Suggest treatment for chronic kidney disease while on Nafrosave and Dytor

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Posted on Wed, 20 Nov 2019 in Internal Doctor Category
Question: Dear Sir/Madam,
My mother was diagnosed to be suffered from chronic kidney disease 3 months back and has been taking following medications for the same.
1. Nefrosave Forte
2. Dytor 10 mg.

Recently she went to the diagnostic center and underwent CUE (Complete Urine examination) and the results are listed below.

Test name: Result Biological reference interval
Colour Pale yellow Pale yellow
Appearance Slighly hazy Clear
Protein Present (++) Nil - Trace
Nitrites Positive Negative

Microscopic examination
Pus Cells > 50/HPF 0 - 5/HPF
Remarks Bacteria present
Method Reagent strips dual wave length reflectance method, flow cytometry and microscopy.

I have copied only those results that are not identical to biological reference interval.
Kindly suggest the significance of appearance (color), nitrites and Pus cells that are different from the expected value range. (Two months back, the results were normal for these tests in the same diagnostic centre except for the protein.)
I read that this could be due to urinary tract infection.
But the local doctor asked her whether she experienced any problems during urination like pain or any other symptoms and she replied in the negative. The doctor asked her to ignore it for the time being.

Thanks and Regards,
Ragavendran
doctor
Answered by Dr. Arnab Banerjee 3 hours later
Brief Answer:
She needs to be further evaluated for UTI at the earliest...

Detailed Answer:

Hello,

Yes, you've read it right, this does seem like Urinary tract infection only (all these urine analysis findings are coinciding with it)...

I partially agree with your local doctor as, in some CKD patients, the UTI may present without any problems/symptoms initially. However, it shouldn't be ignored, and first and foremost Urine Culture and Sensitivity study should be done to find out the causative organism.

Secondly, since she's diabetic also, the focus of the infection should also be investigated for (a USG Whole abdomen with pelvis should be done too). Urinary tract infection, although very common, can be notorious if not treated timely.

I'd suggest you not to wait for any further and discuss this with her Nephrologist and proceed with the investigations in the first place. The decision of treating can be taken after the complete investigation reports as well as another set of a clinical check-up.

I hope this helps.

Take Care
Kind Regards


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
Answered by
Dr.
Dr. Arnab Banerjee

Critical Care Specialist

Practicing since :2012

Answered : 1305 Questions

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