Kidney Imaging: When to Repeat and What It Means

Renal imaging

I would like to ask the doctor, a few years ago I had a urinalysis that showed trace hematuria (1+), and the doctor performed an intravenous pyelogram (IVP) which came back normal.
If I have another urinalysis now that still shows trace hematuria (1+), should I undergo another IVP? Is the radiation exposure from this test significant? How often should this test be done? Additionally, when I wake up in the morning, the first urine I pass has most of the bubbles disappear after about half an hour, but there is still a small amount of bubbles left.
Does this indicate proteinuria? Thank you, doctor.

john, 40~49 year old female. Ask Date: 2015/07/19

Dr. Wu Jiyu reply Internal Medicine

1.
It is recommended to consult a nephrologist or urologist for a renal ultrasound for monitoring.
If any issues arise, further examinations such as an Intravenous Pyelogram (IVP) or a CT scan can be considered.

2.
To determine if there is proteinuria, a urinalysis is sufficient; it cannot be diagnosed through visual inspection.
Thank you for your inquiry, and the Nephrology Department at Changhua Hospital is here to assist you.

Reply Date: 2015/07/19

More Info

When it comes to kidney imaging and the management of potential abnormalities, such as hematuria (blood in urine) and proteinuria (protein in urine), it is essential to approach the situation with a thorough understanding of the implications of these findings and the appropriate follow-up actions.

In your case, you mentioned having a history of urine tests showing 1+ hematuria and a normal intravenous pyelogram (IVP) a few years ago. If you are currently experiencing the same level of hematuria (1+), it is advisable to consult with your healthcare provider about repeating imaging studies. The persistence of hematuria can indicate various underlying conditions, ranging from benign issues to more serious concerns such as kidney stones, infections, or even tumors.
The decision to repeat kidney imaging, such as an IVP or other modalities like a CT urogram or ultrasound, should be based on several factors, including your overall health, any new symptoms, and the results of your recent urine tests. If your healthcare provider believes that the hematuria is significant or if there are other risk factors present (such as a family history of kidney disease or cancer), they may recommend further imaging to rule out any serious conditions.

Regarding the radiation exposure associated with imaging studies, it is important to note that while IVP does involve radiation, advancements in imaging technology have led to the development of alternative methods that may expose patients to less radiation. For instance, a CT urogram is often preferred for its detailed imaging capabilities, but it also involves radiation exposure. Your healthcare provider can help you weigh the risks and benefits of each imaging option based on your specific situation.

As for the frequency of follow-up imaging, this can vary depending on the underlying cause of the hematuria and any other risk factors you may have. Generally, if the hematuria is persistent and unexplained, your doctor may recommend annual follow-up imaging or more frequent monitoring until a definitive diagnosis is made.

Regarding your observation of foam in your urine, it is important to understand that while some foaming can be normal, persistent foaming may indicate the presence of protein in the urine, known as proteinuria. This can be a sign of kidney dysfunction or other health issues. It is advisable to discuss this observation with your healthcare provider, who may recommend additional urine tests, such as a 24-hour urine collection or a urine protein-to-creatinine ratio, to assess the level of protein in your urine more accurately.

In summary, if you continue to have 1+ hematuria, it is prudent to discuss with your healthcare provider the need for repeat imaging studies to ensure that any potential underlying issues are addressed. The choice of imaging modality, the associated radiation exposure, and the timing of follow-up tests should all be part of a comprehensive discussion with your healthcare provider. Additionally, any concerns regarding proteinuria should also be evaluated to ensure that your kidney health is being monitored appropriately.

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