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Posted on Mon, 24 Jul 2017 in Hypertension and Heart Disease
Question: I am a 64 yo female, type 2 diabetic with hypertension; both have been under control. I have sleep apnea and use a Bipap whenever I sleep, naps or night time. I had Rt. foot Achilles tendinopathy which resolved after three months in a boot and PT; the three months in the boot aggravated osteoarthritis in both knees and I have been taking Mobic for the last year as well as tramadol prn. I got a UTI and took antibiotic for a week. The follow-up UA showed blood and protein in the urine, no leukocytes. My internist is ordering a kidney echo and more blood tests. Have not talked to the doctor or even his nurse. The receptionist was the person who gave me the results of the urinalysis. I called and asked for a nurse to call me back, but no one did. My question is specifically what blood tests demonstrate the quality of kidney function and how much of the kidney can one see on an echo? Do you get a pic of the glomerulus? That is microscopic, isn't it? Or is the echo just to rule out tumors or questionable tissue in the kidney?
doctor
Answered by Dr. Ilir Sharka 2 hours later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM!

I passed carefully through your recent medical history and would explain that considering your frequent need of urination, an urinary tract infection could not be ruled out easily.

Though the absence of leukocytes in urine isn't too much in favor of an infection, in this regard, it is necessary performing additional medical tests for exploring potential structural and functional disorders of the urinary tract and also an urinary infection.

An urinary tract ultrasound (echo) would be helpful in investigating macroscopic structural components (such as kidneys, ureters, urinary bladder), but it is not able to visualize such microscopic elements like glomerulus. It may explore possible disorder like urinary stones, masses, changes in kidney dimensions, differentiation of kidney parenchyma; it may also raise suspicion of a urinary bladder infection.

But, the presence of protein and glucose in UA may be an expression of a chronic kidney dysfunction, commonly found in diabetic patients.

That's why additional tests are advisable as follows:

- creatinine and BUN,
- creatinine clearance,
- microiological urine culture,
- PCR & ESR,
- complete blood count with leukocytes formula

Only after performing such tests, it would be possible to conclude on a potential urinary tract infection or alternative responsible causes.


Hope to have been helpful to you!

In case of any further uncertainties, feel free to ask me again.

Kind regards,
Dr. Iliri






Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ilir Sharka 20 hours later
Maybe I was not clear. I was diagnosed with a UTI by urinalysis; I did have leukocytes which indicated a bacterial infection. I took nitrofurantoin for a week. Waited two weeks to do a follow-up urinalysis.

The follow-up showed the protein and blood and no leukocytes.

So, could improper kidney function be due to the recent infection? Or, do we need to suspect hypertension and diabetes, even though both have been under good control with medication?
doctor
Answered by Dr. Ilir Sharka 17 hours later
Brief Answer:
My answer as follows:

Detailed Answer:
Hello again!

Thank your for the additional information!

You should know that an infection could cause a temporary damage to the kidney cells, thus leading to increased protein and blood.

Hypertension and Diabetes diagnosis can not be based only on a urine analysis. It is true that they can lead to chronic kidney damage, but considering the fact that you have not suffered before from these tow disorders, I would recommend performing further examinations (as above mentioned) to exclude a kidney disorder (including infection or acute inflammation) first.

Regarding Hypertension, is important to closely monitoring your blood pressure values during the day (in sitting position after 10 minutes of total relax). This is a safe way to check if your blood pressure fluctuates during the day.

Regarding Diabetes, I would recommend performing a blood fasting glucose test and HbA1C levels, which would help detect diabetes. Besides, diabetes can also cause glucose in the urine, which was not detected by your urine analysis.

Hope to have clarified some of your uncertainties!

Wishing good health,

Dr. Iliri



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

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Practicing since :2001

Answered : 7415 Questions

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