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Forum Name: Miscellaneous Nephrology Topics

Question: proteinuria & pelviectasis


 alexussl - Mon Sep 22, 2008 10:34 am

In my yearly physical this year, my doctor noticed protein in the urine test was elevated. we have repeated this test 3 times, and all showed increased levels of protein. I redid the blood work and did a 24 hour urine test, which still showed elevated protein.
When I went for an ultrasound, the results showed pelviectasis in the upper right kidney.
Now it is 6 months later, and I will be going for more blood work and another ultrasound. I am on a waiting list to see a kidney specialist.
I have been online to research these findings and I cannot seem to get much info on why this is happening or how concerned I should be. What could be causing this, can it be fixed, and what can I do now while I wait for the specialist's appointment.
I am young, healthy otherwise, perfect sugar levels, blood pressure of 110/70 is my norm.
Please help me put all this into perspective.
Thanks Sarah
 Dr. Safaa Mahmoud - Wed Nov 12, 2008 9:54 am

User avatar Hello,
It would be more helpful if you can inform us about the exact level of proteinuria in the urine analysis test, if any previous US abdomen was done before this problem was discovered, especially before or after the onset of the previous urinary tract infection.

This is a condition in which there is dilatation of the renal pelvis, the kidney part that is in direct connection with the ureter. The ureter is in direct communication with urinary bladder. If urinary bladder infection occurs, transmission through the ureter to the renal pelvis may occur resulting a more serious infection known as pyelonephritis which was reported to be more common in children born with pelviectasis. Pyelonephritis can cause chronic renal damage. Pelviectasis is usually diagnosed in the prenatal period or shortly after in newborns and is thought to be a self limited that resolves later.

Dilatation in the renal pelvis in adults occurs when obstruction below the kidney level occurs either in the ureter or in the bladder near the ureteric orifice (like stones, fibrosis). Back pressure will cause changes in the kidney usually in the form of renal pelvis dilatation and calcyeal dilatation.

Proteinuria could be a coexisting problem or related to the first one. It should be investigated properly. Kidney function tests; Cratinine, urea, GFR or eGFR are essential. It can be due to a transient problem or it may indicate permanent renal damage. The degree of proteinuria is also helpful in defining the possible causes. Persistent proteinuria indicates the presence of a glomerular lesion (most common) or tubular or increased flow of proteins due to systemic cause like in some hematologic malignancies.

I would advise you to follow up with your doctor and to discuss with him your concerns to get clear picture of your situation. Consultation of a nephrologist is essential too.

Please keep us updated.
Best regards.
 alexussl - Wed Nov 12, 2008 12:30 pm

I have met with a Nephrologist, he ordered another 24 hour urine test, and all the routine blood work, as well as another ultrasound.I will be following up with him in 2 days. In this second ultrasound, Pelviectasis was still discovered in the right kidney with no change. They found my liver to be enlarged (19.3cm). Liver blood work came back normal.
The proteinuria was stated to be albuminuria, with 31mg.
The pelviectasis has never been seen until these 2 ultrasounds, I had ultrasound 3 yrs ago, and 1 year ago before I had my gall Bladder removed in Dec 2007. All of these conditiond seem to be new, since my physical in Feb 2008. The protein is still showing in urine tests - 9 months now. I haven't had any UTIs since I was 6 years old.
I will be seeing a Urologist in Dec 2008 in regards to overactive Bladder and the fact that my bladder has dropped in the last few months.
My GP has ordered an abdominal/pelvis ultrasound which I will be going for tomorrow morning.
I am concerned that all of these issue must be connected, and my GP seems to think they are all unrelated. The Nephrologist is leaning more towards it being a vascular problem. I am concerned about family history of Multiple Myeloma, and if this could be a possibility. Also, I have had a sore back for months now, especially in the morning, and when sitting. A very widespread throbbing pain, and a feeling of tightness. Can this be related ??
Thank you for your response.

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