Need Help. proteinuria and hematuria child
I need a little advice. My daughter, 13.6yrs old has been having abdominal and flank pain for 2 years. This pain is severe when it happens but has been intermittent. the first time we remember her having it, 2 years ago on a saturday morning she was doubled over with pain for about two hours (right sided lower abdomen and right flank) she got very pale, had dark urine (we thought perhaps it was the start of her menses she was 11 or a UTI but pain resolved by lunch hour on saturday) took her in Monday for a urine dip stick test at pedi to see if she had UTI. it was neg.
over the next two years she experienced this same type of pain episode 4-5 times each year for a total of 8-10 bouts in two years. she also experienced a more frequent "nagging" abdominal pain with right sided flank tenderness. We went in a couple more times for a U/A check when she had the severe pain episodes and it never produced much. on two occasions she had small levels of microscopic blood in urine but no infection.
a few months ago she started having these pain episodes more frequently and she began to notice her urine had a foul smell following a severe pain episode.
two months ago she had a completely unrelated surgery on a bone/orthopedic issue) but had to have labs run for the surgery.
Jan 6th the flags in CBC and CHem panel were:
RBC low 3.60
HGB low 10.8
HCT low 31.1
Mono% high 13
BUN high 19
BUN/Creat ratio high 35
Calcium low 8
PTT high 35
*everything else was normal range
on Feb 15th she had a very severe pain episode and the foul urine oder so we took her into the pedi once again.
on Feb 16 her urinalysis showed these flags:
Protein 30 mg/dL
* the rest were neg or normal
she was sent for a stat CT scan for possible kidney stones
CT was normal
another urinalysis done two days later showed
BLO moderate intact
*no protein, the rest was normal
Urinalysis was sent in for microscopic exam and culture
Culture was neg. no infection
Micro revealed large amounts of RBCs
she was sent for renal ultrasound
mild fullness of right renal pelvis was noted - otherwise normal
3 more urinalysis over the next 3 weeks showed continued hematuria and two of them showed proteinuria.
saw nephrologist two weeks ago. he sent her for another renal ultrasound which showed NO dilation in the collecting areas (no fullness or hydronephrosis) He also ran Urine protein creatinine and calcium. Here are results of random urine sample:
Creatinine Urine 123.7 mg/dL
Protein urine ** 35.0 mg/dL (H)
Protein/Creatinine ** 283 mg/g creat (H)
Calcium Urine 16.5 mg/dL (no refrence range established?)
She still has the "large" amounts of microscopic hematuria
the elevated protein urine as noted above
mild anemia (low H&H and RBCs)
elevated BUN and BUN/creatinine ratio
low serum calcium
and the pain episodes (had one yesterday followed by urine odor)
I have called the nephrologist's office each day since Monday to find out what this means and what our next step is. its wednesday and I have not gotten a call back yet. I'm just wondering what all this means, are her urine protein levels high? are these numbers a concern? as I do research on the internet it looks like they are indeed high and abnormal for a child her age (for anyone actually) but I don't know that much about kidneys and renal function and I don't want to get worked up over something that may not be a big deal. I know sometimes labs can be a little off and not mean much. I just don't know if THESE labs are only a little off or are they way off? and the nephrologist can not seem to find time to call me and explain anything (which makes me think it must not be too big of a concern??) Any insight you can offer me would be appreciated. Thanks so much! sorry its so long.
Last edited by KD44; 03-21-2012 at 11:22 AM.