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What Does My Biopsy Test Report Indicate?
Question: I am a 40 year old female with hypertension and Sjorgren's Syndrome. I have had a couple of episodes of gross hematuria. I had a CAT scan done that revealed bilateral kidney stones, left 2mm and right 4mm. I also had a cystoscopy and biopsy done. I had red patches all over the back wall of my bladder. The biopsy was negative for malignancy but showed reactive changes, moderate chronic inflammation, congestion and hemorrhage. All of my urine cultures have been negative for infection. My blood work showed normal calcium and uric acid levels. My 24 hour urine collection showed very high levels of calcium and uric acid. What would cause the chronic inflammation and hemorrhaging in my bladder since there is no infection? I was placed on calcium and vitamin D supplements, hydrochlorothiazide and potassium citrate for the elevated calcium and uric acid. Is this the appropriate treatment? Why would I need to take more calcium if I have too much calcium in my urine already? Will the extra 25mg of hydrochlorothiazide cause my blood pressure to be too low. I already take Benicar HCT 20/12.5. Will the extra diuretic cause me to be even more dry? I have severe dryness in my eyes and have punctal plugs already.
Brief Answer:
Treatment advised conforms to standard approach.
Detailed Answer:
Hello Denices and welcome to HCM.
As an Urologist, i can fully understand your anxiety.
Your kidney stones of 2mm and 4mm are not a cause of concern.
They'll flush out with 3 litres of fluids daily.
Bleeding is from the chronic inflammation in the bladder, as seen in biopsy report.
It's cause is difficult to pin point the other cause of chronic inflammation, as seen in the biopsy, but is seen in patients with Sjogren's syndrome. And that could be the most probable reason.
You're having hypercalciuria with hyperuricosuria as per your question.
The reports will be needed to confirm that.
Potassium citrate solution is being used to dissolve the stones.
Benicar is an anti-hypertensive medication,to control your blood pressure.
Vitamin D levels would have been checked, before giving vitamin D supplements.
Calcium loss is taking place in your urine, not blood.
That needs to be replenished.Hence, you're prescribed calcium supplements.
If the dryness is excessive in the eyes, you should consult an eye specialist.
Hope your doubts are cleared.
Feel free to ask any question,but in that case,do send your reports along.
Also treatment being taken for Sjogrens Syndrome.
wish you well.
Dr.Matthew J. Mangat.
Treatment advised conforms to standard approach.
Detailed Answer:
Hello Denices and welcome to HCM.
As an Urologist, i can fully understand your anxiety.
Your kidney stones of 2mm and 4mm are not a cause of concern.
They'll flush out with 3 litres of fluids daily.
Bleeding is from the chronic inflammation in the bladder, as seen in biopsy report.
It's cause is difficult to pin point the other cause of chronic inflammation, as seen in the biopsy, but is seen in patients with Sjogren's syndrome. And that could be the most probable reason.
You're having hypercalciuria with hyperuricosuria as per your question.
The reports will be needed to confirm that.
Potassium citrate solution is being used to dissolve the stones.
Benicar is an anti-hypertensive medication,to control your blood pressure.
Vitamin D levels would have been checked, before giving vitamin D supplements.
Calcium loss is taking place in your urine, not blood.
That needs to be replenished.Hence, you're prescribed calcium supplements.
If the dryness is excessive in the eyes, you should consult an eye specialist.
Hope your doubts are cleared.
Feel free to ask any question,but in that case,do send your reports along.
Also treatment being taken for Sjogrens Syndrome.
wish you well.
Dr.Matthew J. Mangat.
Above answer was peer-reviewed by :
Dr. Prasad
It will take a few days to get a copy of my results from the 24 hour urine test. My doctor did say my calcium was over 400 and that the uric acid was elevated as well. He did not check my calcium levels. Does this mean my kidneys are not functioning properly? He prescribed 1200mg of calcium and 1000IU of vitamin D per day. He also prescribed potassium citrate ER 15 meq bid and hydrochlorothiazide 25 mg qd. I already take 12.5mg of hydrochlorothiazide in my Benicar. Is this going to be too much diuretic? I already see an ophthalmologist for my eyes. I have severe dryness which causes ulcers on my corneas so I have punctal plugs and I use lubricationg drops and steroids when necessary. I'm not taking any systemic drugs for the Sjorgren's because the symptoms are able to be managed with courses of steroids when I have a bad flare up. Should I be on a systemic medication for the Sjogren's considering it may be the source of the bleeding and inflammation in my bladder? What long term damage can be done to my bladder if the inflammation and bleeding is not controlled.
Brief Answer:
Steroids is the cause for recurrent bleeding in urine.
Detailed Answer:
Hi Denices,
The steroids taken by you, could be the reason for bleeding in urine.
The steroids will delay any healing, in the congested area of bladder.
This would've been told you, by your doctor,who carried out cystoscopic biopsy.
Blood calcium levels are always checked simultaneously with uric acid levels.
The reports along with Vitamin D levels are needed.
Sjogren's syndrome treatment is advised, depending on your symptoms.
Chronic cystitis or inflammation, is seen in people with your condition.
Recurrent bleeding is part of the same condition.
Wish you well.
Dr.Matthew J. Mangat.
Steroids is the cause for recurrent bleeding in urine.
Detailed Answer:
Hi Denices,
The steroids taken by you, could be the reason for bleeding in urine.
The steroids will delay any healing, in the congested area of bladder.
This would've been told you, by your doctor,who carried out cystoscopic biopsy.
Blood calcium levels are always checked simultaneously with uric acid levels.
The reports along with Vitamin D levels are needed.
Sjogren's syndrome treatment is advised, depending on your symptoms.
Chronic cystitis or inflammation, is seen in people with your condition.
Recurrent bleeding is part of the same condition.
Wish you well.
Dr.Matthew J. Mangat.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I have not taken a course of steroids in more than 6 months. My blood calcium and uric acid levels were normal. My urine calcium and uric acid levels were elevated. I have scheduled an appointment with my primary care physician on Monday. I will ask him to check my vitamin D levels since my urologist did not. I will also ask about systemic medication for Sjogren's. Thank you.
Brief Answer:
Treatment protocol and present
Detailed Answer:
Hi Denices,
That will be the best approach to your problem.
Your tests must include :
1. blood routine, creatinine,RBS,LFT,platelets,calcium,phosphorus and uric acid.
2. vitamin D level.
3. urine routine and culture.
4. 24 hours urine calcium,phosphorus and uric acid.
5. biopsy report.
Yes,get back with the treatment protocol, of Sjogren's syndrome,you're getting.
Wish you well.
Dr.Matthew J.Mangat.
Treatment protocol and present
Detailed Answer:
Hi Denices,
That will be the best approach to your problem.
Your tests must include :
1. blood routine, creatinine,RBS,LFT,platelets,calcium,phosphorus and uric acid.
2. vitamin D level.
3. urine routine and culture.
4. 24 hours urine calcium,phosphorus and uric acid.
5. biopsy report.
Yes,get back with the treatment protocol, of Sjogren's syndrome,you're getting.
Wish you well.
Dr.Matthew J.Mangat.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I saw my primary care physician today and had fasting lab work done. I had all of these abnormals. I have never had a high glucose level in my life. I have had elevated liver enzymes, triglycerides, and cholesterol in the past. I've also had autoimmune hepatitis in the past which has resolved on it's own. I'm concerned that the 37.5mg of hydrochlorothiazide and potassium citrate is causing elevated blood glucose levels. My urologist didn't do any baseline bloodwork before placing me on these medications. My follow-up appointment with my primary care physician is not for another 2 weeks.Do I stop taking the medication and repeat bloodwork in a few weeks?
MCH 26.6 L 27.0 34.0 pg
RDW(cv) 15.4 H 11.0 15.0 %
Vitamin D, 25Hydroxy, Total 21.7 L 30.1 100.0 ng/mL
Glucose 195 H 65 99 mg/dL
Protein, Total 8.3 H 6.0 8.0 g/dL
Alanine Aminotransferase 156 H 5 46 IU/L
Aspartate Aminotransferase 110 H 10 41 IU/L
Cholesterol 209 H ≤199 mg/dL
Triglyceride 154 H ≤149 mg/dL
VLDL Cholesterol 31 H ≤29 mg/d
MCH 26.6 L 27.0 34.0 pg
RDW(cv) 15.4 H 11.0 15.0 %
Vitamin D, 25Hydroxy, Total 21.7 L 30.1 100.0 ng/mL
Glucose 195 H 65 99 mg/dL
Protein, Total 8.3 H 6.0 8.0 g/dL
Alanine Aminotransferase 156 H 5 46 IU/L
Aspartate Aminotransferase 110 H 10 41 IU/L
Cholesterol 209 H ≤199 mg/dL
Triglyceride 154 H ≤149 mg/dL
VLDL Cholesterol 31 H ≤29 mg/d
Brief Answer:
continue same medication.
Detailed Answer:
Hi Denices,
You must continue same medication and repeat blood tests as advised.
The blood and urine routine tests as advised, have not yet been done.
It's important to assess the reports,to give an expert advice on treatment.
The present treatment prescription is mandatory.
If biopsy report isn't available,get a copy of the cystoscopy report.
You can contact me with the reports, for an expert opinion.
Drink 10-12 glasses fluids daily.
Dr.Matthew J. Mangat.
continue same medication.
Detailed Answer:
Hi Denices,
You must continue same medication and repeat blood tests as advised.
The blood and urine routine tests as advised, have not yet been done.
It's important to assess the reports,to give an expert advice on treatment.
The present treatment prescription is mandatory.
If biopsy report isn't available,get a copy of the cystoscopy report.
You can contact me with the reports, for an expert opinion.
Drink 10-12 glasses fluids daily.
Dr.Matthew J. Mangat.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi, I have provided some attachments. Please review them.
Brief Answer:
reports show cause for bleeding.
Detailed Answer:
Hi Denices,
I've gone through your reports.
The 24 hours urine calcium and uric acid levels are not there.
It shows the high blood sugar levels,seen in diabetics.
You should get your HbA1C done with a 2hours, post-prandial sugar tested.
Your hyperlipidemia is also seen.
You'll need to exercise and control your diet,avoiding fatty foods.
Whether a statin is needed, will be decided by your physician.
Your biopsy shows the congested areas, from where the bleeding could've come.
The other parameters are all normal.
Hope your doubts are cleared.
If you've any specific doubts, feel free to ask them.
Dr.Matthew J. Mangat.
reports show cause for bleeding.
Detailed Answer:
Hi Denices,
I've gone through your reports.
The 24 hours urine calcium and uric acid levels are not there.
It shows the high blood sugar levels,seen in diabetics.
You should get your HbA1C done with a 2hours, post-prandial sugar tested.
Your hyperlipidemia is also seen.
You'll need to exercise and control your diet,avoiding fatty foods.
Whether a statin is needed, will be decided by your physician.
Your biopsy shows the congested areas, from where the bleeding could've come.
The other parameters are all normal.
Hope your doubts are cleared.
If you've any specific doubts, feel free to ask them.
Dr.Matthew J. Mangat.
Note: Consult a Urologist online for consultation about prostate and bladder problems, sexual dysfunction, kidney stones, prostate enlargement, urinary incontinence, impotence and erectile dysfunction - Click here.
Above answer was peer-reviewed by :
Dr. Prasad
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