Persistent Hematuria and Proteinuria: Seeking Answers After Years of Unexplained Symptoms

Persistent hematuria and proteinuria with no identifiable cause?

Dear Doctor, I have a long history of hematuria and proteinuria, approximately 6-7 years.
Recently, after quitting smoking (with a smoking history of over 25 years), I have noticed a significant decline in my health.
Additionally, my recent health check still shows positive results for hematuria and proteinuria.
Therefore, I have been actively working on improving my health over the past three months and have made multiple visits to both nephrology and urology departments.
I have undergone nearly all possible tests (routine blood and urine tests, X-rays, ultrasounds, cystoscopy, CT scans, and urine cytology), yet no cause has been identified.
Even specialists from the two major hospitals in Hualien find it perplexing.
What else can I do?

Xiang Xiansheng, 40~49 year old female. Ask Date: 2023/09/14

Dr. Xu Wencang reply Urology

Based on your description, if all examinations have been conducted and the cause remains undetermined, it is advisable to consult your attending physician for further treatment options or to consider whether a referral to a medical center for evaluation is necessary.
Thank you.

Reply Date: 2023/09/14

More Info

Persistent hematuria (blood in urine) and proteinuria (protein in urine) can be concerning symptoms that often indicate underlying kidney or urinary tract issues. Given your long history of these symptoms, along with the extensive testing you've already undergone, it is understandable that you are feeling frustrated and seeking further answers.

Firstly, it is important to recognize that hematuria and proteinuria can arise from a variety of causes, including but not limited to glomerular diseases, urinary tract infections, kidney stones, trauma, or even systemic conditions like hypertension or diabetes. In your case, since you have undergone a comprehensive evaluation, including blood tests, imaging studies, and cystoscopy, it is crucial to consider less common causes that may not have been thoroughly investigated yet.

One potential avenue to explore is the possibility of a glomerular disease, such as IgA nephropathy or minimal change disease, which may not always present with obvious symptoms but can lead to persistent hematuria and proteinuria. A kidney biopsy may be warranted if glomerular disease is suspected, as it can provide definitive information about the underlying pathology.

Another consideration is the role of systemic diseases. Conditions such as lupus or vasculitis can affect the kidneys and lead to hematuria and proteinuria. If you have not already been evaluated for these conditions, it may be worth discussing with your nephrologist or primary care physician.

Additionally, you mentioned a recent lifestyle change, specifically quitting smoking. While this is a positive step for your overall health, it is also possible that the stress of this transition, combined with your existing health concerns, could be impacting your body in ways that are not immediately apparent. Stress can exacerbate many conditions, and it may be beneficial to incorporate stress management techniques, such as mindfulness or counseling, into your routine.

If you have not yet consulted with a nephrologist who specializes in rare kidney diseases or a tertiary care center, this may be a worthwhile step. These specialists often have access to advanced diagnostic tools and may be more familiar with atypical presentations of kidney disease.

In terms of managing your symptoms, it is essential to maintain a healthy lifestyle, including a balanced diet, regular exercise, and adequate hydration. Monitoring your blood pressure and blood sugar levels, if applicable, is also crucial, as these factors can significantly impact kidney health.

Lastly, it is important to maintain open communication with your healthcare providers. If you feel that your concerns are not being addressed, do not hesitate to seek a second opinion or ask for further testing. Your health is paramount, and persistent symptoms warrant thorough investigation and management.

In summary, while you have undergone extensive testing, there may still be avenues to explore, including glomerular diseases, systemic conditions, and the potential impact of lifestyle changes. Consulting with a specialist in kidney diseases and maintaining a proactive approach to your health can help you find the answers you seek.

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