Kidney Issues: Possible Causes and Diagnostic Steps

Q: Kidney Issues: Possible Causes and Diagnostic Steps

Hello： Your condition is classified as microscopic hematuria. <br>Generally, the causes of this mild urinary occult blood need to first rule out interference from menstruation. <br>If the urine test is conducted during the menstrual period, it often leads to false-positive result

Kidney problems

Hello Doctor: During a health check-up last September, I was found to have hematuria (1+).
A urine test at the end of July also showed hematuria, but kidney function was normal.
Last week, I underwent another routine urine test and a urine red blood cell morphology test, which also showed hematuria, with red blood cells reaching up to 7.
A renal ultrasound also showed normal results.
Could this possibly be glomerulonephritis? What tests are needed for a definitive diagnosis? How often should I be monitored? I heard from the doctor that there is a specific disease in adolescents; what is it?

Cai, 10~19 year old female. Ask Date: 2018/08/23

Dr. Lin Wuxuan reply Internal Medicine

Hello: Your condition is classified as microscopic hematuria.
Generally, the causes of this mild urinary occult blood need to first rule out interference from menstruation.
If the urine test is conducted during the menstrual period, it often leads to false-positive results.
The primary causes are usually mild infections or minor urinary tract stones.
Since these conditions are typically mild, ultrasound examinations or bacterial cultures may not easily reveal a clear source of the problem.
However, significant improvement can often be achieved with increased fluid intake.
Additionally, many international research reports indicate that some cases of microscopic hematuria have no identifiable cause.
Therefore, if you fall into this category, it is advisable to have regular follow-ups to ensure that any changes in your condition can be detected early and addressed promptly.

Reply Date: 2018/08/23

More Info

Understanding kidney issues can be complex, especially when symptoms like hematuria (blood in urine) are present. Based on your situation, where you have experienced persistent hematuria alongside normal kidney function and ultrasound results, it is essential to consider several potential causes and the appropriate diagnostic steps.

Possible Causes of Hematuria
1. Glomerular Causes: Conditions like glomerulonephritis (inflammation of the kidney's filtering units) can lead to hematuria. This can be caused by infections, autoimmune diseases, or other systemic conditions. Given your age, one possibility could be IgA nephropathy, which is more common in young adults and can present with hematuria.

2. Non-Glomerular Causes: These may include urinary tract infections (UTIs), kidney stones, or tumors in the urinary tract. Even benign conditions can cause blood in the urine.

3. Other Systemic Conditions: Conditions such as hypertension or diabetes can also affect kidney health and lead to hematuria.

Diagnostic Steps
To confirm the cause of hematuria, several diagnostic steps can be taken:
1. Urinalysis: A comprehensive urinalysis can help determine the presence of red blood cells, white blood cells, and protein in the urine. The presence of dysmorphic red blood cells may suggest a glomerular source.

2. Urine Culture: This test can help rule out urinary tract infections, which are a common cause of hematuria.

3. Imaging Studies: While your ultrasound showed normal results, further imaging like a CT scan or MRI may be warranted to evaluate for stones or tumors that might not be visible on ultrasound.

4. Kidney Biopsy: If glomerular disease is suspected and other tests indicate kidney damage, a biopsy may be necessary to obtain a definitive diagnosis.

5. Blood Tests: Tests to assess kidney function (like serum creatinine and electrolytes) and other markers (like complement levels and anti-nuclear antibodies) can provide additional information.

Follow-Up and Monitoring
The frequency of follow-up will depend on the findings of your initial tests. If a specific diagnosis is made, your healthcare provider will recommend a tailored follow-up schedule. For instance, if glomerulonephritis is diagnosed, regular monitoring of kidney function and blood pressure may be necessary.

Special Conditions in Adolescents
You mentioned a specific condition that affects adolescents. One such condition is Henoch-Schönlein purpura (HSP), which can cause kidney inflammation and is characterized by a tetrad of symptoms: purpura, abdominal pain, arthritis, and renal involvement. It is more common in children and young adults and can lead to hematuria and proteinuria.

Conclusion
In summary, while your ultrasound results are normal, persistent hematuria warrants further investigation to rule out glomerular disease or other underlying conditions. It is crucial to work closely with your healthcare provider to determine the appropriate tests and follow-up schedule. Early diagnosis and management can help prevent potential complications and preserve kidney function. If you have any concerns or if your symptoms change, do not hesitate to seek medical advice promptly.

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