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Kidney Diseases

Blood and Protein in Urine

04/26/2007

Question:

The last 18 months I have experienced recurring UTI`s. It started in November 2005 with severe bladder and kidney infection. In January 2006, protein was found in my urine. From June to October 2006 I was on Prednisone due to Ulcerative colitis flare up. In June and October, an Abdomen scan and Xray showed my kidneys were normal. November 2006, blood tests showed kidney function, electrolytes etc were normal. February 2007, had a Midstream Urine test which was Normal. A CBC test was also normal. March - doctor said I had protein and blood in my urine which could be UTI. April - my urine was clear, then 1 week later, the clinic found blood (no protein) in my urine. I have had various CBC tests due to the ulcerative colitis and its always normal. Sugar levels, blood pressure and cholesterol is all normal.

My question is, could I possibly have a kidney disease.

Thank you in advance for your feedback.

Answer:

It is hard to answer your question without having a little more information.  Urinary tract infections can definitely cause small amounts of blood and/or protein in the urine, transiently.  However, large amounts of protein (more than 1+ on the urine dipstick test) generally do indicate some problem with the kidneys.  Inflammation of adjacent organs (such as the colon) can also result in microscopic amounts of blood in the urine. 

There is also the question of why you developed two UTIs in such a short period of time.  Were they definite UTIs, with bacteria growing on urine culture?  Were they treated with antibiotics?  Again, inflammation in the adjacent colon could have caused both white and red cells in the urine, as well as small amounts of protein, even without a bacterial infection being present.  If they were true UTIs (with bacterial growth), then their significance depends on whether you are a male or a female.  UTIs are much more common in females; however, any UTI in a male calls for a thorough investigation to see if there is an anatomic problem with the kidneys or urinary tract, since UTIs almost never occur in completely normal males.

It is reassuring that your kidney function blood tests, kidney imaging, and CBC have been normal.  One test that would also help is a "spot urine protein-creatinine ratio."  This will help quantify the actual amount of protein in the urine; a value is >300 mg of protein/ gm of creatinine would suggest that there is an actual kidney problem. 

Another important question is: were you having a colitis flareup in April when blood was found in your urine?  If not, then further investigation should be undertaken.  Blood in the urine may come not only from kidney disease, but from problems with the bladder and (if you are male) the prostate.  If there is no other explanation for the blood, your physician should refer you to a urologist, who may want to order an intravenous pyelogram (IVP), an x-ray test that can provide great detail about the anatomy of the kidneys, ureters, and bladder.  A cystoscopy (examination of the bladder with a lighted, flexible tube) may also be indicated to be sure that no anatomic abnormality or tumor is present in the bladder causing bleeding.

However, from the data that you give, it is entirely possible (if you are female) that you have no problem with your kidneys except for urinary tract infections, and that some of the abnormalities that have been seen can be explained by the fact that the kidneys are adjacent to inflamed parts of your colon.  

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Response by:

Mildred   Lam, MD Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University