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Suggest Treatment For Elevated ESR And CRP Levels Along With Hemoptysis

Posted on Tue, 21 Jul 2015

Question: 61 years old man complained from arthritis ,malaise , loss of weight and lab were persistent increase ESR,CRP normal protein electrophoresis except alpha ,normal CT but area of consolidation treated by many AB , he was neg PCR for TB , also normal abdominal ct and ultrasound but small renal cyst benign , he receive many many treatement and sudden incresse in kidney function were 5 for creatinine and 80 for urea lastly 0 mg

One alpha

Plavix

Neutomax

Concor 2.5 , steroid 10 mg and he was asymptomless now what can he do now
He stopped all treatment one month ago
But recent history of hemoptysis fresh blood one or two times per day

Answered by Dr. Drkaushal85 (2 hours later)

Brief Answer:
Get done serum ANA level to rule out connective tissue disease.

Detailed Answer:
Thanks for your question on Health Care Magic.
I can understand your situation and problem.
You are having high ESR, altered renal function test and hemoptysis (blood in sputum) with weight-loss. This is suggestive of possibility of connective tissue disease (CTD).
So better to get done serum ANA level and ANA profile to rule out CTD.
Also get done 24 hour Urinary albumin level.
Hope I have solved your query. I will be happy to help you further.
Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (13 minutes later)

We did ANA 4 month ago with normal titre

Answered by Dr. Drkaushal85 (16 minutes later)

Brief Answer:
Possibility of Pulmonary renal syndrome is more.

Detailed Answer:
Thanks for your follow up question on HCM.
I can understand your concern.
Possibility of Pulmonary renal syndrome is more in your case.
So better to get done ANA profile, XXXXXXX levels, if needed renal biopsy.
Sometimes ANA titer can be normal but with active inflammation (hemoptysis) ANA profile and XXXXXXX will be more accurate.
Please let me know
1. Have you ever undergone XXXXXXX and renal biopsy?
Please reply me answer of above asked question, so that I can guide you better.
I will be happy to help you further.
Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (4 minutes later)

Yes indeed , some doctors adviced me to do renal biopsy , but i didinot , but XXXXXXX i remember that i did it and it was normal

Answered by Dr. Drkaushal85 (22 minutes later)

Brief Answer:
Do you have XXXXXXX hemoptysis?

Detailed Answer:
Thanks for your follow up question on HCM.
I can understand your concern.
Renal biopsy will be more informative.
Please let me know
1. Do you have decreased urine out?
2. Do you have XXXXXXX hemoptysis? Means is whole sputum is reddish? Or whitish sputum is having red drops?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (3 minutes later)

The anwer both questions is no
He urinary outflow is normal
Also hemopytsis is not XXXXXXX at all just feww drops in claear white sputum
Thanx dr

Answered by Dr. Drkaushal85 (3 hours later)

Brief Answer:
Bronchoscopy might be helpful.

Detailed Answer:
Thanks for your follow up question on HCM.
Thanks for the reply.
Bronchoscopic evaluation might be helpful in your case if hemoptysis is persistent.
Renal biopsy is definitely recommended.
Some viral infection can affect lung and kidney simultaneously.
So you can wait for sometime, if it is viral than it will be self-limiting. But if not improving in 2-3 weeks than get done bronchoscopic evaluation and renal biopsy.
Hope I have solved your query.
I will be happy to help you further.
Wish you good health.
Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (1 hour later)

I adviced by some doctor to do bone marrow transplantation and he did it actually today for polycythemia hb ratio reached 17.7 mg , is it relevant . ??

Answered by Dr. Drkaushal85 (5 hours later)

Brief Answer:
Yes, polycythemia can cause hemoptysis.

Detailed Answer:
Thanks for your follow up question on HCM.
Polycythemia can cause hemoptysis.
But it can not cause renal dysfunction.
And polycythemia is sign. It is not a disease. It can be due to other causes.
Please let me know
1. Is he smoker?
2. Is he having chronic hypoxia?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wishing him good health.
Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (4 hours later)

Sure he is smoker 35 years , but he is not hypoxic at all also he is hard work man

Answered by Dr. Drkaushal85 (54 minutes later)

Brief Answer:
Better to get done bronchoscopic evaluation and PFT.

Detailed Answer:
Thanks for your follow up question on HCM.
Since he is smoker, possibility of bronchitis is more in his case.
And hemoptysis with weight-loss are seen in bronchitis.
So better to get done bronchoscopic evaluation and PFT (Pulmonary Function Test).
PFT will also tell you about severity of the disease and treatment is based on severity only.
He may need inhaled bronchodilators.
Please let me know
1. Is he having shortness of breath on exertion?
2. Has he ever undergone bronchoscopy?
3. Has he ever undergone PFT?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wishing him good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (1 hour later)

There is no complain related to breathing , no shortening , not undergone bronchoscopy nor PFT

Answered by Dr. Drkaushal85 (2 hours later)

Brief Answer:
Better to first get done broncoscopy and PFT.

Detailed Answer:
Thanks for your follow up question on HCM.
Better to first get done broncoscopy and PFT (Pulmonary Function Test) before going for renal biopsy.
He may be having mild COPD (chronic obstructive Pulmonary disease).
For this inhaled bronchodilators and inhaled corticosteroid (ICS) are needed. Smoking cessation should be initiated as soon as possible.
Hope I have solved your query.
If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
Wishing him good health.
Thanks.

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. Chakravarthy Mazumdar