Who's good at reading labs regarding kidneys? OT.

[moopdog]

Sorry in advance as I'm sure this is OT, but disboards always seems to help me in a pinch!

My 10 year old daughter had a urinalysis done a week ago which was ordered by a pediatric rheumatolgist (she has a non-serious issue called Raynaud's, where her fingers turn white in semi-cold weather). He was doing the tests as a formality, not expecting anything to come back.

He called me Friday evening to say she has protein in her urine (>300) and he wanted her urine re-tested. We did it this AM and I asked for a copy of the results, which I now have. The problem is that her doctore is out of town for a week. He won't see the results & be contacting me until next week. The results are obviously abnormal...my question is: HOW abnormal are they and what COULD this mean?

CREATININE is high, at 177.7 mg/dl (normal is 30 - 125.)
Protein is high at 18.2 mg/dl (nomal range is 0 - 11.9)
Color of urine is abnormal and is classified as TURBID.

I realize that these results are pretty much related to kidney function. But being that she has zero symptoms (very healthy) I'm wondering what could be going on?? I was already told that she does not have a kidney infection.

Trying not to panic - but waiting a week to find out is going to be killing me Is there a guru out there??!!

 

[peemagg]

I don't know too much about the values, but I do know that diabetics tend to drop protein in their urine.

Sue is a nurse, so she might have more insight in what those values mean.

 

[alizesmom]

Exercise, overheating or chilling can cause protein in the urine. Kidney problems can also cause those elevations. An infection is the most likely cause.

 

[Talking Hands]

I don't know too much about the values, but I do know that diabetics tend to drop protein in their urine.

Sue is a nurse, so she might have more insight in what those values mean.

Diabetes who drop protein in their urine because they have kidney damage. A well controlled diabetic may not have any protein in their urine. My doc always checks for this but never finds elevated levels and I have had diabetes for more than 30 years

 

[joanchris]

Ack, I had a LONG reply and touched something on my new laptop and it turned off my browser....
I would call the doctor who ordered the tests, if that is the doctor who is out of town then call your child's regular pediatrician. The urinalysis needs to be redone, along with blood tests to test kidney function. My daughter ended up in Kidney failure in March, out of the blue, no symptoms, just numbers on labs that were rapidly increasing (she gets regular labs for other things). Damage can occur before you even know anything is happening. Kidney issues can happen in conjunction with autoimmune issues, and the raynaud's could be part of other autoimmune issues that may not be diagnosed yet (I'm saying could, not to alarm you!), if there is a kidney problem, then the sooner you can correct the issue and get it under control the better chance you have of preventing permanent damage. My daughter was in acute kidney failure, her numbers were quite high, but it was caught very early due to her regular labs, and her numbers are all normal now, though they still consider her to have "chronic kidney disease".

 

[Bete]

If your regular doctor is out of town usually there is someone there as a back up. This is not true all the time, but most of the time there may be someone else that can help. It sounds like you may have more than one doctor; so, maybe, another doctor can help you.

 

[jworkkul]

If the doctor that ordered the tests is out of town for a week , ask to speak with whoever is covering for that doctor. Only her doctor knows how to interpret these results because they have her full past medical history and knows what is going on with her body in general. There are a lot of factors that could account for abnormal lab tests and if the office thinks that it cannot wait until her doctor comes back, they will take care of it. Sometimes it is the lab, itself, that can make mistakes. Let me give you an example---my daughter had routine blood tests done for a physical and it came back as her being quite anemic. She was called in and again, took another blood test to confirm the first. All of this was sent to an outside laboratory. She had to go to the hospital ER for some stomach pains a little bit after that and the blood test results showed her to be quite fine. She was not anemic at all. I wouldn't worry too much.

 

[TheRustyScupper]

CREATININE is high, at 177.7 mg/dl (normal is 30 - 125.)
Protein is high at 18.2 mg/dl (nomal range is 0 - 11.9)

You need to review the "normal" levels for these.

 

[dis-happy]

Did they run a comprehensive metabolic panel too or just the urinalysis? And were the other parts of the urinalysis normal? (assuming they did a full complete urinalysis?).

When my ds' tests came back iffy for some of the kidney counts I was sent to a ped gastroenterologist. He ran more tests. One thing that was stressed to me was that one test in time isn't terribly definitive. We had repeat tests a few times over several weeks and months. We also had an u/s ordered as well for follow up (came back normal). In the end his kidney numbers improved. He also has liver count issues which are still abnormal but no formal dx has ever been made ( this has been going on for 3+ years now, but the specialists are okay to watch them and just keep checking at regular intervals).

Try not to worry too much. They will probably be ordering more tests next week. If it were really bad someone would have called you right away. One constructive thing you could do is research the best g-e doctors in your area in case you need a referral. It never hurts to get the best.

 

[dis-happy]

PS. If it is the rheumatologist who is out of town for a week, have the results forwarded to your reg ped and make a follow up appt there instead. At least you'll get an assessment back sooner.

 

[moopdog]

I had to go out of town since Tuesday night with my son's class to DC, and have been playing phone tag with the Dr.'s office all week. Still no contact with the ordering physician ( pediatric rheumatologist). I am going to call one last time first thing on Monday morning and will also be calling my family doctor at the same time and ask him to review the results with me, in the meantime. If I don't get in touch with the ordering doctor on Monday morning, I will probably freak out!!

In regards to the comment about reviewing the "normal" range, I am merely going by the lab printout. It states a normal range, then her result, then it is flagged for high or low (in her case - high). I think that the rest of her urinalysis was normal, the bloodwork she had done on the original date was mostly normal with a few things flagged, but he told me he was not concerned about anything except her kidney function labs.... so that's what I'm going with for now.

There is no chance for kidney infection...that part I was already told. As far as I know, she has no indication for diabetes and I'm assuming (but I will find out for sure) that was part of her original bloodwork.

Thanks to all...I will update in a few days for anyone that's interested.

 

[TheRustyScupper]

. . . In regards to the comment about reviewing the "normal" range, I am merely going by the lab printout. It states a normal range, then her result, then it is flagged for high or low (in her case - high) . . .

1) I am not sure about your lab, but
. . . normal 0.6 to 1.2 milligrams (mg) per deciliter (dL) in adult males
. . . normal 0.5 to 1.1 milligrams per deciliter in adult females
2) Typically,
. . . 2.5, or so, is usually level-3 and maybe Chronic Kidney Disease
. . . based upon height/weight, 2.5 could be considered level-4
. . . level 5 usually is dialysis
3) Maybe for a kid it goes higher.
4) But, I have not heard of 177 being anything but major high.
5) What is her GRF (glomerular filtration rate)?
. . . this checks for kidney disease
. . . tested in conjunction with protein in urine
. . . also, in conjunction with blood pressure

 

[joanchris]

The op said this was a urinalysis, not blood labs, the numbers you are staying as normal ranges are for blood levels, hence my suggestion for blood labs as well as repeat urinalysis

 

[moopdog]

Yes they only did blood work on the original date. The repeats were of the urine only. They did not do a GFR, and I am not sure if it's because her BP is totally normal, or if that's just because on that particular day, nobody was concerned about kidney function. This kind of came as an incidental finding when they were trying to rule out autoimmune diseases. We were not expecting to find anything abnormal because although it's clear she has Raynaud's (and chronic GERD), she really is quite healthy in every other way.

 

[moopdog]

1) I am not sure about your lab, but
. . . normal 0.6 to 1.2 milligrams (mg) per deciliter (dL) in adult males
. . . normal 0.5 to 1.1 milligrams per deciliter in adult females
2) Typically,
. . . 2.5, or so, is usually level-3 and maybe Chronic Kidney Disease
. . . based upon height/weight, 2.5 could be considered level-4
. . . level 5 usually is dialysis
3) Maybe for a kid it goes higher.
4) But, I have not heard of 177 being anything but major high.
5) What is her GRF (glomerular filtration rate)?
. . . this checks for kidney disease
. . . tested in conjunction with protein in urine
. . . also, in conjunction with blood pressure

Well, the google search that I did..I did find that her levels fell into the next to the highest category. Out of the 5 categories, her's was in the 4th. I don't want to be the google-searching-freak-mom, however I will not be letting this go one more day. Tomorrow I will find out for sure One. Way. Or. The. Other. I realize there is a lot of room for confusion and misinformation out there, so I am trying to remain calm in the meantime.

 

[dis-happy]

Well, the google search that I did..I did find that her levels fell into the next to the highest category. Out of the 5 categories, her's was in the 4th. I don't want to be the google-searching-freak-mom, however I will not be letting this go one more day. Tomorrow I will find out for sure One. Way. Or. The. Other. I realize there is a lot of room for confusion and misinformation out there, so I am trying to remain calm in the meantime.

In my experience there's nothing wrong with getting informed, even if it's via google (the good medical websites, not the junk ones). It puts you in a better position to understand what the doctors are talking about and lets you ask better questions as needed.

Also, keep in mind that different labs have different standards of range, so your 177 may not equate to the numbers you found online. Plus, things are noted differently for pediatrics and at different ages within that category. Make sure you get a copy of ALL labs done and go over them yourself...sometimes doctors are dismissive of certain things but they may add up in the bigger picture. Again, I personally like to go over everything. (bit then again, I am a former cancer patient and know how important it is to keep track of things and be your own advocate). Keep a good notebook with all the information, which is especially helpful if you are referred to another specialist. GL

 

[QueenElinor]

A spot urine test is not diagnostic of anything, no matter how many of them are done. Lots of times (especially with little kids) there's contamination. One-time urine specimens are very unreliable, they are strictly screening tests, or used to follow a problem that's already been diagnosed. They are NOT diagnostic- that means further testing must be done.

I don't think I can emphasize this enough. A spot urine collection is completely nondiagnostic- there has to be a collection of urine for 24 hours, and some blood work, to tell what's going on. If anything.

So all of these diagnoses that are being tossed about on this thread are nothing but speculation based on very little information.

Your doctor will order a 24 hour urine collection, do some blood work and from there be able to tell things like a RELIABLE amount of total protein, her GFR, serum creatinine, etc.

If your daughter is feeling well, just hold tight (hard to do, I know!) and get the labs done as soon as your doctor is available. Until then, you (and everyone else) will just be guessing and speculating- which is very natural, but remember the test you are basing your concerns on is a very rough guide to one's kidney function.

Kidney problems are serious business, but unless your daughter has been taken suddenly very ill, it is best to let her usual doctor arrange everything as this type of illness is a long-term problem. If she has a problem at all!

 

[disfan07]

A spot urine test is not diagnostic of anything, no matter how many of them are done. Lots of times (especially with little kids) there's contamination. One-time urine specimens are very unreliable, they are strictly screening tests, or used to follow a problem that's already been diagnosed. They are NOT diagnostic- that means further testing must be done.

I don't think I can emphasize this enough. A spot urine collection is completely nondiagnostic- there has to be a collection of urine for 24 hours, and some blood work, to tell what's going on. If anything.

So all of these diagnoses that are being tossed about on this thread are nothing but speculation based on very little information.

Your doctor will order a 24 hour urine collection, do some blood work and from there be able to tell things like a RELIABLE amount of total protein, her GFR, serum creatinine, etc.

If your daughter is feeling well, just hold tight (hard to do, I know!) and get the labs done as soon as your doctor is available. Until then, you (and everyone else) will just be guessing and speculating- which is very natural, but remember the test you are basing your concerns on is a very rough guide to one's kidney function.

Kidney problems are serious business, but unless your daughter has been taken suddenly very ill, it is best to let her usual doctor arrange everything as this type of illness is a long-term problem. If she has a problem at all!

Agree! I had a very weird urine test about 2 months ago. The numbers were so out of whack and I have never. Seen any results like that on any of my urine tests and neither have my doctors.

My doctors weren't overly concerned but they ordered a 24 hour urine and lab tests. All tests regarding kidney function came back fine. My kidney function is onto red every 4 months anyway so we just keep an eye out.