Pathalogical significiance of acute decrease in creatinine level and M-hematuria

[gentlegaint]

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21 yr. old male non-diabetic outpatient first diagnosed with
isolated persistent microscopic hematuria > 5RBC & WBC with a blood serum creatinine of 0.9mg in the previous year have complete resolution of hematuria over the course of an 8 month follow-up period, yet serum creatinine levels fell to 0.8mg and remains stabilized over 4 month period. x-ray KUB imaging, RFT with kidney ultrasound reveals no urological malignancies with urea creatinine ratio within normal ranges. In absence of proteinuria, microalbuminuria and phosphaturia a kidney biospy was not recommended. Patient has pre-hypertension (135/83), ACE not recommended. microscopic examination of urine RBCs reveals >80% to be normochromic and normocytic with zero blast cells. Patient urine is yellow/clear, noted occasional cloudy urine without proteinuria, casts, and crystals.

continued monitoring for creatinine level increase, recurrent micro and visible hematuria, developmental hypertention and/or proteinuria over 12 months.
in absense of all of the above by follow-up period's end, no further investagation is needed.


what is the pathological and clinical significance of an acute decrease in creatinine levels and relative effects on E-GFR if it remains stable over 3 months?


what is the pathological significance of resolved isolated microscopic hematuria that persisted >3 months if age and normocytic RBCs ruled out IGAn?

what is the pathological significance of normochromic and normocytic RBCs suggestive of non-glomerular origin if it becomes recurrent and persistent?

what is the pathological and clinical significance of recurrent cloudy urine in absense of proteinuria and UTI infections?


-cheers

 

[greatnt249]

21 yr. old male non-diabetic outpatient first diagnosed with
isolated persistent microscopic hematuria > 5RBC & WBC with a blood serum creatinine of 0.9mg in the previous year have complete resolution of hematuria over the course of an 8 month follow-up period, yet serum creatinine levels fell to 0.8mg and remains stabilized over 4 month period. x-ray KUB imaging, RFT with kidney ultrasound reveals no urological malignancies with urea creatinine ratio within normal ranges. In absence of proteinuria, microalbuminuria and phosphaturia a kidney biospy was not recommended. Patient has pre-hypertension (135/83), ACE not recommended. microscopic examination of urine RBCs reveals >80% to be normochromic and normocytic with zero blast cells. Patient urine is yellow/clear, noted occasional cloudy urine without proteinuria, casts, and crystals.

continued monitoring for creatinine level increase, recurrent micro and visible hematuria, developmental hypertention and/or proteinuria over 12 months.
in absense of all of the above by follow-up period's end, no further investagation is needed.


what is the pathological and clinical significance of an acute decrease in creatinine levels and relative effects on E-GFR if it remains stable over 3 months?


what is the pathological significance of resolved isolated microscopic hematuria that persisted >3 months if age and normocytic RBCs ruled out IGAn?

what is the pathological significance of normochromic and normocytic RBCs suggestive of non-glomerular origin if it becomes recurrent and persistent?

what is the pathological and clinical significance of recurrent cloudy urine in absense of proteinuria and UTI infections?


-cheers

Sounds like a toughie; good luck with it.

 

[Pansit]

21 yr. old male non-diabetic outpatient first diagnosed with
isolated persistent microscopic hematuria > 5RBC & WBC with a blood serum creatinine of 0.9mg in the previous year have complete resolution of hematuria over the course of an 8 month follow-up period, yet serum creatinine levels fell to 0.8mg and remains stabilized over 4 month period. x-ray KUB imaging, RFT with kidney ultrasound reveals no urological malignancies with urea creatinine ratio within normal ranges. In absence of proteinuria, microalbuminuria and phosphaturia a kidney biospy was not recommended. Patient has pre-hypertension (135/83), ACE not recommended. microscopic examination of urine RBCs reveals >80% to be normochromic and normocytic with zero blast cells. Patient urine is yellow/clear, noted occasional cloudy urine without proteinuria, casts, and crystals.

continued monitoring for creatinine level increase, recurrent micro and visible hematuria, developmental hypertention and/or proteinuria over 12 months.
in absense of all of the above by follow-up period's end, no further investagation is needed.


what is the pathological and clinical significance of an acute decrease in creatinine levels and relative effects on E-GFR if it remains stable over 3 months?


what is the pathological significance of resolved isolated microscopic hematuria that persisted >3 months if age and normocytic RBCs ruled out IGAn?

what is the pathological significance of normochromic and normocytic RBCs suggestive of non-glomerular origin if it becomes recurrent and persistent?

what is the pathological and clinical significance of recurrent cloudy urine in absense of proteinuria and UTI infections?


-cheers

Is there an HPI? Because you are just giving lab values. Was there trauma? was there exercise involved? is the patient immobile (musle atrophy)? Is there a family history? what drugs is he taking?...etc.

 

[jdh71]

smells like homework

 

[greatnt249]

Is there an HPI? Because you are just giving lab values. Was there trauma? was there exercise involved? is the patient immobile (musle atrophy)? Is there a family history? what drugs is he taking?...etc.

Doesn't really matter, since the OP's rather ham-handedly fishing for homework help.

 

[Pansit]

Doesn't really matter, since the OP's rather ham-handedly fishing for homework help.

Well..it does matter if you are trying to understand if something is significant or not. Chest pain in a 30 year old...significant? Then you get the story that he was lifting weights and then felt a dull pain that only comes when he moves his arms back and forth. Ecg normal, troponins negative, no family history, no cocaine use but d-dimer and cpk are elevated!...is that significant?...NO...its nothing but a muscle sprain. You send them home, no need for a ct to rule out PE. Without the story an elevated d-dimer and CPK are grounds for possible admission. But since you have the HPI, you send the patient home.

 

[greatnt249]

Well..it does matter if you are trying to understand if something is significant or not. Chest pain in a 30 year old...significant? Then you get the story that he was lifting weights and then felt a dull pain that only comes when he moves his arms back and forth. Ecg normal, troponins negative, no family history, no cocaine use but d-dimer and cpk are elevated!...is that significant?...NO...its nothing but a muscle sprain. You send them home, no need for a ct to rule out PE. Without the story an elevated d-dimer and CPK are grounds for possible admission. But since you have the HPI, you send the patient home.

Lemme be a little more clear; SDN isn't the place for homework help, regardless of whether all necessary/relevant information is given.

 

[gentlegaint]

Is there an HPI? Because you are just giving lab values. Was there trauma? was there exercise involved? is the patient immobile (musle atrophy)? Is there a family history? what drugs is he taking?...etc.

incidental discovery of Micro-hematuria, no previous history of uro and neph sydrome. avarge build, no straneous excercises, no previous history, no prescriptions of any kind.


i'll admit that this is not homework. this is for someone i'm concerned about, since he has this condition.


edit: he's already got a few second opinion from different nephs and uro, all whom laughed him out of the office so he called me and i didn't know what i should tell him.

i've got his reports sitting on my lap with a USB camera. this is definitely not homework. just being a worrywart for someone i know.

 

[Pansit]

incidental discovery of Micro-hematuria, no previous history of uro and neph sydrome. avarge build, no straneous excercises, no previous history, no prescriptions of any kind.


i'll admit that this is not homework. this is for someone i'm concerned about, since he has this condition.


edit: he's already got a few second opinion from different nephs and uro, all whom laughed him out of the office so he called me and i didn't know what i should tell him.

i've got his reports sitting on my lap with a USB camera. this is definitely not homework. just being a worrywart for someone i know.

There is your answer. It is probably NOTHING.

 

[greatnt249]

incidental discovery of Micro-hematuria, no previous history of uro and neph sydrome. avarge build, no straneous excercises, no previous history, no prescriptions of any kind.


i'll admit that this is not homework. this is for someone i'm concerned about, since he has this condition.


edit: he's already got a few second opinion from different nephs and uro, all whom laughed him out of the office so he called me and i didn't know what i should tell him.

i've got his reports sitting on my lap with a USB camera. this is definitely not homework. just being a worrywart for someone i know.

Oh, well in that case, this isn't the place for medical advice either.🙄

 

[gentlegaint]

There is your answer. It is probably NOTHING.

i told him that but he's worried about the microscopic hematura and i don't want him to think i'm hiding something from him.

 

[greatnt249]

i told him that but he's worried about the microscopic hematura and i don't want him to think i'm hiding something from him.

Sounds as if he's going to think he has a problem regardless of who the news comes from; don't stress yourself too much over it.