Should I be worried about this or just assume everything will be fine ??

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civilstudent
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I don't know if I should be worried about this or not! I'm trying to be patient but am having to wait months for a follow up appointment. Basically I don't know if I'm at risk of kidney failure in the future or if I'm obsessing too much over something which could just be nothing/one of those things. Basically after 2 days of feeling very tired I had red/dark brown blood in my urine for 10 days in December. Gp confirmed it was blood, no infection was found of uranalysis and antibiotics didn't clear it.

All my blood tests including urea and creatinine were normal at the time. A few days after the blood started I developed a bad cold. Then when the blood cleared my urine looked normal but still tests positive for blood on dipstick (I've been testing it with dipsticks everyday). I've been to urology who have confirmed there are no stones or tumours.

So only thing I can think of is a kidney/autoimmune problem, to me it sounds like Bergers disease with the blood being at the same time as a virus. I'm sick of waiting though and even at the appointment they will probably just say keep an eye on it with annual blood tests etc. I just want to know how serious this could be and if I'm likely to get kidney failure. I don't know anyone else who gets blood in their urine and when they do it's usually something like cystitis... What else apart from autoimmune/kidney problems can cause an episode of macroscopic hematuria/blood followed by persistant microscopic blood...

I'm just worried about getting kidney failure in the future.
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Doctor_Einstein
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(Original post by civilstudent)
I don't know if I should be worried about this or not! I'm trying to be patient but am having to wait months for a follow up appointment. Basically I don't know if I'm at risk of kidney failure in the future or if I'm obsessing too much over something which could just be nothing/one of those things. Basically after 2 days of feeling very tired I had red/dark brown blood in my urine for 10 days in December. Gp confirmed it was blood, no infection was found of uranalysis and antibiotics didn't clear it.

All my blood tests including urea and creatinine were normal at the time. A few days after the blood started I developed a bad cold. Then when the blood cleared my urine looked normal but still tests positive for blood on dipstick (I've been testing it with dipsticks everyday). I've been to urology who have confirmed there are no stones or tumours.

So only thing I can think of is a kidney/autoimmune problem, to me it sounds like Bergers disease with the blood being at the same time as a virus. I'm sick of waiting though and even at the appointment they will probably just say keep an eye on it with annual blood tests etc. I just want to know how serious this could be and if I'm likely to get kidney failure. I don't know anyone else who gets blood in their urine and when they do it's usually something like cystitis... What else apart from autoimmune/kidney problems can cause an episode of macroscopic hematuria/blood followed by persistant microscopic blood...

I'm just worried about getting kidney failure in the future.
Do you know if tests found protein in the urine as well? Do you know if red cell casts were found in urine microscopy? Any associated symptoms such as pain or change in frequency or volume of urine? Is there a family history of renal failure, or renal diseases?

If you answered negative to all of the above, Ig A nephropathy (also known as Burger's disease) is most likely.

"There are two major clinical presentations of IgA nephropathy: gross hematuria, often recurrent, following shortly after an upper respiratory infection or athletic exertion; and persistent asymptomatic microscopic hematuria with or without mild to moderate proteinuria"

The bold above seems to fit with your symptoms.

Have you noticed any skin changes or rashes, with joint or abdominal pain? This can sometimes be associated with Ig A nephropathy.

From up to date:

In three series of 240 patients with isolated microscopic hematuria, no proteinuria, a normal serum creatinine concentration, and, in two studies, a negative radiologic and cystoscopic evaluation, IgA nephropathy was present in 20 to 30 percent, thin basement membrane disease in 4 to 43 percent, and, in one study, mesangioproliferative glomerulonephritis without IgA deposits in 10 percent. In one of these reports, 86 percent of patients with hematuria persisting for four years had either IgA nephropathy or thin basement membrane disease.

So the other likely possibilities include thin basement membrane disease, and less likely mesangioproliferative glomerulonephritis.

Now with IgA nephropathy, you will in all likelihood not get kidney failure, especially based on normal urea and creatinine results, and I assume your BP is also normal? So you have nothing to worry about until your appointment, where the doctor will give you more information about potential management.

Now with the next most likely cause, thin basement membrane disease, this has an excellent prognosis and you will absoultely fine. This disease is sometimes known as benign hematuria, with most patients never experiencing any kidney trouble in their lives.

Finally if you have mesangioproliferative glomerulnonephritis, which is far less likely than the above two conditions, in the absence of protein in the urine, you also are unlikely to develop kidney failure.
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civilstudent
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(Original post by Doctor_Einstein)
Do you know if tests found protein in the urine as well? Do you know if red cell casts were found in urine microscopy? Any associated symptoms such as pain or change in frequency or volume of urine? Is there a family history of renal failure, or renal diseases?

If you answered negative to all of the above, Ig A nephropathy (also known as Burger's disease).

"There are two major clinical presentations of IgA nephropathy: gross hematuria, often recurrent, following shortly after an upper respiratory infection or athletic exertion; and persistent asymptomatic microscopic hematuria with or without mild to moderate proteinuria"

The bold above seems to fit with your symptoms.

Have you noticed any skin changes or rashes, with joint or abdominal pain? This can sometimes be associated with Ig A nephropathy.

From up to date:

In three series of 240 patients with isolated microscopic hematuria, no proteinuria, a normal serum creatinine concentration, and, in two studies, a negative radiologic and cystoscopic evaluation, IgA nephropathy was present in 20 to 30 percent, thin basement membrane disease in 4 to 43 percent, and, in one study, mesangioproliferative glomerulonephritis without IgA deposits in 10 percent [3,38,77]. In one of these reports, 86 percent of patients with hematuria persisting for four years had either IgA nephropathy or thin basement membrane disease [77].

So the other likely possibilities include thin basement membrane disease, and less likely mesangioproliferative glomerulonephritis.

Now with IgA nephropathy, you will in all likelihood not get kidney failure, especially based on normal urea and creatinine results, and I assume your BP is also normal? So you have nothing to worry about until your appointment, where the doctor will give you more information about potential management.

Now with the next most likely cause, thin basement membrane disease, this has an excellent prognosis and you will absoultely fine. This disease is sometimes known as benign hematuria, with most patients never experiencing any kidney trouble in their lives.

Finally if you have mesangioproliferative glomerulnonephritis, which is far less likely than the above two conditions, in the absence of protein in the urine, you also are unlikely to develop kidney failure.
Ive read all about iga I'm sick of reading about it people say you shouldn't diagnose yourself but my symptoms fit perfectly. Apparently up to 50 percent get renal failure eventually within 20 years that's why I'm concerned I was hoping I wouldn't have anything lifelong/progressive. I don't know if I have protein or casts etc the dipsticks are just revealing light blood at the moment. If it is iga proteinuria usually develops later on.
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Doctor_Einstein
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(Original post by civilstudent)
Ive read all about iga I'm sick of reading about it people say you shouldn't diagnose yourself but my symptoms fit perfectly. Apparently up to 50 percent get renal failure eventually within 20 years that's why I'm concerned I was hoping I wouldn't have anything lifelong/progressive. I don't know if I have protein or casts etc the dipsticks are just revealing light blood at the moment. If it is iga proteinuria usually develops later on.

Not everyone's disease will progress, and hopefully you do not have a progressive form of the disease. According to up to date, most progressive forms have high BP, high creatinine or proteinura at time of diagnosis. Perhaps if you can have your condition diagnosed and managed early, you will be part of the 50% who avoid disease progression.

Clinical predictors of progression
— Patients with IgA nephropathy who develop progressive disease typically have one or more of the following clinical or laboratory findings at the time of diagnosis, each of which is a marker for more severe disease:

●Elevated serum creatinine concentration
●Hypertension (>140/90 mmHg)
●Persistent (eg, for more than six months) protein excretion above 1000 mg/day
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Doctor_Einstein
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Also, I believe it takes much longer than 20 years to renal failure to develop in the absence of the above symptoms. This is because the studies that indicate a 20 year progression rely on biopsies to confirm diagnosis. Such biopsies however are only undertaken when there are indicates of more severe renal disease such as above. Therefore the average time of asymptomatic hematuria to potential renal failure would be longer than the 20 years that may be given in some studies.
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civilstudent
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(Original post by Doctor_Einstein)

Not everyone's disease will progress, and hopefully you do not have a progressive form of the disease. According to up to date, most progressive forms have high BP, high creatinine or proteinura at time of diagnosis. Perhaps if you can have your condition diagnosed and managed early, you will be part of the 50% who avoid disease progression.

Clinical predictors of progression
— Patients with IgA nephropathy who develop progressive disease typically have one or more of the following clinical or laboratory findings at the time of diagnosis, each of which is a marker for more severe disease:

●Elevated serum creatinine concentration
●Hypertension (>140/90 mmHg)
●Persistent (eg, for more than six months) protein excretion above 1000 mg/day
It's not usually managed though until evidence of progression develops ie protein, low GFR, high Bp etc. I've read a study where a 'significant' number of people with iga with only microscopic hematuria eventually develop proteinuria years later. It confuses me really I first thought that there were 2 types of iga progressive and non progressive. But after reading more about it it seems that anyone with it can develop high Bp, protein etc and progress eventually. My family say I'm obsessing and reading too much into it all when I've not even been diagnosed but I'm sure it's this. :/ The only odd thing is that I think the blood came on a few days before the cold. I felt very tired/ill and then noticed dark urine. Then the tiredness disappeared but the blood went worse.(id put it down to a kidney infection but the uranalysis showed no infection although the antibiotics could have affected the result. Eitherway the antibiotics didn't work) The cold came on days later though.
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civilstudent
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(Original post by Doctor_Einstein)
Also, I believe it takes much longer than 20 years to renal failure to develop in the absence of the above symptoms. This is because the studies that indicate a 20 year progression rely on biopsies to confirm diagnosis. Such biopsies however are only undertaken when there are indicates of more severe renal disease such as above. Therefore the average time of asymptomatic hematuria to potential renal failure would be longer than the 20 years that may be given in some studies.
Even so I don't want kidney failure when I'm in my 50's. But yea they probably won't do a biopsy so I won't even know what it is. I'll just be obsessing and testing my urine all the time lol.
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Doctor_Einstein
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(Original post by civilstudent)
Even so I don't want kidney failure when I'm in my 50's. But yea they probably won't do a biopsy so I won't even know what it is. I'll just be obsessing and testing my urine all the time lol.
Do you think you could get your close family members to use the dipstick test for hematuria? Thin membrane disease is the other common cause, and usually 50% of close relatives will also test positive for hematuria. So if your parents and siblings do this test and 50% test positive, you will have more peace of mind.
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civilstudent
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(Original post by Doctor_Einstein)
Do you think you could get your close family members to use the dipstick test for hematuria? Thin membrane disease is the other common cause, and usually 50% of close relatives will also test positive for hematuria. So if your parents and siblings do this test and 50% test positive, you will have more peace of mind.
Would thin basement make you feel
very tired/unwell for 2 days followed by gross hematuria for 10 days though? Yea my mum gets blood sometimes when she tests but not everytime. She has never had heavy visible blood like i had. My dad wont test his and ive no siblings.
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Doctor_Einstein
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(Original post by civilstudent)
Would thin basement make you feel
very tired/unwell for 2 days followed by gross hematuria for 10 days though? Yea my mum gets blood sometimes when she tests but not everytime. She has never had heavy visible blood like i had. My dad wont test his and ive no siblings.
While gross hematuria is more common in IgA nephropathy, 5-22% of patients with thin membrane disease may still have a period of gross hematuria, usually while they have an infection or after intense athletic activity.

Note: I am not a doctor and so do not take my posts as a substitute for professional medical advice. Obviously we are just trying to speculate what it is, but you'll have to see your nephrologist, or other specialist for information and a possible diagnosis.
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