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Wednesday, November 26, 2014
Fat in urine
Hello, This is a follow up to a previous question and answer. The post is here: Kidney Pain and Other Symptoms - www.netwellness.org/question.cfm/43015.htm
I have had numerous tests since then but unfortunately I am no closer to a diagnosis. I will update you and then I was hoping that you may be able to answer a couple more questions? On every occasion since November that I have been tested I have had mild heamaturia and pyuria but negative for protein. 24Hr protein is also normal. My kidney function is mildly impaired but due to neg protien my nephrologist refuses to do a biopsy. CT scan shows 5 small stones less than 5mm in both kidneys.
Urologist and nephologist both agree that they should not cause the pain I am in. They think it may be the fibromyalgia as tests also show no reflux. My urologist and nephologist have only seen fat in the urine (lipiduria) in nephrotic syndrome and fabry disease. They have ruled out nephrotic due to neg protein and I am awaiting the test for Fabry. They do not feel I have fabry and are simply ruling it out. Urine analysis has shown to have many fat globules present. The fat loss has increased and at every urination now causing the urine to foam. The bladder pain has subsided but I have regular and painful diarheah, sometimes with blood and mucus. Two colonoscopies have been normal. The headaches and itching have also stopped. The flushing has continued although it has changed in nature. Less intense and confined to face only, with no headache.
I have been reviewed for this and I am: Negative for: Carcinoid, pheocromocytoma, addisons, thyroid problems, parathyroid liver function and CBC, CRP, tests are also still normal I have done several 24hr urine samples for stone forming disorders eg calcium etc. all are negetive and no phosphates are present. caeliac screen was negetive. I have also had a spinal mri to see if the pain is coming from there and it was clear. I have recently diagnosed with vitiligo, The pain I am learning to live with and I am awating IV infusion lidocain for the fibrmyalgia and I take Tramadol now which really helps.
My concern is the fat in the urine. In the absence of fabry if my test is negetive, do you know what else can cause this as its just not normal when you look down the toilet to see it there. Are there any protiens lost in nephrotic syndrome that would not show up on a 24hr protien test? And also a standard urinanalysis? My fatigue at the moment is really bad, I have to sit down after doing simple things like going upstairs, bending down etc. I could not brush my own hair today due to weakness and lack of strength. Do you know of anything that would tie everything together? Any tests I should request? Any help greatly appreciated. Many thanks
You are correct that fat in the urine is rarely seen, and is almost always accompanied by protein in the urine. Fat does not usually appear as bubbles, though, nor should it cause foamy urine. It sounds like the fat or bubbles that you describe could be coming from some sort of foreign substance contaminating of the urine sample, and not from your kidneys.
Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University