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What Causes Casts In The Urine When Diagnosed With Waldenstrom's Macroglobulinemia?

Posted on Thu, 9 Feb 2017

Question: Dr. Saddiq Ulabidin
I have an appt with a Lahey Clinic Urologyst on Feb 7th unless they have a cancellation sooner than that. You mentioned a clotting profile in your ans. I do a blood test with MDINR machine at home once a wk. Is that what you mean? What do you mean by casts in urine?

Answered by Dr. Saddiq Ulabidin (13 hours later)

Brief Answer:
Proceed with urologist review and INR is part of clotting profile

Detailed Answer:
Hi! Welcome again and thank you for sharing your concerns and feedback. Well, INR is a part of clotting profile buy mt also does include other tests like apTT and bleeding time etc as well as complete blood also measure indirectly about any illness which may lead to easy bleeding if platelet count is low.

These all parameters were suggested in your case to make sure that blood in urine isn't due to thinning of blood because in that case it can dribble into urine causing urinalysis to be containing blood cells.

But having said that since findings of radiological investigations in your past queries necessitates to undergo cystoscopy to look for any signs of bladder growth or neoplasm. Casts are basically degraded blood cells or protiens due to breakdown of these blood cells or of normal cells present in urinary tract. You may proceed with urologist review alongwith your whole old record and labs.

At last, it would be good if you share that why are you needing weekly INR as it is usually suggested for those who are on blood thinning medications like warfarin and these medicines can also cause blood in urine.

Hope this has answered your query, if you have any more questions, feel free to ask. Regards.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Saddiq Ulabidin (8 hours later)

I am on Coumadin(allergic to warfarin), because I am subject to pulmanary embolisms. I am worried that the symptoms could be from the Waldenstroms Macraglobulanimia that I have or perhaps a tumor, although the cat scan I had did not show it. Cat scan did say a small cyst, 1.6cm, unchanged since 03/2015 - probably benign. I appreciate the explanations you have given me. I will be having blood test done for cancer Dr. in early March unless urologists requests it before that date. I do have alot of protein in my blood. Cancer Dr. checks every 3 mos., because immunoglobulin runs high . Imun.G 795, Imug.A 119. ImunM [H] 770 , but Viscosity, Serum is 1.7 rel.saline - which she says is not that bad.
Again Thankyou fo advice.
Lorraine Burdo

Answered by Dr. Saddiq Ulabidin (22 hours later)

Brief Answer:
A biopsy of the growth may be taken with cystoscopy

Detailed Answer:
Hi! Thanks for the detailed feedback. Yes these symptoms can be due to coumadin but the other findings which you have discussed specially that unchanged growth, is worth digging into as painless hematuria with a growth accelerates the need to have cystoscopy to look into internal structures in detail and is obviously more revealing than scans from outside.

Another advantage is to take biopsy of the swelling and to assess it's nature. Tumor markers as have been planned must be pursued with.

The other findings are due to walderstroms so may keep fluctuating in between though viscosity isn't that bad at this moment but blood thinners should be continued specially with the history of pulmonary embolism.

Hope this has answered your query, if you have any more questions, feel free to ask. Regards.

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Above answer was peer-reviewed by : Dr. Prasad