Fluctuating Hematuria and Proteinuria in Young Adults

Hello, why is it that urine tests sometimes detect hematuria and proteinuria, and at other times do not?

I am currently an 18-year-old male with intermittent proteinuria, which has been monitored for three years.
My nephrologist has advised to continue monitoring.
In early February, I underwent hernia surgery.
Three weeks ago, I also experienced otitis media, orchitis, and paronychia, for which I was treated with erythromycin and tetracycline.
The otitis media has resolved, and I applied antibiotics for the paronychia.
Two weeks ago, I visited a urologist who diagnosed me with orchitis and confirmed a left-sided hernia a week ago.
The doctor mentioned that I am almost fully recovered and that I can resume normal activities after this week.

I had a urine test that showed no occult blood, but five days later, after school, I went to the lab for another urine test, which revealed 28 red blood cells and ++ proteinuria.
That evening, I immediately consulted my nephrologist again and had another urine test, which diagnosed proteinuria +/- with no occult blood.
Since my white blood cell count was normal, kidney inflammation was ruled out.

I would like to ask the doctor why there are fluctuations between having occult blood and not having it.
Is there a possibility of a tumor? Additionally, why did I suddenly experience multiple inflammatory conditions in my body? I hope the doctor can clarify these concerns.

Da Ye, 10~19 year old female. Ask Date: 2015/03/09

Dr. Wu Jiyu reply Internal Medicine

1.
There are many causes of occult blood, and orchitis can be one of them; further follow-up may be needed.

2.
As for the multiple inflammatory conditions (otitis media, orchitis, and paronychia), they are likely not related.
If inflammation occurs frequently in the future, it is recommended to consult an infectious disease specialist.

3.
Given the history of proteinuria, it is advisable to monitor proteinuria and kidney function once a year.
Thank you for your inquiry; the Nephrology Department at Changhua Hospital cares about your health.

Reply Date: 2015/03/09

More Info

Fluctuating hematuria (the presence of blood in urine) and proteinuria (the presence of protein in urine) can be concerning symptoms, especially in young adults. Your case, involving an 18-year-old male with a history of intermittent proteinuria and recent infections, raises several important points for consideration.

Firstly, it is essential to understand that both hematuria and proteinuria can have various causes, ranging from benign to serious conditions. In young adults, common causes of these symptoms include urinary tract infections (UTIs), kidney stones, glomerulonephritis, and, less commonly, tumors. Given your recent medical history, including orchitis (inflammation of the testicle) and other infections, it is possible that these infections could have contributed to the transient nature of your symptoms.

The fluctuation in your urine tests, where you sometimes have hematuria and sometimes do not, can be attributed to several factors. For instance, the presence of blood in urine can be influenced by physical activity, dehydration, or even the timing of the urine sample collection. In some cases, infections or inflammation in the urinary tract can lead to intermittent bleeding. Since you mentioned that you had a recent diagnosis of orchitis and underwent surgery for a hernia, it is plausible that these conditions could have caused temporary irritation or inflammation in the urinary system, leading to the presence of blood in your urine at times.

Regarding the proteinuria, it is important to note that transient proteinuria can occur due to various factors, including exercise, fever, dehydration, or stress. In your case, the protein levels in your urine may fluctuate based on your overall health, hydration status, and any acute illnesses you may be experiencing. The fact that your nephrologist has advised you to continue monitoring your condition suggests that they do not currently see a significant risk for chronic kidney disease or other serious conditions, especially since your kidney function tests have been normal.

As for your concerns about the possibility of a tumor, while it is always prudent to consider all potential causes of hematuria, tumors in young adults are relatively rare. The presence of red blood cells in urine does warrant further investigation, but it is essential to consider the context of your overall health and recent infections. If your healthcare provider has ruled out significant causes and your symptoms remain stable, it may be reasonable to continue with regular monitoring.

In summary, fluctuating hematuria and proteinuria in young adults can arise from various benign causes, particularly in the context of recent infections and inflammation. It is crucial to maintain open communication with your healthcare providers, follow their recommendations for monitoring, and report any new or worsening symptoms. Regular follow-up appointments and urine tests will help ensure that any potential issues are identified early, allowing for timely intervention if necessary. If you experience persistent symptoms or new concerns arise, do not hesitate to seek further evaluation.

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