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Medical Forum / General / General / October 2006Blood in urine and abnormal complement
Hi all, For two years now, I've had trace amounts of blood in my urine, with abdominal discomfort (flank pain, upper-abdominal pain and sore ribs, and a burning sensation down my right side when urinating). I was diagnosed and treated for prostatitis in January 2005. The only tests that have come back abnormal are my urine tests (trace blood, but protein and ketones negative, normal glucose and pH 7), and an abnormal complement (two different complement tests that were low). I'm emigrating to the US in December and won't have any health insurance for 6 months, so I'm anxious to rule out anything serious while I still have free healthcare. What could blood in my urine and low complement indicate? Is there anything you would recommend testing for? Thanks, Paul Hi all, For two years now, I've had trace amounts of blood in my urine, with abdominal discomfort (flank pain, upper-abdominal pain and sore ribs, and a burning sensation down my right side when urinating). I was diagnosed and treated for prostatitis in January 2005. The only tests that have come back abnormal are my urine tests (trace blood, but protein and ketones negative, normal glucose and pH 7), and an abnormal complement (two different complement tests that were low). I'm emigrating to the US in December and won't have any health insurance for 6 months, so I'm anxious to rule out anything serious while I still have free healthcare. What could blood in my urine and low complement indicate? Is there anything you would recommend testing for? Thanks, Paul ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Paul, I am not a doctor and am not an expert related to kidney disease. I suggest that you read the following book. The info. in the book will help you rule in or rule out kidney problems as a cause for your symptoms: "Coping With Kidney Disease" by Mackenzie Walser, M.D. Doctor Walser is a kidney specialist and a professor at Johns Hopkins University School of Medicine Jason ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ > Hi all, > [quoted text clipped - 12 lines] > What could blood in my urine and low complement indicate? Is there > anything you would recommend testing for? What's your serum creatinine level? Input it into a GFR calculator http://nephron.com/cgi-bin/MDRD_GFR.cgi Serum creatinine can fall in normal levels even if you have CKD. Paul wrote: > Hi all, > [quoted text clipped - 12 lines] > What could blood in my urine and low complement indicate? Is there > anything you would recommend testing for? What's your serum creatinine level? Input it into a GFR calculator http://nephron.com/cgi-bin/MDRD_GFR.cgi Serum creatinine can fall in normal levels even if you have CKD. ~~~~~~~~~~~~~~~~~~~~~~~~~~ XYZ, Excellent post. You are correct. Based upon my research, many of the people that have Renal Tubular Acidosis have normal creatinine levels. Do you know of any other kidney diseases or disorders that are not effected by creatinine levels? Jason ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ > Paul wrote: >> Hi all, [quoted text clipped - 30 lines] > Jason > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ I wasn't referring to Renal Tubular Acidosis. I was talking about Chronic Kidney Disease. In CKD, creatinine is raised but still falls within normal lab levels - because the lab normal levels are stupid (or too broad) - creatinine is related to age, muscles, sex & race - hence GFR is the way to go. Jason Johnson wrote: > In article <4oo225Ffh5r9U1@individual.net>, "XYZ" <xyz@6url.com> > wrote: [quoted text clipped - 33 lines] > Jason > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ I wasn't referring to Renal Tubular Acidosis. I was talking about Chronic Kidney Disease. In CKD, creatinine is raised but still falls within normal lab levels - because the lab normal levels are stupid (or too broad) - creatinine is related to age, muscles, sex & race - hence GFR is the way to go. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ XYZ, Thanks. I'll do some research on CKD tomorrow. Jason ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ > Hi all, > [quoted text clipped - 16 lines] > > Paul You might want to google hematuria and complement. If both C3 and C4 are reduced then probably and immune complex has to be ruled out with things such as ANA lupus, virus, even urates etc. This would indicate the classic activation of complement rather than the alternate activation. Well, my ANA came back negative, so I guess that rules out lupus, and the kidney doctors didn't think the hematuria was of renal origin, so I guess that rules out kidney problems. I've had an ultrasound of my upper and lower abdomen where nothing showed up. The only thing the GP noticed was that my bowel might a little blocked on one side, causing the abdominal pain. Is it possible for someone to have blood in the urine and low complement without anything being wrong? Thanks, Paul > > Hi all, > > [quoted text clipped - 22 lines] > This would indicate the classic activation of complement rather than > the alternate activation. Well, my ANA came back negative, so I guess that rules out lupus, and the kidney doctors didn't think the hematuria was of renal origin, so I guess that rules out kidney problems. I've had an ultrasound of my upper and lower abdomen where nothing showed up. The only thing the GP noticed was that my bowel might a little blocked on one side, causing the abdominal pain. Is it possible for someone to have blood in the urine and low complement without anything being wrong? Thanks, Paul ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Paul, The best thing to do is to have your urine tested about once a month to determine if you continue to have blood in your urine. You can purchase test strips that allow you to test your own urine for blood and various other items such as protein and glucose. The toll free number is 1-800-443-9942. You can buy the test strips at some drug stores. You may want to google "urine test strips" to compare prices. I copied the above toll free number from a book related to kidney disease. You should visit this web site: http://www.nlm.nih.gov/medlineplus/ency/article/000466.htm The ultrasound was a great idea. I am not a doctor. Jason ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ > Well, my ANA came back negative, so I guess that rules out lupus, and > the kidney doctors didn't think the hematuria was of renal origin, so I [quoted text clipped - 27 lines] > Jason > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Why are you advising someone with hematuria that "the best thing to do" is to have their urine tested once a month for blood. How exactly do you know that is the best thing to do?  SignatureDavid Rind drind@caregroup.harvard.edu > Well, my ANA came back negative, so I guess that rules out lupus, and > the kidney doctors didn't think the hematuria was of renal origin, so I [quoted text clipped - 26 lines] >I am not a doctor. >Jason Paul, One of the best moves you can make for your health is to ignore anything Jason says. He is not a doctor, has no medical training, and is an idiot. He keeps promising to stop giving medical advice, but since he is an idiot, and compulsive to boot, he is unable to keep that promise. -- David Wright :: alphabeta at prodigy.net These are my opinions only, but they're almost always correct. "George Bush is a gruesome boob." -- Bill Maher > One of the best moves you can make for your health is to ignore > anything Jason says. He is not a doctor, has no medical training, and > is an idiot. He keeps promising to stop giving medical advice, but > since he is an idiot, and compulsive to boot, he is unable to keep that > promise. Jason *desperately* wants to have kidney disease despite having absolutely no signs or symptoms, no matter how many tests he has his doctor run on him. He fancies himself to be an expert as he's read exactly one book, written by a pharmacologist, on kidney disease. David Wright is correct; ignoring Jason is a sound move unless you read him for entertainment. Signature"Did Father shoot him? I will eat Grandfather for dinner." - Helen Keller, on learning of the death of her grandfather email: aripee at inanna . com > Well, my ANA came back negative, so I guess that rules out lupus, and > the kidney doctors didn't think the hematuria was of renal origin, so I [quoted text clipped - 10 lines] > > Paul Well it depends on the value and the test in question. The more prolonged and profound depression then the more significant. The complement is functional and serves to protect against bacterial infection. Congenital and aquired conditions may result in increase infections. The activation of the classic components of complement indicate immune complexes are present and they can be inflammatory ie vasculitis, nephritis, depending on the location of these immune complexes. One would definitely screen for hepatitis B and C as these are common causes. A person can be asymptomatic and still have urinary abnormalities. In your case they are minimal abnormalities without a nephrotic syndrome. If anything it would resemble IgA nephropathy in presentation with the exception of an upper respiratory infection. It does not impact or activate complement and so that would not be consistent with low complement levels.. Glomerular hematuria is generally associated with proteinuria with a 2+ protein having a high confidence level of it being glomerular. Although not always possible is a phase examination of a fresh urine sample within an hour of voiding for abnormal deformed red cells consistent with glomerular lesions. It is more likely that the origins would be lower urinary tract via bladder or prostate. Renal calculi would also show microscopic hematuria. As far as chronic prostatitis aka CPPS one may see blood with prostatitis and some have studied the condition as an autoimmune disorder including C3 levels in prostatic fluid. Sorry about the rambling so lets just say that one looks for the most common things and looks at the clinical picture in order to make decisions. As far as the doctors response to the complement levels they did do additional testing and felt it not beneficial in going any further without a clear cut clinical picture. You might have just had a bad day with borderline values. http://www.emedicine.com/med/topic1119.htm Paul wrote: > Well, my ANA came back negative, so I guess that rules out lupus, and > the kidney doctors didn't think the hematuria was of renal origin, so I [quoted text clipped - 10 lines] > > Paul Well it depends on the value and the test in question. The more prolonged and profound depression then the more significant. The complement is functional and serves to protect against bacterial infection. Congenital and aquired conditions may result in increase infections. The activation of the classic components of complement indicate immune complexes are present and they can be inflammatory ie vasculitis, nephritis, depending on the location of these immune complexes. One would definitely screen for hepatitis B and C as these are common causes. A person can be asymptomatic and still have urinary abnormalities. In your case they are minimal abnormalities without a nephrotic syndrome. If anything it would resemble IgA nephropathy in presentation with the exception of an upper respiratory infection. It does not impact or activate complement and so that would not be consistent with low complement levels.. Glomerular hematuria is generally associated with proteinuria with a 2+ protein having a high confidence level of it being glomerular. Although not always possible is a phase examination of a fresh urine sample within an hour of voiding for abnormal deformed red cells consistent with glomerular lesions. It is more likely that the origins would be lower urinary tract via bladder or prostate. Renal calculi would also show microscopic hematuria. As far as chronic prostatitis aka CPPS one may see blood with prostatitis and some have studied the condition as an autoimmune disorder including C3 levels in prostatic fluid. Sorry about the rambling so lets just say that one looks for the most common things and looks at the clinical picture in order to make decisions. As far as the doctors response to the complement levels they did do additional testing and felt it not beneficial in going any further without a clear cut clinical picture. You might have just had a bad day with borderline values. http://www.emedicine.com/med/topic1119.htm ~~~~~~~~~~~~~~~~~~~~~~~~~ Robert, Excellent post. Could a really small stone (perhaps a kidney stone or uninary stone) cause blood in the urine? In most cases, people know they passed a stone due to pain. However, if they passed a stone that was really small--perhaps people such as Paul may not even know that they passed a stone. In such a case, could the stone have caused blood in the urine? I agree that an infection may have been the source of the blood in the urine. If so, the blood in the urine will stop after the infection goes away. I seem to recall learning that prostate problems can cause blood in the urine--is this true? Jason ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Thanks again for your post > Robert, > Excellent post. Could a really small stone (perhaps a kidney stone or [quoted text clipped - 9 lines] > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ > Thanks again for your post There was an old study 1956 of microhematuria which is somewhat different than gross hematuria as far as breakdown in diagnosis. Don't know if the break down would be similar now but the breakdown goes like this. 1. BPH 24% 2.Urethritis 21% 3. Renal Calculus 3% 4.Cystitis 3% 5.Other 3% 6. No lesion found 44% I don't know what the negative or positive predictive values of RBCs, microhematuria, in urine involving stones are. It is not uncommon to see blood in urine and or sperm with prostatitis patients. |
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