0.28 in the recent test. I also had a sore throat (mucus and irritation but no fever) 3 days before and during my recent blood and urine test. My questions are as follows:
1. Would these i.e the benign enlarged prostrate and sore throat have also contributed to the sudden increase in RBCs?
2. At what stage do I need to worry about the level of RBCs and protein in the spot urine - these have usually varied from Trace to ++ and medication (BP 12.5 mg and statins 10 mg) have remained unchanged. If RBCs remain at 8-10 hpf is that something to worry about given the normal threshold is 3-4 hpf?
3. Do you suggest I repeat the spot urine test say after a month or just continue with the usual 6 monthly tests.
Many thanks in advance for your advise.
My microalbumin in spot urine was 143 mg/l with an ACR of 178 ug/g in my recent test. This is more or less in line with past trends over the years although it suddenly spiked to 459 mg/l in Sept15 but then became gradually lower with each subsequent test. At that time my BP medication (10 mg Cardace) was increased with 2.5 mg of Maxipress. Creatinine has been at 1.2 mg/dl for the last 3 years. My protein in spot urine per Oct 15 test was 44mg/dl. I usually do a spot microalbumin test.
My concern was over the RBCs at 8-10 hpf given that these were either nil (in the previous test 6 months ago) or was at 4-5 hpf in earlier tests.
I also have a benign enlarged prostrate problem which was diagnosed in July16 -no medication at present. My PSA total was 1.04 ng/ml and Free PSA 0.28 in the recent test. I also had a sore throat (mucus and irritation but no fever) 3 days before and during my recent blood and urine test. My questions are as follows:
1. Would these i.e the benign enlarged prostrate and sore throat have also contributed to the sudden increase in RBCs?
2. At what stage do I need to worry about the level of RBCs and protein in the spot urine - these have usually varied from Trace to ++ and medication (BP 12.5 mg and statins 10 mg) have remained unchanged. If RBCs remain at 8-10 hpf is that something to worry about given the normal threshold is 3-4 hpf?
3. Do you suggest I repeat the spot urine test say after a month or just continue with the usual 6 monthly tests.
Many thanks in advance for your advise.
Brief Answer:
If stable can do with monitoring at 6 month
Detailed Answer:
Hi,
benign enlarged prostate is not likely to increase rbc unless there is urine infection. sore throat or feberfrom any cause can lead to transient increase in rbc and protiens but these should settle down by itself over few weeks. If the rbc remain around ten it does not cause any specific danger. but if the protein remains more than 1 gm/ 24 hrs it can definitely cause kidney damage in long term . so it is important to monitor protein in urine. If the test are abnormal and worsening you can repeat a test in less than a month also but if stable can wait for 3 to 6 months.
best wishez
If stable can do with monitoring at 6 month
Detailed Answer:
Hi,
benign enlarged prostate is not likely to increase rbc unless there is urine infection. sore throat or feberfrom any cause can lead to transient increase in rbc and protiens but these should settle down by itself over few weeks. If the rbc remain around ten it does not cause any specific danger. but if the protein remains more than 1 gm/ 24 hrs it can definitely cause kidney damage in long term . so it is important to monitor protein in urine. If the test are abnormal and worsening you can repeat a test in less than a month also but if stable can wait for 3 to 6 months.
best wishez
Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.
Above answer was peer-reviewed by :
Dr. Prasad
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